Laser Tattoo Removal Informed Consent
This procedure uses laser technology for the removal of tattoos. Patients should avoid direct sun exposure for two months after the procedure. If it is necessary to be in the sun, a sunscreen with SPF 30 or greater protection should be used. Multiple treatments may be necessary to achieve desired results. Complete tattoo removal is not always possible, as tattoos were meant to be permanent. Possible risks of the procedure include, but are not limited to pain, purpura, swelling, redness, bruising, blistering, crusting/scab formation, ingrown hairs, infection, and unforeseen complications that can last many months or years, or may even be permanent. There is a risk of scarring.
Short-term and long-term effects
Short-term effects may include reddening, mild burning, temporary bruising or blistering. A brownish/red darkening of the skin (known as hyperpigmentation) or a lightening of the skin (known as hypopigmentation) may occur; this usually resolves in weeks, but it can take up to three to six months to heal. Permanent color change is a rare risk. Loss of freckles, hair or pigmented lesions can occur.
Textual and/or color changes in the skin can occur and can be permanent. Many cosmetic tattoos and body tattoos are made with iron oxide pigments, which can turn red-brown or black; titanium oxide and other pigments may also turn black. This black or dark color may not be removable. Because of the immediate whitening of the exposed treated area by the laser, there can be a temporary obscuring of ink, which can make it difficult or impossible to notice a specific color change from the tattoo removal process.
Possible side-effects
Although infection following treatment is rare and unusual, bacterial, fungal and viral infections can occur. Herpes simplex virus infections around the mouth can occur following a treatment; this applies both to individuals with a past history of herpes simplex virus infections and individuals with no known history of herpes simplex virus infections in the mouth area. Should any type of skin infection occur, additional treatments or medical antibiotics may be necessary.
Pinpoint bleeding is rare but can occur following treatment procedures. Should bleeding occur, additional treatment may be necessary.
There have been reports of hypersensitivity to the various tattoo pigments during the tattoo removal process, especially if the tattoo pigment contains mercury, cobalt or chromium. Upon dissemination, the pigments can induce a severe allergic reaction that can occur with each successive treatment. Superficial erosions, bruising, blistering, milia, redness and swelling that can last many months or years or be permanent have been noted in some patients.
I acknowledge that while good results are expected, I may be disappointed with the results of the procedure. I understand there is no guarantee of results of any treatment. Even though appropriate measures are taken to reduce side effects, they cannot be completely eliminated in every case. I understand that the treatment may involve risks of complication or injury from both known and unknown causes. I agree to follow the pre- and post-treatment instructions carefully. I understand that compliance with the recommended pre- and post-procedure guidelines is crucial for healing and reducing the risk of complications.
I consent to photographs of before and after to demonstrate results in my chart, and will give separate permission for photographs published on social media, for educational purposes, conferences, or websites if desired.
I am aware that follow-up treatments may be necessary for desired results. Clinical results will vary per patient. There may be other treatment options that achieve similar effects, and I have discussed these. With this in mind, I am choosing this non-invasive treatment using lasers. The nature, risks and purpose of the treatment have been explained to me, and all my questions have been answered to my satisfaction. I, therefore, consent to this treatment.