Fractional CO2 Laser Consent Form
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ScribdTranslationsFractional CO2 Laser Consent Form
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ScribdTranslationsTerm of Clarification and Consent
Fractional CO2 Laser Procedure
(Through Patient)
GENERAL GUIDELINES
In the fractionated CO2, the laser beam is separated into several microbeams of light, like a shower.
With this, the laser reaches micropieces of skin, leaving areas of intact skin between the islands of affected skin.
It is this unaffected skin that will facilitate the healing of the columns of tissue affected by the laser.
The small bridges of intact skin allow for the restructuring of the epidermis (the superficial layer of the skin) of a
faster way and allows the patient to return to their normal activities in a shorter time.
This results in improvement in lines, wrinkles, scars (including acne scars), sagging, and others.
skin irregularities. This device also stimulates the formation of new collagen that remains.
In Fractional CO2 laser treatment, the procedure is performed with topical anesthesia. Redness and slight edema.
occur after treatment that regresses in 3 to 4 days.
CAUTIONS LIKE AVOIDING THE SUN AND PROPER USE OF SUNSCREEN MUST BE COMPLETE
RESPECTED DURING TREATMENT.
The LASER procedure (Fractional CO2) requires several sessions to achieve the desired result.
I authorize the above-mentioned doctor/professional and assistants of their choice to carry out the procedures
above mentioned.
In addition, I authorize the doctors/professionals to perform any other procedure they consider necessary.
necessary or advisable in case any unforeseen event occurs during the procedure.
This authorization will be valid for 6 (six) months from the date of execution of the first session.
I also declare that the following items have been duly discussed and clarified with me:
a) The potential benefits of the adopted procedure;
The possibility of success will depend on factors that were explained to me;
c) The need to repeat the procedure several times;
d) Any potential and possible complications including risks of the procedure to be
carried out, such as: reactions specific and inherent to my person, subsequent healing period, infection
(ex: herpes virus), scars, bleeding, and spots;
The need to appear in advance for each session of the procedure,
evaluation and photographic documentation of the location to be treated with LASER, in addition to control photos during and after
the end of the treatment. The photos will only be for evaluating the procedure, and they will not be exposed or
disclosed without my prior authorization except in medical congresses or academic activities where there is
my consent;
f) The need to attend scheduled follow-ups for post-procedure evaluations. Failure to do so
attendance to the requested returns will relieve the doctor of any commitment to the result
pretendido, bem como na programação estipulada;
There is a possibility of not achieving the desired objective in some cases, even at the end of the treatment;
h) The importance of not exposing oneself to the sun (tanning) before and during treatment
If sun exposure occurs, notify the doctor before the next application.
I declare that I am aware of the following effects and risks of the LASER procedure (Fractional CO2):
1. Discomfort: Some discomfort or pain may be experienced during the procedure. I agree to submit myself
submit to local anesthesia, if the doctor deems it necessary.
[Link]
Rua Taquari, 43–Mooca | Tel: (11) 2692-5625 | São Paulo–SP | Cep: 03166-000
2. Healing: the procedure may result in edema (swelling), exudation (secretion), formation of blisters,
crusts and peeling in the treated area, which may require a period of one to two weeks approximately,
for healing. Once healed, it should be applied to the treated area from the first session of
procedure, a sunscreen compatible with the type of skin I need,
Indication that will be given by the professional who will perform the procedure. Right after each session, the skin
it may become erythematous (red), edematous (swollen) and sensitive for a period of a few days.
3. Changes in skin coloration during the healing process may occur in the treated area.
to make it lighter or darker than the neighboring area. This is usually temporary, but in rare cases
occasions can be permanent.
4. Scars: the appearance of scars is rare, but it can also occur.
5. Persistence of the injury: some patients may require more sessions for the final resolution of the injuries.
since each patient may have different intensity response to treatment. Thus the number of
sessions are just an estimate and may require subsequent adjustments in some cases.
6. Eye Exposure: Eye protection (special glasses) will be provided to you. It is important to wear these.
glasses all the time during treatment to protect from accidental exposure.
To minimize the chances of complications, it is very important that the patient correctly follows the instructions.
pre and post-operative such as: using herpes medications, antibiotics, and sunscreen that are prescribed to you
indicated.
I declare that I have read this authorization carefully, fully understanding its content and I am
consents and is totally in agreement with the times and conditions for the execution of the procedure and that the
Possible complications referred to here have been duly communicated to me.
______________________________
Dr. Consuelo Junqueira
Dermatologist - CRM 31822
[Link]
Rua Taquari, 43–Mooca | Tel: (11) 2692-5625 | São Paulo–SP | Cep: 03166-000
Common questions
Powered by AIProper pre-operative preparation, including patient education on using sun protection, following prescribed medication regimes, and avoiding tanning, directly influences the success of fractional CO2 laser treatments. By ensuring optimal skin condition prior to the procedure, these measures reduce the risk of complications such as infection or prolonged recovery, enhance the effectiveness of the laser treatment, and help in achieving the desired aesthetic outcomes. Expected results are also better maintained when patients understand and adhere to these guidelines .
Patients may require multiple sessions of fractional CO2 laser treatment to achieve desired results due to individual variations in skin response and the intensity of skin issues being addressed, such as deep wrinkles or severe scarring. The number of sessions needed is an estimate, as each patient's response to treatment can differ. Expected outcomes are determined based on initial assessments of the skin condition and ongoing evaluations during follow-up visits, with adjustments made as needed to the treatment plan to better achieve the targeted results .
Patient compliance with post-procedure follow-ups is crucial for monitoring the skin's healing process, addressing any emerging complications promptly, and evaluating the effectiveness of each treatment session. Regular follow-ups allow healthcare providers to adjust the treatment plan based on the patient's progress, ensuring the attainment of the best possible results. Inconsistent attendance at these follow-ups can leave potential issues unmanaged, negatively impacting the overall efficacy and longevity of the treatment outcomes .
During fractional CO2 laser treatments, safety measures include the provision of eye protection through special glasses to prevent accidental laser exposure to the eyes. Local anesthesia may be offered to reduce discomfort or pain during the procedure. These precautions ensure patient safety and comfort while minimizing risks related to the laser's powerful energy .
Post-treatment care is vital in fractional CO2 laser procedures to minimize complications and ensure optimal results. Patients are required to avoid sun exposure and use prescribed sunscreens to protect the treated skin. Adherence to pre- and post-operative instructions, such as using medications for herpes or antibiotics, is crucial. Neglecting these guidelines can lead to increased risk of complications such as infections, more pronounced or prolonged side effects, and less effective results. Medications and protections like special glasses during the procedure help prevent side issues like herpes flares or eye damage .
After a fractional CO2 laser procedure, the healing process involves some redness and slight swelling that generally subsides within 3 to 4 days. The affected skin may experience swelling, exudation, blistering, crusting, and peeling, with healing potentially taking one to two weeks. During this time, skin redness and sensitivity are common. Side effects like temporary changes in skin coloration or rare scarring may occur. Proper care, including the use of sunscreen and avoidance of sun exposure, is crucial to minimize risks .
Risks associated with fractional CO2 laser treatments include discomfort, temporary changes in skin coloration, possible scarring, infection, edema, and persistence of the initial skin conditions. Contingency measures include proper patient instruction on sun avoidance and skincare, pre-treatment screening for potential risk factors like herpes infection, and the provision of medications like antivirals or antibiotics when necessary. Informed consent and predetermined action plans for unforeseen events during the procedure are critical in risk management to ensure patient safety and satisfactory outcomes .
Communication with patients regarding fractional CO2 laser treatments should include discussions about potential benefits, expected outcomes, multiple session requirements, and inherent risks like discomfort, temporary or permanent skin color changes, and rare scarring. Additionally, the potential need for adjusted treatment plans based on individual responses, and the possibility of not achieving desired results even after treatments, must be clearly communicated. This dialogue ensures that patients have realistic expectations, are informed about the entire treatment process, and understand the importance of compliance with pre- and post-treatment protocols .
Fractional CO2 laser treatment stimulates the dermal layer of the skin to promote the formation of new collagen by causing controlled micro-damage to specific skin areas. This microdamage triggers the body's natural healing process, which includes collagen production, leading to firmer, more youthful skin. Increased collagen helps to improve skin elasticity, reduce wrinkles, and enhance overall skin texture, making it an effective anti-aging treatment .
The principle behind fractional CO2 laser treatment is the use of a laser beam that is divided into multiple microbeams of light, targeting microscopic fractions of the skin while leaving areas of intact skin between treated zones. This selective targeting allows the unaffected skin to expedite the healing process of the treated areas. The treatment is effective for improving lines, wrinkles, scars, skin sagging, and other irregularities. Additionally, the procedure stimulates the formation of new collagen, aiding in skin rejuvenation and surface texture .