I am aware that laser/light source hair removal is a relatively new procedure. My doctor has explained to me that much of what has been written about these methods in newspapers, magazines, television, etc. has been sensationalized. I understand the nature, goals, limitations, and possible complications of this procedure, and I have discussed alternative forms of treatment. I have had the opportunity to ask questions about the procedure, its limitations and possible complications (see below).
I clearly understand and accept the following:
1. The goal of these surgeries, as in any cosmetic procedure, is improvement, not perfection.
2. The final result may not be apparent for months postoperatively.
3. In order to achieve the best possible result, more than one procedure will be required. There will be a charge for any further operations performed.
4. Strict adherence to the postoperative regimen (i.e., appropriate wound care and sun avoidance) is necessary in order to achieve the best possible result.
5. The surgical fee is paid for the operation itself and subsequent postoperative office visits. There is no guarantee that the expected or anticipated results will be achieved.
Although complications following laser/light source hair removal are infrequent, I understand that the following may occur:
1. Bleeding, which in rare instances could require hospitalization.
2. Infection is rare, but should it occur, treatment with antibiotics may be required.
4. Alterations of skin pigmentation may occur in the areas of laser surgery. These are usually temporary, but rarely can be permanent.
5. A paradoxical increased hair growth may occur at or near treated sites. This generally responds to further treatments.
This authorization is given for the purpose of facilitating my care and shall supersede all previous authorizations and/or agreements executed by me. My signature certifies that I understand the goals, limitations and possible complications of laser surgery, and that I wish to proceed with the operation.
Fig. 4.1. Consent form
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