RF- LIPOLYSIS PATIENT CONSENT FORM

This form is designed to give you the information you require to make an informed choice of whether to undergo treatment with lipolysis technology. If you have any questions before your treatment, please feel free to ask.

The Lipolysis Shaping technology: Lipolysis Shaping technology is non-invasive treatment and is based on radiofrequency (RF) at levels that induce heating of the fat cells, stimulating fat metabolism and breakdown, as well as destroying some of the fat cells’ membranes. All these effects lead to circumference reduction and body contouring, as well as to cellulite improvement. In addition, the RF-induced heat is stimulating collagen regeneration and replenishment for skin tightening. The treatment creates redness and a warm sensation over the skin surface for several hours, as a normal response. Possible side effects of the treatment: local pain, skin redness (erythema), swelling (edema), damage to the natural skin texture (crust, blister, burn), change of pigmentation (hyper- or hypo-pigmentation), scarring. Although these effects are rare and expected to be temporary, any adverse reaction should be reported immediately.

I certify that I have been given the opportunity to ask questions and that I have read and fully understand the contents of this consent form. I hereby authorize Elite beauty studio, or such assistants as may be selected to perform the Lipolysis procedure.