Restylane® | Register for Restylane® Rewards

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.

*Denotes required field

First Name*

Street Address 1*

City*

Your Birthday

Your Email*

Last Name*

Street Address 2

Zip Code*

Telephone*

Confirm Email*

You must complete this registration form and have a valid user name to be eligible for Restylane Rewards^®.

User Name*

Need Help?

Password*
Confirm Password*	Need Help?

Yes, I would like to receive news and updates regarding Restylane^® and/or Restylane Rewards^®.

What is a User Name and Password?

Your user name is the unique name you choose for signing into RestylaneUSA.com. Your user name can be a combination of letters and numbers, but cannot exceed 20 characters. We suggest that you do not use spaces or any special characters (e.g., &, >, $, etc.) when creating your user name. Examples of user names are Mary214, Snowman8, and SueB.

Your password is the key to your information. Only the correct combination of the user name and password will allow access to your information. Your password can be a combination of letters and numbers, but cannot exceed 20 characters. We suggest that you do not use spaces or any special characters (e.g., &, >, $, etc.) when creating your password. Examples of passwords are 1234, ABC123, and Jane5.

User Name/Password Retrieval

It's easy to retrieve your password if you have registered for Restylane Rewards^®. Simply enter the email address contained in your membership record you used to initially register with www.RestylaneUSA.com below and submit. Your password will be emailed to you in a matter of moments. If you forgot your user name, please call 800-211-6794 between 9 a.m. and 5 p.m. Eastern Time.

Please note that, for security purposes, the only email address to which the password can be sent is the one in your membership record.

My Email Address Is:	<

	Submit>>

Please see Important Safety Considerations and complete product information for Restylane^® and Perlane^®. Restylane^® and Perlane^® are only available through a licensed practitioner.

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