Laser Hair Removal Treatment & Consent Form

I understand that all items contained herein apply to the following procedure(s): Laser-Assisted Hair Removal

No Results are guaranteed!

The 3 most important risks/complications of Laser procedures are - Burns, Scarring, and Discoloration, which can be lighter (hypopigmentation) or darker (hyperpigmentation), all 3 can be permanent. These are rare but we need you to be aware before starting this procedure.
Pain an important determinant to prevent burns and other adverse events during the procedure. If your pain is more than 5 on a scale of 10, you must ask the staff to STOP the procedure. Pain scale -1 being the least and 10 being the worst pain you have ever had.

Nature of the Laser Hair Removal Procedure

The purpose of this procedure is to reduce unwanted hair. When the laser beam passes over the skin, the heat from the energy source selectively destroys the hair follicles that are actively growing (versus those that are resting or in falling out phase). Because hair actively grows in different cycles, approximately 10-12 or sometimes more treatments are required to achieve a significant, long-term reduction in hair growth. Industry standard for hair reduction is generally about 80 to 90% reduction in hair. However, there are no guarantees of any % reduction due to several factors that are different for every individual including but not limited to skin type, hair color, hair type, hair density, medical history, medications, patient compliance with pre/post care instructions and individual response to treatment. It is important to maintain a regular treatment schedule as proposed by us.

Potential benefit and what to reasonably expect 
Again no results guaranteed but the benefit is - Permanent hair reduction. When all is said and done you should not have to shave daily again ever. You may have a stray hair here or there but for all practical purposes you should not have to shave or wax etc on a regular basis. You should expect 80 – 90% of your hair on the treatment area gone. Laser Hair Removal can permanently reduce the numbers of hairs growing in the treated areas. Any remaining hair will generally be thinning and more easily treated by alternative methods.
Limitations
No results guaranteed. This program will require multiple treatments. The goal of Laser Hair Removal, as in any cosmetic procedure, is improvement, not perfection.

COMPLICATIONS (which can be PERMANENT) of this procedure include but are not limited to:
• Burns – Laser treatment can result in blistering/crusting/ flaking of the treatment areas
• Scarring – can occur when the skin surface is disrupted / when a burn heals. Follow post procedure instructions carefully to minimize the risk of scarring
• Discoloration - Skin Color changes, either lighter (hypopigmentation) or darker
(hyperpigmentation) may occur. Usually temporary but can become permanent
• Eye Hazard – use the provided protective eyewear at all times during the treatment to protect accidental laser exposure

RISKS of this procedure include but are not limited to 
• Pain / Discomfort – Many pts describe the sensation as ‘warm heat sensation’ or snap of a rubber band with pain scale of 2 to 3. It is your responsibility to inform us if your pain during the procedure is more than 5 on a scale of 10. 1 being the least and 10 being the worst pain you ever had.
• Slight Redness or Swelling – hive like reaction,
• Tenderness or mild tingling
• Sun Sensitivity - temporary increased susceptibility to sunburn
• Acne Breakout
• Activation of Fever Blisters (herpes)
• Melasma – may get worse
• Bruising
• Blister/Scab and Skin Infection
• Drug reactions or interactions
• Mismatch in color or texture of the skin

CONTRAINDICATIONS of this procedure include but are not limited to
• Tanning – excess Sun Exposure, Tanning Beds & Sunless Tanners 2 weeks prior
• Accutane (must discontinue 6 months before beginning treatment)
• Use of photosensitive medications which cause increased sensitivity to treatment
• History of keloid scarring or abnormal wound healing
• Tattoos, active sores, rash (psoriasis, eczema) or infection in the treatment area
• History of Seizures/Epilepsy
• Pregnancy and nursing
• Any internal metal device, i.e. surgical screws, pins, plates, or implants in the area to
• Hormonal imbalance, pregnancy and menopause can affect treatment outcomes

Tanning – No tanning during the course of the laser treatments. Tanning increases risk of
complications. Avoid all tanning, sun exposure, tanning beds etc for 2 weeks before and 1 week after each treatment. Your scheduled treatment will be postponed if you’re too tan.
Tattoos (and ‘permanent’ makeup) - We do not perform laser procedure over the tattoo, unless specifically approved by Ashley. Lasering over tattoo may damage or lighten it and increase risk of burns, scarring and discoloration.

 

I understand, read and completed the form truthfully. I understand that withholding ANY information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. I understand that this waiver replaces any verbal or written disclosures. The treatments I receive here are voluntary, and I release Ashley Lynn Esthetics LLC and/or esthetician from any liability, and I assure full responsibility thereof. I hereby grant irrevocable consent to and authorize the use of any reproduction by Ashley Lynn Esthetics LLC, all photographs which are taken of me, negative or positive proof which will be hereby attached for any purposes whatsoever, without further compensation to me. All negatives, together with the prints, video or live internet stream shall become and remain the property of Ashley Lynn Esthetics LLC, solely and completely. I understand and release Ashley Spina from any liability if I should fall or hurt myself in any way on the property located at 641 Union Rd. I understand that Ashley Spina is not responsible for lost, stolen or damaged items including my vehicle that is parked on the property.