Informed Consent

For Removal/Reduction of Brown

Spots & Spider Veins


Name:___________________________ Date:_________________


I authorize ____________­­________, experienced and trained in the removal of brown spots and superficial spider veins, to perform the procedure. The light pulsed system will dramatically reduce darkly pigmented sunspots and spider veins. More than one laser session may be necessary to achieve desired results. However, other treatments, including skin care products, are often needed to blend color, reduce sun damage, and give the best results. The FDA has given the clearance for removal of brown spots, spider veins, and rosaccea.


The skin treated will be red and swollen with fine, thin scabs forming. Please keep the treated areas covered with Polysporin and Aquaphor until the thin scabs fall off. This process will take anywhere from 1-3 weeks. It could take as long as 3-6 months in some cases. Do not scratch the scabs, which can cause scarring.


We are unable to treat clients that are on ACCUTANE, and PHOTOSENSITIZING medications. Clients using ANTICOAGULANTS  should be noted.


 The following problems may occur with treatment:


  1. Scarring: The light pulsed system can create a bruising and a moderate burn or blister to the skin. For an effective treatment, the power (joules) needs to be just below the blistering point which means skin will be red. Although it is certainly possible to scar with a burn or blister, it has not been a problem with the Medilux. However slight, there is a risk of scarring.


  1. Hyper-pigmentation (browning) and Hypo-pigmentation (whitening) have been noted after treatment, especially with a darker complexion. This usually resolves within weeks, taking as long as 3-6 months in some cases. Permanent color change is a rare risk. If you have a lot of color in your skin, a skin lightening cream will be advised to reduce the melanin in your skin before the treatment. Avoiding sun exposure after the treatment reduces the risk of color change.


  1. Infection: Although infection following pulsed light treatment is unusual, bacterial, fungal, and viral infections can occur. Herpes simplex virus infections around the mouth can occur following a laser treatment. This applies to both individuals with a past history of herpes simplex virus infections in the mouth area. Should any type of skin infection occur, additional treatment including antibiotics might be necessary. If you have a history of herpes simplex virus in the treated are we would recommend preventative therapy.


  1. Bleeding: Pinpoint bleeding is rare but can occur following brown spot and spider vein treatment procedures. Should bleeding occur, additional treatment might be necessary.


  1. Laser Smoke (plume): Although brown spot/solar lentigo removal treatment normally involves minimal laser smoke, the smoke is noxious to those who come in contact with it. This smoke may be representing a possible biohazard.


  1. Skin tissue pathology: Energy directed at skin lesions may potentially vaporize the lesion. Laboratory examination of the tissue specimen may not be possible. Only clearly benign pigmented lesions can be treated. Check with your doctor for a clearance for the treatment.


  1. Allergic reactions: In rare cases, local allergies to tape, preservatives used in cosmetics or topical preparations, have been reported. Systemic reactions (which are more serious) may result from prescription medicines. Allergic reactions may require additional treatment.


  1. Please wear sunscreen of SPF 25 or higher before and after treatment to protect your skin.


  1. I understand I may need multiple treatments for the desired outcome.


  1. I understand that exposure of my eyes to light could harm my vision. I will keep the eye protection on at all times.


  1. Compliance with the aftercare guidelines is crucial for healing, prevention of scaring, hyper-pigmentation and hypo-pigmentation.


  1. I release ________________________________ from these liabilities.


Occasionally, unforeseen mechanical problems may occur and your appointment will need to be rescheduled. We will make every effort to notify you prior to your arrival to the office. Please be understanding if we cause you any inconvenience.





Signature: _____________________________ Date: ___________________


Technician: ____________________________ Date: ___________________








Post Treatment Instructions:


1.                  Immediately after the treatments, you should apply an ice pack, as there may be mild swelling.  It is normal for the treated area to feel like sunburn for a few hours.  You should use a cold compress if needed.  Avoid any trauma to the skin for up to 2-5 days, such as bathing with very hot water, strenuous exercise, or massage.


2.                  Avoid picking or scratching the treated skin to achieve your best results.  If any crusting, apply antibiotic cream.  Some physicians recommend aloe vera gel or some other after sunburn treatment such as Desitin.  Darker pigmented people may have more discomfort than lighter skin people and may require the aloe vera gel or an antibiotic ointment longer.   Follow instructions as specified by your laser professional.


3.                  Makeup may be used after the treatment has quit swelling unless there is epidermal bleeding.   It is recommended to use new makeup to reduce the possibility of infection.  Keep the area moist.  Any moisturizer without alpha-hydroxy acids will work.


4.                  You may shower after the laser treatments in tepid water.  The treated area may be washed gently with a mild soap.  Skin should be patted dry and NOT rubbed.


5.                  You will experience redness and bruising from five to fourteen days at the treatment.  Avoid direct sun exposure and tanning beds for 1-2 months and throughout the course of the treatment so as to reduce the chance of dark or light spots.  Use sunscreen SPF 25 or higher at all times throughout the treatment when going outside.


6.                  Avoid tweezing, waxing, bleaching or chemical peels during the course of the treatment.   Do not use any irritants such as Retin-A, Benzoyl Peroxide or astringents.


7.                  If work on the leg has been done, wear compression stockings for 48 hours and then during the day while on feet for up to two weeks.  


8.                  Call your physician’s office with any questions or concerns you may have after the treatment