Venus Legacy INFORMED CONSENT
The instructions provided in this informed consent should be followed by all patients receiving a Venus Legacy™ treatment. You will be asked to sign this form to acknowledge that you have read and understood all of the information presented.
Indication
The Venus Legacy™ system is indicated for temporary reduction in the appearance of cellulite, improved in local blood circulation, and for the relief of minor muscle aches and pain, relief of muscle spasm. Treatment duration with Venus Legacy™ will last approximately 20-30 minutes, depending on the number of treated areas as well as the size of the area treated.
REALISTIC TREATMENT EXPECTATIONS
- There will be improvement in cellulite appearance, but not complete elimination. There will be improvement in thigh's circumference. However, the response is individual.
- The degree of response to the Venus Legacy treatment, and the number of treatment sessions required will vary among patients and will depend on the clinical and physiological condition at the start of the treatment regimen. Some patients respond more than others.
- The treatment results are temporary, and one maintenance treatment session every 3-6 months is recommended to sustain them.
- A healthy lifestyle (diet and exercise) may help to obtain better results but is not essential. However, weight gain may have a negative effect on the results.
- Non-ablative gradual improvement of skin texture/laxity without downtime or high-risk factors, more commonly associated with laser skin resurfacing.
- Superficial acne scarring and enlarged pores may show some improvement by building new collagen in the dermal area.
PATIENTS WHO SHOULD NOT BE TREATED
A Venus Legacy™ treatment SHOULD NOT be performed on patients with the following:
- Any skin disease in the treatment area
- Tattoo or permanent makeup in the treatment area
- History of hip replacement, hip or femur surgery, or other metallic implants (such as gold threads) in the treatment field
- Pregnancy and nursing as well as 3-6 months post-childbirth or until normal hormonal balance is regained
- Cardiac pacemaker, defibrillator, or other implanted electronic/electrical device
- Blood coagulopathy or excessive bleeding or bruising
- History of deep vein thrombosis
- Use of Accutane within the past 6 months
- Use of blood-thinning medications, whether prescription or over-the-counter (including Coumadin or other prescription blood thinners, corticosteroids, aspirin or aspirin-containing products, chronic use of NSAIDs, garlic supplements, ginkgo, ginseng, St. John's Wort, fish oil)
- Active of recent malignancy (excluding cutaneous basal cell carcinoma or squamous cell carcinoma, provided there is no involvement of the treatment area)
- Uncontrolled thyroid disease Impaired immune system (such as HIV)
- Any prior aesthetic or medical surgery affecting the area to be treated (liposuction, subcision) in the 3
- Any history of disease which may be stimulated by heat, such as Herpes in the treatment area
- Any endocrine disorder such as diabetes
ADDITIONAL contraindications for ST treatments
- Patients who receive Botox injections should avoid any treatment for 5-7 days thereafter
- Patients who have undergone chemical peels or natural fillers should avoid treatment for at least two (2) weeks
- before beginning the skin tightening treatment
- Patients should wait at least 3-6 months after deep chemical peels and laser fillings
- Patients who had epilation treatments must wait at least 6 weeks before commencing the treatment course
ADVERSE EXPERIENCES - The following adverse effects may be experienced. While these symptoms are rare and temporary, they are to be carefully considered following treatment and prior to continuing the treatments:
- Discomfort
- Excessive skin redness (erythema) and/or mild swelling (edema)
- Changes in skin texture (crust, blister, burn)
- Urticaria (hives)
- Purpura or ecchymosis (bruising)
- Hematoma
- Allergic contact dermatitis to the acoustic contact gel
NOTE:
Some areas are more sensitive to vacuum, such as the front of the leg, above the knee and the outside and inside of the thigh and this sensitivity may cause bruising.