Cutera ‘LimeLight’ Intense Pulsed Light
I understand that intense pulsed light (IPL) therapy is a noninvasive procedure designed to lighten, fade, or remove sun damage/pigmentation spots, benign ‘spider’ blood vessels of the face, facial flushing and blushing, and/or scars and stretch marks. The light settings are chosen to selectively damage the targeted blood vessel or pigmentation with minimum damage to surrounding tissue. IPL therapy may consist of multiple treatments given over several months with gradual clearing occurring over this time. While IPL treatments are effective in most cases, no guarantee can be made as to how much a specific client will benefit from the procedure. Clinical results may vary per individual and it may be determined that IPL therapy may not be completely effective in treating your particular condition.
Contraindications for this procedure include pregnancy, use of medications that increase photosensitivity, diabetes, history of keloid scarring, use of anticoagulants, and history of bleeding disorders. Recent sun exposure, planned sun exposure, and self-tanner use is also contraindicated, as tanned skin is at a much greater risk for burns.
I am aware that Intense pulsed light may not completely remove and will not prevent future vascular or pigmented lesions. Results are not guaranteed. Discomfort may be experienced during the procedure. The sensation of the IPL treatment may feel like a moderate to severe hot snap or prick, which lasts for only a few seconds. Bruising of the area may occur, which usually resolves in 2-3 days. During the healing process, there is a possibility of the treated area becoming either darker (hyperpigmented) or lighter (hypopigmented) in color than the surrounding skin. This is usually temporary, but on a rare occasion, it may be long-lasting. Scarring is a very rare occurrence, but it is a possibility when the skin’s surface is disrupted. To minimize the chances of scarring, it is the patient’s responsibility to follow all post-treatment instructions carefully. Persons with a history of keloid scar formation may be more prone to scarring after any skin trauma, including IPL treatments, therefore caution is advised. Those who are prone to herpes simplex cold sores may have a “flare-up” of their condition. It is advisable to be on an anti-viral medication to prevent this from occurring.
You will be required to wear dark glasses or opaque eye shields during the treatment. While the light is not in itself dangerous, it is very bright (similar to a camera flash).
By my signature below I certify that I have read and fully understand the contents of this consent for intense pulsed light therapy and that the disclosures referred to herein were made to me. The potential benefits of the proposed procedure, the probability of success, and the most likely possible complications/risks involved with the proposed procedure and subsequent healing period, including but not limited to superficial crusting, blisters, burns, infection, scarring, pigmentation changes, and pain have all been discussed with me. I understand the risks and alternatives involved in this
procedure. I also understand that there may be other treatment options. With this in mind I am choosing to try IPL, a non-invasive treatment for vascular and/or pigmented lesions. I have had the opportunity to ask any questions that I had, and all of my questions have been fully answered to my satisfaction. No refunds will be given for treatments received.
I hereby authorize Alison Zollars to perform IPL treatments on me. I further authorize her, Dr. Juan Stern, or another laser technician to do any other procedure that in their judgment they may dictate to be necessary or advisable should unforeseen circumstances arise from this procedure.