Consent for Amethyst Aesthetics Treatment
This is an informed consent document, which has been prepared to help inform you about laser treatment procedures of skin, its risks and complications. I hereby authorize any delegated associate of Amethyst Aesthetics to perform the Opus Plasma laser treatment.
This laser device uses metal pins charged with high radio frequency energy to create microscopic injuries to the skin. This stimulates the production of collagen through the body’s natural wound healing response. The collagen stimulation and rebuilding process is crucial when targeting deeper lines, skin laxity, as well as skin colour and texture.
I am aware of the following possible experiences/risks:
DISCOMFORT – Some discomfort may be experienced during treatment. A topical anaesthetic will be applied to your skin before treatment. Your skin may feel like it has a sun burn for a few hours after the treatment.
REDNESS/SWELLING – Redness (erythema) and/or swelling (edema) of the treated area is common. This usually resolves in a 24-48 hours but can last up to a few days. Sensitive skin types experience more redness and may take longer to heal.
PIGMENT CHANGES (Skin Colour) – During the healing process, there is a possibility that the treated area can become either lighter (hypopigmentation) or darker (hyperpigmentation) in colour compared to the surrounding skin. This is usually temporary, but, on a rare occasion, it may be permanent. You should avoid sun exposure after the treatment and use sunblock.
WOUNDS – Treatment can result in burning, blistering, or bleeding of the treated areas. Although rare it is important that you not pick or scratch the sites as this may lead to permanent scars or promote an infection. If any of these occur, please call our office.
INFECTION – Although rare, infection is a possibility whenever the skin surface is disrupted, though proper wound care and keeping the treated area clean should prevent this. Herpes simplex (cold sores) is seen in a small percentage of patients, even if prophylaxis (anti-viral medication) is used. This may lead to scarring. If signs of infection develop, such as pain, heat or an increase in redness, please call our office.
SCARRING – Scarring is a rare occurrence, but it is a possibility if the skin surface is disrupted. To minimize the risk of scarring, it is IMPORTANT that you follow all post-treatment instructions carefully.
ALLERGY – Although uncommon, there is a risk of an allergic reaction to the numbing cream and/or any other product that comes in contact with your skin.
BRUISING – Bruising in the treated area is possible. Especially if, within the last 10 days, I have taken aspirin or aspirin containing products, or other medications that thin the blood.
The following points have been discussed with me:
– Potential benefits of the proposed procedure
– Probability of success
– Possible complications/risks involved with the proposed procedure and subsequent healing period
– Post-treatment instructions
By signing below I indicate that I am not pregnant. Furthermore, I agree to keep staff informed should I become pregnant during the course of treatment.
I have read, understood and accepted that Amethyst Aesthetics will not provide refunds on services already rendered. By signing this form, I acknowledge that I have read this form, that I fully understand its contents, and that I have been given ample opportunity to ask questions and that all questions have been answered to my satisfaction. I understand that I can call or return to the office at any time to ask for more information from staff.
I authorize the taking of photographs and videos before, during and after the laser procedures. I understand these may be used for medical education, research, documentation of the medical record and/or social media and the website. I acknowledge and grant permission to Amethyst Aesthetics the use of the photos and videos at their discretion with the expectation that my information and identity will be kept confidential at all times.
I consent to allow Amethyst Aesthetics to perform an Opus Plasma treatment on me and understand the risks associated with them. I do not hold them responsible for
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