Laser Hair Removal Procedure Consent

Laser hair removal may require multiple sequential treatments. The laser only affects hair that is actively growing. For this reason, complete destruction of all hair from any one treatment is unlikely, and several treatments are required to obtain a significant, long-term reduction of hair growth. As will all procedures, some individuals show a dramatic improvement, while others show little improvement. The people who have a poor response to laser/IPL hair removal are often those with red or blond hair or hair that has a finer texture, and they may be disappointed. White and gray hair is not affected by laser/IPL devices. Due to multiple types of hair, you acknowledge that there are no guarantees, warranties, or assurances that you will be satisfied with your results. In our experience, approximately 10% of the population does not respond to laser/IPL for hair reduction. As hair grows in cycles, multiple treatments offer the best results.

Prior to treatment, the area to be treated may be anesthetized with a topical numbing cream. Following your treatment, you may experience pain, swelling and redness, similar to a mild-sunburn, for the first several days. .

Contraindications For This Treatment Include:
1. Unprotected sun exposure, tanning beds, and sunless tanners 3-4 weeks prior
2. Waxing of the area within the last 8 weeks
3. Use of depilatory creams or bleach 4-6 weeks prior
4. Pregnancy and nursing mothers
5. Temporary dermal fillers within the last 2 weeks
6. Permanent fillers particularly silicone (silicone insulates creating much heat)
7. History of seizures
8. History of keloid scarring
9. Active infection, undiagnosed lesions, warts, tattoos in the treatment area
10. History of cold sores (herpes simplex); treatments can reactivate herpes, and prophylactic medication may be recommended
11. Retin-A and similar products 3 days before and 7 days after treatment

Risks of this procedure include, but are not limited to, the following:

Pain – Some people may feel some pain with this treatment, similar to snapping the skin with a rubber band. Stinging or sharp pain may be present after the procedure and throughout the healing process.

Redness – Laser treatment will cause redness of the area. The redness may be present for weeks to months.

Swelling – Swelling will be present after the procedure and should likely resolve after 1-2 weeks.

Pigmentary Changes – The treated area may heal with altered pigmentation (either lighter or darker skin). This occurs most often with darker colored skin and after exposure of the area to sun. You may have experienced this type of reaction before and noticed it with minor cuts or abrasions. The treated area must be protected from exposure to the sun (sunscreen for 4 weeks after treatment) to minimize the possibility of such changes, although pigmentary changes may occur despite sunavoidance. While these pigmentary changes usually fade in three to six months, in some cases, the pigment change is permanent.

Alert us immediately if you have been in the sun, have had a tan, or a sunburn, within the last 4 weeks.

During pregnancy, areas of increased pigmentation frequently appear spontaneously. For this reason, laser therapy is not recommended during pregnancy.

Scarring – There is a risk of scarring with this procedure at any time during the healing process. The scarring may be discolored and may be permanent.

Blistering – The laser procedure may produce heating in the upper layers of the skin resulting in blister formation. The blisters should go away within two to four days. Scarring or discoloration may result from any blister formation.

Scabbing – A scab may be present after a blister forms. The scabbing will disappear during the natural wound healing process of the skin. Scarring or discoloration may result from any scab formation.

Infection – An infection of the wound is always possible. Any blistering or bleeding must be dressed with an antibiotic ointment and covered. Any infection could last seven to ten days and could lead to scarring.

Acne Breakout – Acne or folliculitis may follow laser/IPL hair reduction treatments.

Eye Damage – Protective eyewear will be provided; it is important to keep this eyewear on at all times during the treatment to protect your eyes from accidental laser/IPL exposure.
Failure to Achieve Desired Results – It is very possible that this procedure may fail to achieve your desired results. Strict adherence to the pre-op and post-op instructions is essential. You may need to repeat your treatments to achieve the desired results.

Consent

I, the undersigned, have read and understand the information contained within this consent form. My signature indicates that I have read and understand the information in the consent. I hereby release the dermatology office and my physician from all liability associated with this procedure. Furthermore, my signature below indicates my consent to the treatment described and my agreement to comply with the requirements placed on me by this consent form.

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