and that once treatments begin, there are no refunds. I also have read and signed the Financial Policy Form provided to me which explains my financial responsibility for this procedure.
I understand that the Laser Hair Removal procedure will require several treatments to obtain a significant, long-term reduction of hair growth. I also understand some people may not experience complete hair loss even with multiple treatments and that it is only effective on hair with color and does not treat white, grey, blonde, or red hair. I understand that genetics, hormones, and hair color may interfere with hair loss thus, favorable results for everyone are not guaranteed and I am undergoing treatments at my own risk.
By signing below, I acknowledge and understand that the following topics have been discussed with me prior to any procedure being performed:
- Possible alternative procedures such as electrolysis, waxing, plucking and depilatories
- Potential benefits of the proposed procedure
- Probability of success
- Reasonably anticipated consequences if the procedure is not performed, if any
- Possible Post-Procedure Experiences and Risks and subsequent healing period
- Post-treatment instructions
- Pregnancy status
By signing below, I hereby indicate that I am not pregnant.
Dr. K’s Laser Hair Removal Guarantee
Our goal is to meet or exceed every client’s expectation. The success of laser hair removal is based on genetics, hormones, following a treatment protocol, and laser technology being utilized during your procedure. Cynosure Vectus produces permanent hair reduction and is safe for all skin types. Treatments are performed every 6 to 8 weeks. Most of our clients are very satisfied after six treatments.
Packages include 6 treatments and 4 free treatments. Packages must be paid in full at the time of purchase. There are no refunds once treatment has started. If you completed all six laser treatments in accordance with protocols and time cycles of the package you purchased, then after 8 weeks following the sixth treatment has been completed, you will receive 4 free treatments to be redeemed within 12 months. Transferring the complimentary 4 touchups to other areas is not permitted.
Purchase of a laser hair removal package entitles clients to our lifetime appearance promise. Future laser hair removal treatments in the originally purchased area will be performed at 75% off the non-discounted per treatment price. By initialing below, I acknowledge the policy explained above.
Melasma generally occurs when your hormones go astray. It’s a natural darkening of the skin caused by excessive production of melanin (the pigment that causes your skin to tan). These melanin cells exist at various depths in the skin making treatment difficult. Melasma will worsen when exposed to the sun. It can affect pregnant women, women taking birth control pills or hormone therapy and even some men who are genetically predisposed to this lifelong hyper pigmentation issue.
Treatment: There are no guarantees of treatment results with any Melasma therapy. All treatment plans include the understanding that more than one treatment is usually necessary to achieve the desired cosmetic result, and that Melasma may worsen with treatment regimens. Options include:
Lasers are one of the safest options for treating Melasma. The IPL is ideal for removing dark pigmentation. For best results, you will need more than one treatment.
Microdermabrasion is a cosmetic technique that uses a mechanical medium for exfoliation to remove the outermost layer of dead skin cells from the epidermis.
Bleaching Agents typically use 4% Hydroquinone and 0.1% Tretinoin.
Often combination therapy works when single treatments do not.
Possible Post-Procedure Experiences and or Risks
Depending on the procedure being performed, you may experience some of the following:
DISCOMFORT – Some discomfort may be experienced during treatment.
REDNESS/SWELLING/BRUISING – Short term redness (erythema) or swelling (edema) of the treated area is common and may occur. There also may be some bruising.
PIGMENT CHANGES (Skin Color) – During the healing process, there is a possibility that the treated area can become either lighter (hypopigmentation) or darker (hyperpigmentation) in color compared to the surrounding skin. This is usually temporary, but, on a rare occasion, it may be permanent.
WOUNDS – Treatment can result in burning, blistering, or bleeding of the treated areas. If any of these occur, please call our office at (727) 518-1000.
INFECTION – Infection is a possibility whenever the skin surface is disrupted, although proper wound care should prevent this. If signs of infection develop, such as pain, heat, or surrounding redness, please call our office immediately at (727) 518-1000 for instructions.
SCARRING – Scarring is a rare occurrence, but it is a possibility if the skin surface is disrupted. To minimize the changes of scarring, it is IMPORTANT that you follow all post-treatment instructions carefully.
EYE EXPOSURE – Protective eyewear (shields) will be provided. It is important to keep these shields on at all times during the treatment in order to protect your eyes from injury.