Allergan Plastic Surgery Product Order Form

1 To Order Allergan Aesthetics Plastic Surgery products, please call Customer Service at 1-800-766-0171. 2022 AbbVie. All rights reserved. All trademarks are the property of their respective owners. MBD92309-v6 01/22 015054 Allergan Aesthetics Plastic Surgery Product Order FormOffice contactDoctorSurgery locationNotesSurgery datePatient identifierStyles SCX, SSX, & SRXEXTRA-FULL PROFILEVOLUME (cc)DIAMETER (cm)PROJECTION (cm)SMOOTH COHESIVE (SCX)QTYSMOOTH SOFTTOUCH (SSX)QTYSMOOTH RESPONSIVE (SRX)QTY200 X-310 X-615 X-700 X-750 SCF, SSF, & SRFFULL PROFILEVOLUME (cc)DIAMETER (cm)PROJECTION (cm)SMOOTH COHESIVE (SCF)QTYSMOOTH SOFTTOUCH (SSF)QTYSMOOTH RESPONSIVE (SRF)QTY180 C F-18 0S S F-18 0S R F-18 0 200 C F -74 5S S F -74 5 SRF-745 RE-STERILIZABLE GEL SIZERCATALOG NUMBERQTYMSZ-F180 MSZ-F200 MSZ-F220 MSZ-F240 MSZ-F265 MSZ-F295 MSZ-F325 MSZ-F335 MSZ-F345 MSZ-F365 MSZ-F385 MSZ-F415 MSZ-F450 MSZ-F485 MSZ-F520 MSZ-F560 MSZ-F605 MSZ-F650 MSZ-F695M S Z- F 74 5 MSZ-F770 SINGLE-USE GEL SIZERCATALOG NUMBERQTYS SZ-F180S SZ-F200 SSZ-F220S SZ-F240 SSZ-F265S SZ-F295S SZ-F325S SZ-F335S SZ-F345 SSZ-F365 SSZ-F385S SZ-F415S SZ-F450S SZ-F485 SSZ-F520 SSZ-F560 SSZ-F605 SSZ-F650S SZ-F695S S Z- F 74 5 SSZ-F770RE-STERILIZABLE GEL SIZERCATALOG NUMBERQTYMSZ-X 205 MSZ-X 225 MSZ-X255 MSZ-X 285 MSZ-X310 MSZ-X340 MSZ-X375 MSZ-X400 MSZ-X420 MSZ-X4 45 MSZ-X470 MSZ-X495 MSZ-X525 MSZ-X545 MSZ-X560 MSZ-X580 MSZ-X615 MSZ-X650 MSZ-X 700 MSZ-X750 MSZ-X800 SINGLE-USE GEL SIZERCATALOG NUMBERQTYS SZ-X 205S SZ-X 225S SZ-X 255S SZ-X 285S SZ-X310S SZ-X340S SZ-X375S SZ-X400S SZ-X420S SZ-X4 45S SZ-X470S SZ-X495S SZ-X525 SSZ-X545

2 SSZ-X560S SZ-X580S SZ-X615 SSZ-X650 SSZ-X700 SSZ-X750S SZ-X800 KELLER FUNNEL 2 DESCRIPTIONCATALOG NUMBERQTYCase of 5HA-005 SMOOTH ROUND GEL BREAST IMPLANTS & SIZERSREVOLVE Advanced Adipose SystemDESCRIPTIONCATALOG NUMBERQTYCase of 1RV0001To Order Allergan Aesthetics Plastic Surgery products, please call Customer Service at 1-800-766-0171. 2022 AbbVie. All rights reserved. All trademarks are the property of their respective owners. MBD92309-v6 01/22 015054 Allergan Aesthetics Plastic Surgery Product Order FormOffice contactDoctorSurgery locationNotesSurgery datePatient identifierStyles SCM, SSM, & SRMMODERATE PROFILEVOLUME (cc)DIAMETER (cm)PROJECTION (cm)SMOOTH COHESIVE (SCM)QTYSMOOTH SOFTTOUCH (SSM)QTYSMOOTH RESPONSIVE (SRM)QTY140 SM -14 0 SRM-140 SM RE-STERILIZABLE GEL SIZERCATALOG NUMBERQTYMSZ-M140 MSZ-M175 MSZ-M195 MSZ-M210 MSZ-M240 MSZ-M255 MSZ-M275 MSZ-M295 MSZ-M310 MSZ-M330 MSZ-M345 MSZ-M360 MSZ-M375 MSZ-M405 MSZ-M4 45 MSZ-M485 MSZ-M520 MSZ-M560 MSZ-M600 MSZ-M640 MSZ-M685 MSZ-M755 SINGLE-USE GEL SIZERCATALOG NUMBERQTYS SZ-M140 SSZ-M175 SSZ-M195S SZ-M210S SZ-M240S SZ-M255S SZ-M275 SSZ-M295S SZ-M310S SZ-M330S SZ-M345 SSZ-M360S SZ-M375 SSZ-M405S SZ-M4 45S SZ-M485 SSZ-M520 SSZ-M560 SSZ-M600S SZ-M640S SZ-M685S SZ-M755 Styles SCL, SSL, & SRLLOW PROFILEVOLUME (cc)DIAMETER (cm)PROJECTION (cm)SMOOTH COHESIVE (SCL)QTYSMOOTH SOFTTOUCH (SSL)

3 QTYSMOOTH RESPONSIVE (SRL) C L-110S S L-110S R L-110 C L-12 5S S L-12 5S R L-12 5 C L-14 0S S L-14 C L-17 0S S L-17 0S R L-17 0 C L-2 0 0S S L-2 0 0S R L-2 0 0 C L-2 3 0S S L-2 3 0S R L-2 3 C L-2 6 0S S L-2 6 0S R L-2 6 0 C L-2 9 0S S L-2 9 0S R L-2 9 0 C L- 3 2 0S S L- 3 2 0S R L- 3 2 C L- 3 8 0S S L- 3 8 0S R L- 3 8 0 C L- 410S S L- 410S R L- C L- 4 6 0S S L- 4 6 0S R L- 4 6 0 C L- 5 10S S L- 5 10S R L- 5 10 61017. 0 C L- 6 10 SSL-610S R L- 6 10 Styles SCLP, SSLP, & SRLPLOW-PLUS PROFILEVOLUME (cc)DIAMETER (cm)PROJECTION (Cm)SMOOTH COHESIVE (SCLP)QTYSMOOTH SOFTTOUCH (SSLP)QTYSMOOTH RESPONSIVE (SRLP)QTY125 C L P-125S S L P-125S R L P-125 C L P-14 5S S L P-14 5 SRLP-145 C L P-16 5S S L P-16 5S R L P-16 5 C L P-19 0S S L P-19 0S R L P-19 RE-STERILIZABLE GEL SIZERCATALOG NUMBERQTYMSZ-LP125 MSZ-LP145 MSZ-LP165 MSZ-LP190 MSZ-LP205 MSZ-LP220 MSZ-LP235 MSZ-LP250 MSZ-LP265 MSZ-LP280 MSZ-LP300 MSZ-LP320 MSZ-LP340 MSZ-LP360 MSZ-LP400 MSZ-LP4 40 MSZ-LP490 MSZ-LP540 MSZ-LP590 MSZ-LP 640 SINGLE-USE GEL SIZERCATALOG NUMBERQTYS SZ-LP125S SZ-LP145 SSZ-LP165S SZ-LP190S SZ-LP205 SSZ-LP220S SZ-LP235S SZ-LP250 SSZ-LP265S SZ-LP280S SZ-LP300S SZ-LP320 SSZ-LP340 SSZ-LP360S SZ-LP400S SZ-LP4 40S SZ-LP490 SSZ-LP540S SZ-LP590 SSZ-LP640RE-STERILIZABLE GEL SIZERCATALOG NUMBERQTYM S Z- L110 MSZ-L125 MSZ-L140 MSZ-L170 MSZ-L 200 MSZ-L230 MSZ-L260 MSZ-L 290 MSZ-L320 MSZ-L350 MSZ-L380 MSZ-L410 MSZ-L460 MSZ-L510 MSZ-L560 MSZ-L610 SINGLE-USE GEL SIZERCATALOG NUMBERQTYS S Z- L110S SZ-L125S SZ-L140S SZ-L170S SZ-L 200S SZ-L 230 SSZ-L260S SZ-L 290S SZ-L320

4 SSZ-L350 SSZ-L380S SZ-L410 SSZ-L460S SZ-L510 SSZ-L560S SZ-L610 SMOOTH ROUND GEL BREAST IMPLANTS & SIZERS (continued)To Order Allergan Aesthetics Plastic Surgery products, please call Customer Service at 1-800-766-0171. 2022 AbbVie. All rights reserved. All trademarks are the property of their respective owners. MBD92309-v6 01/22 015054 Style 68 MPMODERATE PROFILEANTERIOR DIAPHRAGM VALVEDIMENSIONS AT MINIMUM VOLUMEDIMENSIONS AT MAXIMUM VOLUMEFILL VOLUME (cc)DIAMETER (cm)PROJECTION (cm)DIAMETER (cm)PROJECTION (cm)CATALOG NUMBERQTY120 -15 0 68-120150-180 6 8-15 6 8-18 68-800 Style 68 LPLOW PROFILEANTERIOR DIAPHRAGM VALVEDIMENSIONS AT MINIMUM VOLUMEDIMENSIONS AT MAXIMUM VOLUMEFILL VOLUME (cc)DIAMETER (cm)PROJECTION (cm)DIAMETER (cm)PROJECTION (cm)CATALOG NUMBERQTY125 -14 5 6 8L P-12515 0 6 8L P-15 0175 -19 6 8L 68LP-680 Style 68 HPHIGH PROFILEANTERIOR DIAPHRAGM VALVEDIMENSIONS AT MINIMUM VOLUMEDIMENSIONS AT MAXIMUM VOLUMEFILL VOLUME (cc)

5 DIAMETER (cm)PROJECTION (cm)DIAMETER (cm)PROJECTION (cm)CATALOG NUMBERQTY16 0 -175 6 8H P-16 0200-220 7. 2 7. 2 68HP-800 SMOOTH ROUND SALINE-FILLED BREAST IMPLANTS & SIZERSO ffice contactDoctorSurgery locationNotesSurgery datePatient identifierAllergan Aesthetics Plastic Surgery Product Order FormSINGLE-USE SALINE SIZERCATALOG NUMBERQTY SZLP68150 SZLP68175 SZLP68200 SZLP68225 SZLP68275 SZLP68300 SZLP68325 SZLP68350 SZLP68400 SZLP68420 SZLP68480 SZLP68525 SZLP68550 SZLP68600 SZLP68640 SINGLE-USE SALINE SIZERCATALOG NUMBERQTY SZ68180SZ68210SZ68240SZ68270SZ68300SZ683 30SZ68360SZ68390SZ68420SZ68450SZ68480SZ6 8510 SZ68650 SINGLE-USE SALINE SIZERCATALOG NUMBERQTY SZHP68200 SZHP68280 SZHP68320 SZHP68350 SZHP68400 SZHP68425 SZHP68465 SZHP68500 SZHP68550 SZHP68650 SZHP68750