As a client, it is important for you to understand the expected results and risks of radiofrequency skin treatment with the TempSure System. Please read this document carefully. Before signing this document, please ask your practitioner, or the consultant providing the RF treatment, about any aspect of this document, or the procedure, that you do not understand.
TempSure System equipment may present a hazard to clients with implanted devices or pacemakers. Please consult qualified medical personnel prior to being treated with radiofrequency
equipment.
Since ongoing feedback by a client during a procedure is required, if you have nerve insensitivity to heat anywhere in the treatment area or neutral pad area, you should not be treated with the TempSure System.
Inadequate or impaired feedback may lead to burns or injury. Ongoing feedback should be provided by you to the individual performing the treatment to avoid excessive discomfort
TempSure System treatments have not been studied for use on pregnant clients, clients with autoimmune disease, diabetes, or herpes simplex.
TempSure System has been cleared by the FDA for the following:
NOTE: All clients are different and exact results of this cosmetic procedure and treatments cannot
be predicted or guaranteed.
• Non-ablative treatment of mild to moderate facial wrinkles and rhytids.
• Elevating tissue temperature for selected medical conditions such as temporary relief of
pain, muscle spasms, and increase in local circulation.
• Temporary reduction in the appearance of cellulite.
During Treatment
You may feel an electric shock similar to a static discharge in a dry environment when the electrode
makes contact or is removed from the skin. A common comparison is the static shock you might
feel when touching something after dragging your feet across carpeting. Beard stubble should be
thoroughly removed prior to treatment as remaining stubble may accentuate shocks. If the eyelids
are to be treated directly, you will have plastic, non-conductive eye shields covering your eyes.
All jewelry and makeup, including lotions, eyeliner and eye shadow should be removed from the
treatment area prior to treatment.
Wrinkles on cut, wounded or infected skin should not be treated as this could promote infection and injury.
Slight discomfort may be experienced while undergoing treatment. Typically, the discomfort is mild and temporary during the procedure and localized within the treatment area. During the treatment you should feel warmth and heat and provide ongoing feedback to the individual performing the treatment. Therefore, no anesthetic (local, oral, or systemic) should be used prior to
or during the treatment.
After Treatment
Studies indicate the possible side effects of TempSure System are usually treatment-site related
and include mild discomfort during the procedure localized within the treatment area. Mild swelling and redness may occur which typically goes away within 2 to 24 hours.
Diligent protection from sun exposure and application of sunscreen for two to three weeks after treatment will minimize pigmentation changes.
A regimen to moisturize and soothe skin for one-week post-treatment is recommended.
There is the possibility that additional risk factors of radiofrequency skin treatments may be discovered. The results of performing RF wrinkle treatments in combination with other treatments
is unstudied and unknown.
It has been explained to me that this is a cosmetic procedure and not covered by insurance. It has been explained to me that more than one treatment may be recommended to achieve the best results and that there are other treatment options such as microdermabrasion, chemical peels, filler injections, or no treatment at all. As mentioned before, there is no guarantee of results and
no refund of payments for the procedure will be made.
My signature below signifies that all my questions have been answered by the treatment provider or consultant. I understand the risks, complications, expected results, and expense of the treatments. I have read and understand this document and give my consent to receive treatment with the tempsure system.