Recruitment Form

The Aerolase is used for several procedures including hair removal, vein treatment and wrinkle reduction.  This form is designed to give you the information you need to make an informed choice of whether to undergo Aerolase laser treatment.  If you have any questions, please do not hesitate to ask. Although the laser treatment is effective in most cases, no guarantee can be made that a specific patient will benefit from the treatment.

The laser emits an intense beam of light that is absorbed in specific body tissues within the skin, and depending upon the type of procedure, several treatments may be required at intervals specified by the
clinician.

Some of the possible complications of Aerolase treatment are:

1. Discomfort – The procedure is done so precisely that surrounding tissue is minimally affected; the patient may experience a mild sensation of pain in the treated areas. Some degree of skin flushing may occur, but it typically resolves within several hours.

2. Scarring – There is a small chance of scarring, including hypertrophic scars, or very rarely, keloid scars. Keloid scars are very heavy raised scar formations. To minimize chances of scarring, it is important that you follow all postoperative instructions carefully. It is important that any prior history of unfavourable healing be reported.

3. Pigmented changes – The treated area may heal with lighter or darker pigmentation. This occurs more often in darker pigmented skin and following exposure of the area to the sun. It is recommended that you protect yourself from any sun exposure for at least three months following treatment. Hyperpigmentation usually fades in three to six months. However, pigment change can be permanent.

4. HSV Reactivation – The patient agrees to notify the physician if he/she has any history of Herpes viral infections, as the laser procedure may cause it to reactivate.

5. Lack of Treatment Response – There is a possibility that the targeted hairs, veins or other treated areas will not respond to the treatment. This is often a function of the specific body chemistry of the patient, including relative pigmentation and light absorption characteristics of the patient’s various body tissues.

6. Eye Exposure – There is also the risk of harmful eye exposure to laser surgery. Safeguards should be provided by the laser practitioner. It is important that you keep your eyes closed and have protective eye wear at all times during the laser treatment.

I certify that I have read or have had read to me, the content of this form. I understand the risks and alternatives involved in this procedure. I have had the opportunity to ask any questions that I had, and all my questions have been answered.

I consent to be photographed before, during, and after the treatment and that these photographs will be stored securely on my file. These photographs may be used, de-identified, for training or marketing purposes.

It is important that you are informed about your skin condition and proposed treatment, including the risks and benefits involved. This disclosure is not meant to scare or alarm you; it is simply an effort to better inform you so that you may give or withhold your consent to the treatment program. It is important that you fully understand thisinformation, so please read this document thoroughly. If you have any questions regarding the procedure, ask your doctor prior to signing the consent form.

WHAT IS BIO-REMODELLING?

This incredible product is known as a skin biostimulator, or skin bio-remodeller, meaning it changes the structure and function of the skin from within. Offering skin rejuvenation, collagen and elastin stimulation and deep hydration all from a single treatment. The first of its kind, this natural enhancer is a revolutionary 'beneath the skin' hyaluronic acid moisturising treatment, made with the patented NAHYCO® technology.

This results in a unique hyaluronic acid injectable gel, which has a prolonged stimulating activity on
the dermal cells. When injected into skin, it stimulates the skin cell receptors to counteract skin laxity and improve and restore the firmness of the skin. One of the highest concentrations of hyaluronic acid on the market, this bio-remodelling treatment boosts and hydrates the skin and remodels ageing and
sagging tissue.

This new bio-remodelling treatment promotes healthy, glowing and radiant skin. It has been used overseas for more than 7 years with excellent results and safety profile. Nearly 5 million treatments have been performed
worldwide.

Best performed as an initial course of 2 treatments, spaced 4 weeks apart, this bio-remodelling treatment will keep you looking natural, rejuvenated and hydrated. The treatment is suitable for men and women as well as offering skin benefits for patients of all ages.

Bio-remodelling is suitable for anyone who wishes to see visible improvements in:

HOW DOES IS WORK?

Ultra-pure hyaluronic acid is precisely injected into the area being treated. Unlike wrinkle relaxing and dermal filler treatments, the natural enhancer stimulates collagen and elastin, attracting water in the deeper layers of the skin. As a stabilised product, the activity on dermal cells will last longer than that of a non-stabilised gel.

During this time, the stimulation of four different types of collagens and elastin takes place by slow release of hyaluronic acid. The stimulation results in significant tissue improvement, building
from the base up.

ADVERSE REACTIONS AND POSSIBLE COMPLICATIONS

No procedure is risk-free. The following risks may occur, but there may be unforeseen risks that are not included on the list. These risks include, but are not limited to:

If any of the inflammatory reactions persist more than 7-10 days, I understand I must contact my physician immediately.

I also declare that I am aware of the advice to follow during the post-injection period which I will follow correctly.

I am not aware that I am pregnant. I am not trying to get pregnant. I am not lactating (breast feeding). I have accurately informed my doctor of my medical history, including any allergies, autoimmune diseases, medications or herbal supplement, including those that would prohibit me from receiving treatment.

Having been properly informed and having completely understood the advantages of the above mentioned treatments and eventual adverse reactions that may occur, I authorise said treatments and
give my full consent.

CONSENT

I declare to be duly informed about use, indications, contradictions, possible adverse reactions and complications regarding the use of the above-mentioned product. I certify that the answers to the questions
regarding my general health, and previous aesthetic and medical treatments are accurate and correct to the best of my knowledge.

I have been given the opportunity to ask questions and have had them fully answered.

Furthermore, I understand that:

The duration of the results may vary depending on skin type, treated area, quantity injected and injection techniques.