Fat Freezing Treatment Consent Form

Fat Freezing Treatment Consent Form

Clatuu Alpha
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CryoglobulinaemiaParoxysmal cold haemoglobinuriaPregnancy or lactationKnown sensitivity to cold, such as cold urticaria or Raynaud’s diseaseImpaired peripheral circulation in the area to be treatedNeuropathic disorders such as post-hepatic neuralgia or diabetic neuropathyImpaired skin sensationOpen or infected woundsBleeding disorders or concomitant use of blood thinnersRecent surgery or scar tissue in the area to be treatedHernia in, or adjacent to the treatment siteSkin condition such as eczema, dermatitis, or rashes in the area to be treatedActive implanted devices, such as pacemakers and defibrillators: the effect of performing treatments directly over such devices is not knownNone of the above
YesNo
If yes, what area did you have treated and how long ago was this?
ABOUT THE CLATUU ALPHA TREATMENT

The CLATUU Alpha treatment uses a vacuum to draw skin and fat into the applicator, cooling the tissue to a temperature of – 9°C where you can expect to permanently remove 20 – 30% of the localised fat in the treated area. As with all procedures, results vary from person to person.
WHAT TO EXPECT DURING THE TREATMENT
- Photographs of the treatment area will be taken to monitor your progress during the treatment. The photos will NOT be shared with anyone
- The treatment area will be marked up and you'll need to remain still and in position for the entire duration of the treatment
- A gel pad will be placed over your skin to protect any damage occurring to your skin cells and tissue
- The applicator is then placed over the gel pad and suction will occur, causing sensations of deep pulling, tugging and pinching
- You may experience intense cooling, numbness, stinging, tingling, aching, pain or cramping during or throughout the treatment
- Once the treatment has finished and the applicator is removed, the therapist will massage the treatment area as this has been shown to improve the treatment outcome. This can feel odd, uncomfortable or painful
- The treatment area will look and feel stiff. There could be transient blanching (whiteness) of the skin and intense red to purple colour, as well as bruising, swelling or tenderness, with the risk of a central blister. These changes can last up to several hours after the treatment.
COMMON SIDE EFFECTS
- In the days following treatment, the area may ache and feel bruised. This aching, as well as redness, bruising, swelling, numbing, tenderness, itching, skin sensitivity and tingling can last up to two weeks
- Bloating and swelling of the area may occur and is easily overcome by drinking 2L - 3L of water a day
- For 1 in 20 people, there is the possibility of strong cramping, muscle spasm or a shooting pain that occurs up to 2 weeks after treatment. This can be overcome by taking pain relief in the form of paracetamol or similar
- You may start to see changes as early as 3 weeks after the treatment, with full results achieved at 3 months
- Multiple treatments are required, with best results achieved with 3 or more treatments
- Eating a healthy and balanced diet is required in the weeks leading up to and after your treatment, to optimise the results
RARE SIDE EFFECTS OF CRYOLIPOLYSIS

There have been no reported cases of the following using the Clatuu Alpha device.
- Paradoxical hyperplasia: visibly enlarged volume within the treatment area, which may develop two to five months after treatment. Surgical intervention may be required
- Late-onset pain several days after treatment and resolution within several weeks
- Darker skin colour and/or freeze burn may be seen
- Vasovagal symptoms: dizziness, light-headedness, nausea, flushing, sweating, or fainting during or immediately after the treatment
- Subcutaneous induration: generalised hardness and/or discrete nodules within the treatment area, which may develop after the treatment, and may present with pain and/or discomfort.
- Temporary hyperpigmentation
- The Treatment may cause new hernia formation or exacerbate pre-existing hernia, which may require surgical repair
I have read and understood all of the information above and have been given the opportunity to ask questions
I hereby give consent to receive a cryolipolysis treatment using the Clatuu Alpha and authorise the taking of clinical photographs to document my progress
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