IPL/Photofacial Consent Form
I consent to and authorize MedSpa at Villagio to perform IPL treatments on me. Photo-therapy, despite its high levels of efficacy and safety, is not free of side effects. I understand that this procedure treats pigmented lesions, age spots, and sun spots by targeting melanin with a bright pulsed light. I understand I may not experience complete clearance, and that it may take multiple treatments.
I am aware of the following possible experiences/risks:
- DISCOMFORT – A slight warming sensation may be experienced during treatment.
- REDNESS/SWELLING/BRUISING – Short term redness (erythema) or swelling (edema) of the treated area is common and may occur. A mild burning sensation much like a sunburn can occur but usually subsides within a few hours there also may be some bruising.
- PIGMENT CHANGES (Skin Color) – During the healing process, there is a possibility that the treated area can become either lighter (hypopigmentation) or darker (hyperpigmentation) in color compared to the surrounding skin. This is usually temporary (lasting up to six months), but, on a rare occasion, it may be permanent.
- HAIR LOSS/REDUCTION- Additionally, there is a known and expected loss of hair in the treated areas. In a very small percentage of people there is new hair growth in the surrounding areas being treated.
- SCARRING – Scarring is a rare occurrence, but it is a possibility if the skin surface is disrupted. To minimize the changes of scarring, it is IMPORTANT that you follow all post-treatment instructions carefully.
- EYE EXPOSURE – Protective eyewear (shields) will be provided. It is important to keep these shields on at all times during the treatment in order to protect your eyes from injury.
I understand that the treatment may involve risks of complications or injuries from both known and unknown causes, and I freely assume these risks. There may be other treatment options, such as injections, other types of lasers/light sources or peels. With this in mind, I am choosing this non-invasive treatment for vascular and/or pigment lesions and other indicated skin conditions.
No guarantee, warranty, or assurance has been made to me as to the results that may be obtained. I am aware that follow-up treatments may be necessary for desired results.
Clinical results will vary. I agree to adhere to all safety precautions and regulations during the treatment. The nature and purpose of the treatment have been explained to me. I have read and understand this agreement. Alternative methods of treatment and their risks and benefits have been explained to me and I understand that I have the right to refuse treatment.