Consent Form for CO2 Laser Treatment

Aluna Cosmetic Dr. Ramtin Massoudi

You have chosen to undergo CO2 laser treatment for skin resurfacing and rejuvenation. This procedure uses carbon dioxide laser technology to remove the outer layers of damaged skin, promoting the growth of new, healthy skin. Purpose: The CO2 laser treatment aims to improve the appearance of the skin by addressing issues such as fine lines, wrinkles, acne scars, sun damage, and uneven skin tone and texture. Procedure Description: The procedure will be performed using a CO2 laser device. Local anesthesia or a topical numbing cream will be applied to minimize discomfort. The laser will be applied to the treatment area, removing the outer layers of skin. Post-treatment care instructions will be provided to aid in the healing process. Potential Risks and Complications:

While CO2 laser treatment is generally safe, there are potential risks and complications, including but not limited to:

Redness and swelling Infection

Scarring Changes in skin pigmentation Prolonged healing time Discomfort or pain Herpes simplex virus (cold sores) reactivation

Alternative treatments to CO2 laser therapy include, but are not limited to, other types of laser treatments, chemical peels, microneedling, and dermabrasion. These options can be discussed with Dr. Ramtin Massoudi to determine the most suitable treatment for your condition.

Follow all post-treatment care instructions provided by Dr. Ramtin Massoudi and the Aluna Cosmetic team. Avoid direct sun exposure and use sunscreen as recommended. Keep the treated area clean and moisturized. Report any unusual symptoms or concerns to our office immediately.

By signing this form, I acknowledge that I have read and understood the information provided about CO2 laser treatment. I have had the opportunity to ask questions and discuss any concerns with Dr. Ramtin Massoudi. I understand the potential risks and benefits associated with the procedure, as well as alternative treatment options. I consent to proceed with the CO2 laser treatment under the care of Dr. Ramtin Massoudi and the Aluna Cosmetic team.

Please ensure all information is filled out accurately and consult with our team if you have any questions or need further clarification.