Laser Skin Resurfacing Consultation and Consent Form

Client Details


What is Laser Skin Resurfacing?

Laser skin resurfacing removes the outer layers of the skin that are damaged. The laser resurfacing procedure stimulates the production of collagen and new skin cells in the underlying layers of the skin. Laser resurfacing is now used to eliminate or reduce wrinkles and fine lines on the face and neck.


Contraindications

Although it is impossible to list every potential risk and complication, the following conditions are recognized as contraindications for laser skin resurfacing and must be disclosed and discussed with the specialist prior to treatment.


Pre-treatment and Post-treatment Instructions

- Do not take any medications or supplements that can affect clotting (e.g. aspirin, ibuprofen, vitamin E) for 10 days before the treatment.
- Do not smoke for 14 days before the treatment, and for 14 days after the treatment as smoking during this period can interfere with the healing process.


Risks and Side effects of Laser Skin Resurfacing

Ablative laser resurfacing can cause various side effects, including:

- Redness, swelling and itching. Treated skin may be itchy, swollen and red. Redness may be intense and might last for several months. The aggravation of a previously existing skin condition, such as rosacea, can contribute to redness.
- Acne. Applying thick creams and bandages to your face after treatment can worsen acne or cause you to temporarily develop tiny white bumps (milia) on treated skin.
- Infection. Ablative laser resurfacing can lead to a bacterial, viral or fungal infection. The most common infection is a flare-up of the herpes virus — the virus that causes cold sores. In most cases, the herpes virus is already present but dormant in the skin.
- Changes in skin color. Ablative laser resurfacing can cause treated skin to become darker than it was before treatment (hyperpigmentation) or lighter (hypopigmentation), beginning weeks after laser resurfacing. Permanent changes in skin color are more common in people who have darker skin.
- Scarring. Ablative laser resurfacing poses a slight risk of permanent scarring.
- Turning of the eyelid (ectropion). Rarely, ablative laser resurfacing done near the lower eyelid can cause the eyelid to turn out and expose the inner surface.

Non Ablative laser resurfacing also can cause side effects, including:

- Infection. Nonablative laser resurfacing can cause a flare-up of the herpes virus.
- Changes in skin color. Non Ablative laser resurfacing can cause treated skin to become temporarily darker than it was before treatment (hyperpigmentation).
- Mild swelling and redness. Swelling and redness typically last only hours or days.


BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ THE ABOVE INFORMATION AND THEREBY CONSENT AND AGREE TO THE TREATMENT WITH ITS ASSOCIATED RISK.



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Appointment Guidance

If you have tested positive for COVID-19, or have any symptoms of COVID-19 (see below) please do not attend your appointment. Please contact us as soon as you know you will be unable to attend so we can reschedule.

COVID-19 Symptoms:

  • a high temperature or shivering (chills) – a high temperature means you feel hot to touch on your chest or back (you do not need to measure your temperature)
  • a new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours
  • a loss or change to your sense of smell or taste
  • shortness of breath
  • feeling tired or exhausted
  • an aching body
  • a headache
  • a sore throat
  • a blocked or runny nose
  • loss of appetite
  • diarrhoea
  • feeling sick or being sick
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