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Welcome!

To receive your Restylane Rewards®, simply complete the registration form below.

After your treatment, complete and print the Restylane Rewards® form and mail it along with your receipt documenting treatment with Restylane® or Perlane® (credit card receipts cannot be accepted as proof of treatment) and the box end(s) from the Restylane or Perlane box(es) containing Medicis Aesthetics™ proof of purchase hologram to:

Restylane Rewards®
P.O. Box 6422
West Caldwell, NJ 07007-6422

You can complete the Restylane Rewards® redemption form after you register, or at another time.

Just a few moments of your time will ensure you don't miss out! If you have any questions or need help completing this registration form, please call 800-769-5944, 9 a.m. to 5 p.m. Eastern Time.

*First Name

*Last Name

*Street Address

Street Address (Line 2)

*City

*State

*ZIP Code

*Telephone		*E-mail Address
		*Confirm E-mail Address
*User Name		*Password
You must complete this registration form and have a valid User Name to be eligible for Restylane RewardsSM.		*Confirm Password
*When is your birthday?		Did you hear about the Restylane* Rewards® program from an advertisement you saw in a magazine or on television? Yes No




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Restylane^® and Perlane^® are available only through a licensed practitioner.
You must register on RestylaneUSA.com to be eligible for Restylane Rewards^®.

Restylane (and stylized), Perlane (and stylized), Redefining Beauty and Restylane Rewards are trademarks of HA North American Sales AB.
All other trademarks are the property of their respective owners.
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