INFORMED CONSENT FOR LASER PIXEL
FRACTIONAL ABLATIVE SKIN RESURFACING
I DECLARE THAT I UNDERSTAND THE FOLLOWING INFORMATION:
The goal of laser Pixel for fractional ablative skin resurfacing is to reduce or partially eliminate signs of photodamaged/aged skin, skin tags, facial wrinkles or reduce scarring from skin conditions such as acne.
The laser Pixel technology targets only small segments of the total skin mosiac, leaving uninjured skin areas to facilitate rapid wound healing. In other words, only a fraction of the target area – not the entire surface area – is damaged. The pain level is minimal, and under normal conditions, unless requested by the patient, no local anesthetic is usually used.
Generally, the results of the laser Pixel for fractional ablative skin resurfacing demonstrate improvement in the smoothness of the skin; however, a complete elimination of wrinkles or scarring is not a realistic expectation.
Alternatives to laser Pixel for Fractional Ablative Skin Resurfacing:
The alternative to laser Pixel fractional ablative skin resurfacing include dermabrasion and chemabrasion. The advantages and disadvantages (risks and benefits) of each of these alternatives to laser Pixel have been explained to me as well as the alternative of having no surgery, accepting my present skin condition, using cosmetics and considering other methods of skin rejuvenation procedure.
Possible Short-Term Effects of Laser Pixel Fractional Ablative Skin Resurfacing:
1. Pain- Minimal discomfort, burning sensation or very mild pain in the first few hours after the procedure. A local anesthetic is usually not used during the treatment, but some degree of discomfort may appear after the procedure and this pain may persist for several hours-days.
2. Redness of Skin – Erythema or redness of skin (1st degree burn) of the skin for several hours up to 2 days period.
3. Wound Healing – Flakiness of the treated area, usually persisting for 2-7 days.
4. Skin Thickening- Textural changes of the treated skin, such as skin thickening, which may persist for a variable amount of time.
5. Skin Tightness – Sensation of skin tightness (peaks at 3-8 weeks postoperatively).
6. Herpes Simplex Dermatitis (Fever Blisters) – Occurrence or recurrence of herpes simples dermatitis, particularly if not pre-, intra-, and post-operatively treated with a systemic antiviral medication such as Zovirax.
7. Skin Itchiness – Pruritis or itching in the early healing phase.
8. Skin Hyperpigmentation – Transient hyperpigmentation (darkening of the skin), especially in darker – skinned people, occurring three to eight weeks after laser therapy.
9. Skin Hypopigmentation – Hypopigmentation (lightening of the skin), which occurs because of laser-induced injury to the melanocytes (pigment containing cells in the skin) and which can be permanent.
Please Initial after reading this page ____________________
I certify that I have no metal objects or a pacemaker in my body. _________________________
I understand that unprotected sun bathing must be avoided for a period of 3 months. To do so would encourage skin pigment changes and rhytids (wrinkles) necessitating further treatment.
I also understand that more than one fractional resurfacing with the laser Pixel procedure may be required to achieve the optimal obtainable results.
I understand the practice of medicine and surgery is not an exact science and I acknowledge that no guarentees have been made to me concerning the results and procedure. It is not possible to state every complication that may occur as a result of laser Pixel fracitional ablative skin resurfacing procedure.
My medical professional has explained laser Pixel fractional ablative skin resurfacing and its risks, benefits and alternatives and has answered all my questions about the laser Pixel fractional ablative skin resurfacing procedure. I therefore consent to having laser Pixel fractional ablative skin resurfacing procedure.
With this form, I give my full consent for all photographs/footage captured, during and after my treatment by Beauty Redefined to remain the property of the clinic.
Signature: _________________________________________ Date:_____________________
Witness Signature:___________________________________ Date:_____________________
I refuse to have my photograph taken, being fully aware that this will eliminate the opportunity to evaluate the effectiveness of my procedure.
Signature: _____________________________ Date: ________________
A Medical Aesthetic Clinic
Pixel Skin Resurfacing Post Treatment Instructions
Meticulous wound care is crucial after pixel skin resurfacing; below are our recommendations for after treatment care. Discontinue use of all products that have not been discussed and approved in advance.
DAYS 1-3 or while the skin is sensitive to the touch
You will be experiencing redness similar to severe sunburn. Your skin will sting similar to a harsh windburn. Your color may appear blotchy as some areas may have been treated more aggressively than others and could even be puffy or swollen. Do not moisturize, we want the skin to peel and rejuvenate naturally.
1. Immediately after treatment, we will apply a wound-healing product such as Aloe and sunblock.
2. Wash with cool water only as needed to remove make-up, etc. When cleansing, use a gentle cleanser such as SkinMedica Daily Cleanser (nothing with glycolic acid) , rinse and pat dry with a soft towel.
3. Immediately after cleansing, apply a wound healing product such as Organic Almond Oil and a sunblock (if going outside at all). Periodically throughout the day re-apply sun protection if outside (every 1-2 hours).
4. Stinging or burning may occur immediately after applying any of the above cleanser and topicals but should stop within 5-10 minutes. The pixel has removed the natural barrier on your skin; therefor some irritation is expected (and not harmful) as well as just simply touching the treated area with your hands to apply topicals will induce irritation.
5. Organic aloe may be gently sprayed, cold compress or cold packs can be applied to the treated area throughout the day to control discomfort and swelling.
6. Avoid direct sun exposure and harsh chemicals that may cause stinging (peroxide/hair color, alcohol, raw onions, raw peppers, anything with glycolic acid). If you come into contact with chemicals, wash hands, then rinse the treated area with cool water for relief and re-apply wound healing product.
7. Do not rub skin, use a wash cloth, sponge, etc.
8. Sleep with elevated head to minimize swelling.
DAYS 3-7 or once the sensitivity has subsided and skin is flaky
The redness and blotchy appearance of the most severely treated areas will start subsiding. Your skin may appear more taut and shiny than usual. Although your skin looks fine, it is important to remember that you are still healing and must follow the treatment regimen. Your skin will feel “crusty”, flaky, and dry as the healing progresses.
1. Wash morning and night with cool water, a gentle cleanser such as the Vivite Replenish Hydrating Cleanser, rinse and pat dry with a soft towel.
2. Immediately after cleansing, apply a wound healing product such as Vivite Replenish Hydrating Cream and/or Organic Almond Oil ,and a sunblock (if going outside). Periodically throughout the day re-apply sunblock (every 1-2 hours if outside).
3. Avoid direct sun exposure.
4. Do not pick or peel flaky skin. Use a wash cloth, sponge, etc.
1. You may begin using Vivite products with glycolic acid or bleaching cream one week after procedure. You may also use a light exfoliator, such as Vivite Exfoliating Cleanser, to remove any remaining “flaky” skin or schedule a professional diamond microdermabrasion for smoother, longer lasting results.
2. Once skin is done flaking, you may return to your normal daily skin care regimen.
3. Avoid direct sun exposure during treatment series as you may be more prone to a sunburn or hypopigmentation.
If you have any questions or concerns call us immediately 408-356-7050
Receive 25% off any SkinMedica products purchased at the time of your Pixel/Lunchtime Pixel.
Signature: _______________________________________ Date: _____________________
Witness: _________________________________________ Date: _____________________