Informed Consent Form Template for PDO Threads

November 11, 2026 · 6 min read

Editorial illustration about an informed consent template for PDO threads

PDO (polydioxanone) threads are a procedure with particularities: the material stays inside the skin for a while, the effect has a mechanical and stimulating component, and the possible complications are not the same as with an injectable. The form must reflect that and not be a hasty adaptation of the filler consent form.

The template below is generic, with no brand, no number of threads and no technique. To understand the material, read the entry on PDO, types of PDO threads and complications with PDO threads.

When should you use this template?

Before the procedure, after the medical history and an unhurried conversation about what the thread does and does not do. Give the form to the patient for prior reading, not at the moment they lie down on the table. If the patient already has threads from an earlier time, record it.

How do you adapt it?

Describe the area and the type of thread by class, according to your records, without going into technique.
Explain that the thread is absorbable and the effect is temporary, with variation between patients. See PDO threads: how long they last and do PDO threads work?.
Include the specific complications: skin irregularity, palpable thread, extrusion, nodule and change in sensation. See PDO threads: risks.
Record the product and batch in the patient record routine. See the batch record template.
Align the aftercare with the post-procedure instructions template for PDO threads.
State what is possible in case of dissatisfaction or complication: assessment, adjustment, removal, when indicated.
Review with a lawyer and with your professional council's rules.

What can never be missing?

Item	Reason
Nature of the procedure and the material	The patient understands there is material in the body
Temporary and variable effect	Avoids the expectation of a permanent effect
Common effects: pain, swelling, bruising, pulling sensation	What a good share of patients notice
Complications: irregularity, asymmetry, palpable thread, infection, nodule, sensation changes	Duty to inform
Possibility of removal or correction	Approach in case of a problem
Conditions that call for caution	The patient's duty to inform
Alternatives, including not treating	Free consent
Contact, return visit and warning signs	Safety after the procedure
No guarantee of results	No promises
Signatures and date	Validity of the record

Informed consent form template for PDO threads

Template

FREE AND INFORMED CONSENT FORM: PDO THREADS

Patient: ________

Date of birth: ________

CPF: ________

Responsible professional: ________

Council and registration number: ________

Clinic: ________

1. What the procedure is

PDO (polydioxanone) threads are absorbable threads placed under the skin with a needle or cannula. They may be used to improve the support, texture or contour of the skin, according to the professional's assessment. The material is absorbed by the body over time. Area(s) to be treated: ________. Type of thread, according to the care record: ________.

2. How it is done

The procedure is done with skin asepsis and, in general, with local or topical anesthesia. The quantity, type and placement of the threads are defined by the professional according to my individual assessment. There may be discomfort during and after the procedure.

3. When the effect appears and how long it lasts

I understand that the effect is neither immediate nor the same for everyone, that there may be gradual improvement and that it is not permanent. The threads are absorbed, and it may be necessary to repeat the procedure, which has a cost. Agreed review or touch-up policy: ________.

4. Common effects

The following may occur, generally temporarily: pain, a sensation of pulling or pressure, swelling, redness, bruising, tenderness to the touch, difficulty or discomfort when chewing, opening the mouth or making expressions in the first days, and temporary asymmetry.

5. Less common and rare complications

The following may occur, less commonly: skin irregularities or waviness, a palpable or visible thread, a thread coming out through the skin (extrusion), movement or displacement of the thread, persistent asymmetry, an insufficient result or one different from expected, infection, formation of a nodule or an inflammatory reaction to the material (granuloma), change in skin color, scarring, temporary or prolonged change in sensation or movement in nearby areas, and persistent pain. In rare cases, there may be an allergic reaction. These occurrences may require treatment, removal of the thread or an additional procedure, and may have costs.

6. Conditions that call for caution or contraindicate

I have truthfully reported my illnesses, allergies, use of medications (including anticoagulants), tendency toward abnormal scarring, infection or a wound in the area, pregnancy or breastfeeding, autoimmune diseases, previous procedures and any other relevant condition. I have also reported whether I have previous threads, fillers or implants in the area. I know that omitting information increases the risks.

7. Alternatives

Alternatives were presented to me, including other aesthetic procedures, skin care and the option of not having any procedure. I freely choose this option.

8. Care and contact

I received written instructions on care after the procedure and on warning signs (severe pain, increasing redness and warmth, discharge, fever, a thread coming out, a nodule, a change in skin color or sensation). I know how to contact the professional: ________. Planned return visit: ________.

9. No guarantee of results

I understand that the result depends on individual factors and that the professional cannot guarantee a specific result. Illustrative images, when used, serve to discuss possibilities and do not promise what will happen.

10. My data

I authorize the processing of my personal and health data for my care and for recording in the patient file, with confidentiality, in accordance with Brazil's General Data Protection Law (LGPD). The use of my images for other purposes only occurs with separate authorization.

11. Declaration

I have read this form, or it was read to me. I was able to ask questions and they were answered. I understood the information and I decide to have the procedure of my own free will. I know I may withdraw at any time before it begins.

Place and date: ________

Signature of the patient or legal guardian: ________

Name of the legal guardian and relationship, if applicable: ________

Signature of the professional: ________

Witness (optional): ________

Does the form protect you in case of a complication?

It helps show that the patient was informed, but it does not resolve the complication or replace care. Record the occurrence in the patient record, follow the patient closely and document the action taken, including if there was a nodule or granuloma. For the basis of consent, see informed consent, and for organizing safety in the practice, safety and complications in facial harmonization.

Frequently asked questions

What should be in the informed consent form for PDO threads?

What the threads are and how they are placed, the area, the temporary and variable effect, common effects (pain, swelling, bruising), possible complications (irregularities, palpable thread, infection, nodule, change in sensation), alternatives, the absence of any guarantee, aftercare and the professional's contact, with signatures.

What complications are possible with PDO threads?

Those described include skin irregularities or waviness, asymmetry, palpable or visible thread, extrusion, infection, nodule or granuloma and changes in sensation. Frequency varies with the technique and the patient, and complications must be known and disclosed beforehand.

Does a signed form exempt the professional if there is a complication with a PDO thread?

Not automatically. It shows that the patient was informed, but responsibility also depends on the indication, the technique, the follow-up and the care provided. Ask a lawyer to assess the scope of the document.

Terms mentioned

PDO (polydioxanone)Thread lift Informed consent in orofacial harmonization Nodule after filler Foreign Body Granuloma After Filler Paresthesia after harmonization Hematoma After Filler Facial asymmetry Patient record in facial harmonization