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CO2RE Treatment Consent

My provider at Arsenault Aesthetics has explained to me that I am a good candidate for CO?RE™ Fractional Laser Resurfacing treatment and that although laser surgery has been shown to be highly effective, no guarantees can be made that I will benefit from treatment. I understand that the most common side effects and complications of this laser treatment are the following:

  1. Pain. The sharp, burning sensation of each laser pulse may produce a moderate to severe amount of discomfort. Topical anesthetics, anesthetic injections, or intravenous sedation may be used to block the pain during the procedure. Oral pain medication may be prescribed for the postoperative period.
  2. Swelling and oozing. Areas most likely to swell are around the eyes and neck. A clear fluid may be present in the lased areas and may create a crust (or scab) if the areas are not kept moist. Within about 2 days, you may appear to have an exaggerated tan with slight micro-crusting that may last as long as two weeks. It is recommended that a healing ointment be kept on the skin during this period.
  3. Prolonged skin redness. The laser-treated areas will initially appear bright red in color. After the first few days, the redness can be camouflaged with opaque makeup. The redness will fade to pink over the following couple of weeks, and normal skin color over the next couple of months.
  4. Skin darkening (hyper-pigmentation). “Tanning” of the skin can occur in the treated areas and will eventually fade within a few months. This reaction is more common in patients with olive or dark skin tones and can worsen if the laser-treated area is exposed to the sun.
  5. Skin lightening (hypo-pigmentation). Light spots can appear in an area of skin that has already received prior treatment or can be a delayed response to the laser surgery. The pale areas can darken or re-pigment in several months, but could be permanent.
  6. Scarring. The risk of this complication is minimal, but it can occur whenever the skin’s surface is disrupted. Strict adherence to all advised postoperative instructions will reduce the possibility of this occurrence.
  7. Infection. A skin infection in the postoperative period can result. This risk is minimized by the appropriate use of antibiotics and good skin care, including frequent hand washing.
  8. Allergic reaction. It is possible that an allergic reaction to an anesthetic, topical cream or oral medication can occur.
  9. Ectropion. In rare instances, a downward pull of the eyelids can result after peri-orbital laser resurfacing.
  10. Acne or milia formation. Flare-up acne or formation of milia can occur in the postoperative.
  11. Aftercare. I understand Arsenault Aesthetics is packaging in my aftercare and I am to use these products and only these products during the healing process. I will not use any additional products at home that could cause infection, oozing, swelling, etc.

Your consent and authorization for this elective procedure is strictly voluntary. By signing this informed consent form, you hereby grant authorization to our medical staff to perform and/or to administer any related treatment as may be deemed necessary or advisable in the diagnosis and treatment of your condition.

The nature and purpose of this elective procedure and the complications and side effects have been fully explained to me. Alternative treatments and their risks and benefits have been explained to me and I understand that I have a right to refuse treatment. I agree to adhere to all safety precautions and instructions after the treatment. I have been instructed in and understand post treatment instructions and have been offered a written copy of them. I understand that no refunds will be given for treatments received. No guarantee has been given by anyone as to the results that may be obtained by this treatment.

I have read this informed consent and certify that I understand its contents in full. All of my questions have been answered to my satisfaction and I consent to the terms of this agreement. I have had enough time to consider the information given me and feel that I am sufficiently advised to consent to this procedure. I accept the risks and complications of the procedure. I certify if any changes occur in my medical history I will notify the office.

I hereby give my voluntary consent to this elective procedure and release the facility, medical staff, and specific technicians from liability associated with the procedure. I certify that I am a competent adult of at least 18 years of age and am not under the influence of alcohol or drugs. This consent form is freely and voluntarily executed and shall be binding upon my spouse, relatives, legal representatives, heirs, administrators, successors and assigns.

I agree, if I should have any questions or concerns regarding my treatment / results I will notify this office at immediately so that timely follow-up and intervention can be provided.