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I First Name Last Name authorize Satin Laser Lounge to perform an Intense Pulsed Light System procedure. I am aware that these treatments are used for hair reduction and skin rejuvenation thus intended to reduce and improve the appearance of pigmented lesions, vascular lesions, skin’s texture and/ or mild to moderate acne.I understand and accept that it is necessary to conduct more than one treatment in order to achieve results and that a treatment series will be necessary, and that the treatment series/program may need to be extended or changed by the Sharplight Technician at any time to create the appropriate long-term plan best suited for the area intended. I also accept that it may be necessary to use other manners of treatments, including skin care products, that may be needed to blend the skin tone and skin color while reducing the potential of sun damage during and post treatment. The skin treated may be red and swollen for a period of time, with the forming of fine, thin scabs. Keep the treated areas covered with aloe vera gel and soothing creams until the thin scabs fall off. This process may take between 1- 4 weeks. It could take as long as 3-6 months in some rare cases. Do not scratch the scabs, as scarring may result.
I First Name Last Name understand that I must complete a Medical History Form, which must be updated if any changes occur during the treatment period. I certify the information on my Medical History Form to be true and correct. I also certify that I have not withheld or omitted any medical information.The following problems may occur with treatment:1. Scarring: The pulsed light system can create bruising and a moderate burn or blister to the skin. For an effective treatment, the intensity (joules) must be just below the blistering point which means that the skin will be red (erythema). There is a risk of scarring in burned skin cases.2. Hyperpigmentation and Hypopigmentation: These have been noted to occur after treatments, especially with a darker complexion. This usually resolves within weeks, but it can take as long as 3-6 months in some cases. There is a rare risk of permanent color change. If you have dark skin, a skin lightening cream may be advised as a treatment to reduce the melanin in your skin before and after treatment and must be regulated by a physician. Avoiding sun exposure before and after the treatment is crucial to reduce the risk of color change and burns.3. Infection: Although infection following pulsed light treatment is unusual, bacterial, fungal, and viral infections can occur. Herpes simplex virus infections around the mouth can occur following a treatment. This applies to individuals with a past history of Herpes simplex virus infections in the area. Should any type of skin infection occur, additional treatment including antibiotics will be necessary. If you have a history of Herpes simplex virus in the treated area, we recommend preventive therapy.4. Bleeding: Pinpoint bleeding is rare but can occur following pigmented and vascular lesion treatment procedures. Should bleeding occur, additional treatment might be necessary.5. Skin tissue pathology: Energy directed at skin lesions may potentially vaporize the lesion. Laboratory examination of the tissue specimen may not be possible. Only clearly benign pigmented lesions can be treated. A physicians approval may be requested in order to proceed with the treatment of certain pigmented and vascular lesions. 6. Allergic reactions: In rare cases, local allergies to tape, preservatives used in cosmetics or topical preparations have been reported. Systemic reactions (which are more serious) may result from prescription medicines. Allergic reactions may require additional treatment.7. Sunscreen: Wear sunscreen of SPF 50 or higher before and after treatment to protect your skin. We highly recommend you use sunscreen at all times. Compliance with the after-care guidelines is crucial for healing, prevention of scaring, hyper-pigmentation, and hypopigmentation.8. I understand that exposure of my eyes to light could harm my vision. I will keep the eye protection on at all times during the treatment session. Occasionally, unforeseen mechanical problems may occur, and the appointment will need to be rescheduled. Our Clinic will make every effort to notify the client prior to his/her arrival should this occur prior to the scheduled treatment time; However, it may not be possible if the circumstance occurs while the treatment is in progress, thus the scheduled treatment will be interrupted and rescheduled once the issue is resolved. Please be understanding if any inconveniences occur.ACKNOWLEDGMENTMy questions regarding the procedure have been answered satisfactorily. I understand the procedure and accept the risks. I hereby release (Clinician: ) and (Facility: ) and (Doctor: ) from all liabilities associated with the above indicated procedure.