It is important that you are informed about your skin condition and proposed treatment including the potential benefits and risks involved.
This disclosure is not meant to scare or alarm you; it is simply an effort to better inform you so that you may give or withhold your consent to the
treatment.
I have requested CryoPen® Therapy to remove my benign skin lesion (skin tag, skin wart, brown spots). Any concerns that the skin lesion is anything other than benign I have cleared and approved by a medical practitioner prior to this treatment.
I certify that I have read, and that I have had sufficient opportunity for discussion and to ask questions. I consent to this procedure today and for all
subsequent treatments.

CryoPen® Therapy is a relatively low-risk treatment and side effects and complications are usually minimal. Some side effects may occur as a results of the treatment. These include:

Pigment changes
Both hypo pigmentation (lightening of the skin) and hyper pigmentation (darkening of the skin). Both generally last a few months, but can belonger lasting.

Shards of frozen humidity
The innovation of CryoPen® is the direct application of nitrous oxide under high pressure (55 bar). This high pressure jet may cause minor shards of frozen humidity in the air blown away in a circle of approximately 30cm. They will thaw the moment they would eventually touch healthy skin.

Lesions on sites with coarse terminal hair
Hair follicles are easily damaged by cryosurgery and permanent alopecia is not uncommon.

Nerve damage
Though rare, damage to nerves is possible, particularly in areas where they lie closer to the surface of the skin, such as the fingers, the wrist, and
the area behind the ear. Reports suggest this will disappear within several months.

Blisters
Patients may experience blistering for a period of 7-14 days post-treatment and potentially up to 2-4 weeks depending on the area being treated, the intensity of the treatment, and skin health prior. Lesions on the body generally have a longer healing time compared to those on the face.

• Impaired sensation
• Impaired circulation
• Open wound
• Recent scar tissue
• Raynaud disease
• Prone to Keloid scarring
• Skin cancer
• Superficial nerves
• Cardiac disease
• Hypersensitivty to cold

Impaired wound healing (e.g. blood thinners, diabetes)
We advise to seek medical advice and deem it safe to treat. Blood thinners can increase sensitivity to cold and the skin will also become thinner.
The healing is compromised; this makes the treatment healing uncertain. If the diabetes is well-controlled, it should be accepted. However, it is recommended to get advice from your GP to the sustainability of the treatment.

Pregnancy or breastfeeding
It is advised to abstain from the treatment due to unknown side effects.

Antihistamine
Treatment with CryoPen® cannot be performed if you are taking Antihistamines. Please avoid taking them 2-3 days prior to your treatment unless medically prescribed. If it is taken for allergy reasons, seek professional medical advice before treating.

 

I have been advised of the risks involved in such treatment, the expected benefits of such treatment, and alternative treatments, including no treatment at all. 

I understand that results can vary depending on skin lesion, the area treated and the intensity of treatment and have discussed expectations with my practitioner. 

I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. 

I certify that I have read, and that I have had sufficient opportunity for discussion and to ask questions. I consent to this procedure today and for all subsequent treatments.