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Laser Consent

  • Moxi and Clear & Brilliant laser that uses a non-ablative, fractional laser, skin resurfacing technique. It essentially creates millions of microscopic zones in your skin, replacing damaged skin with healthy, younger looking tissue.
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    • Visibly illuminated skin tone
    • Renewed, ultra-soft and smoother texture
    • Improved tone, texture, and radiance
    • Naturally radiant and glowing skin
    • While treatments are effective in most cases, no guarantee can be made that a specific client will benefit from the procedure.
    • Moxi and Clear &Brilliant Laser procedures require multiple treatments to achieve the desired results.
    • I understand that Moxi & Clear & Brilliant Laser may not be completely effective in treating my particular condition or concerns.
    • Although rare, some complications/risks may include but are not limited to: infection, scarring, burns, pigmentation changes, pain, and bleeding.
    • Pregnancy
    • Use of medications that increase photosensitivity
    • Diabetes
    • History of keloid scarring
    • Use of anticoagulants
    • History of bleeding disorders/li>
    • Current Accutane use or treatment within the past 1 year is a contraindication
    • Recent sun exposure or applied self-tanning preparations
    • Planned sun exposure including tanning lamps for 7 days post treatment
    • Discomfort may be experienced during the procedure. The sensation of the treatment may be uncomfortable and may feel like a moderate to severe prick or a sensation of heat which lasts for only a few seconds
    • To the administration of topical anaesthetics, when deemed appropriate.
    • That I have notify your Practitioner if I have an allergy to topical anaesthetics containing lidocaine
    • During the healing process, there is a possibility of the treated area becoming either darker (hyperpigmented) or lighter (hypopigmented) in colour than the surrounding skin. This is usually temporary, but on rare occasions, it may be more prolonged or permanent.
    • Symptoms of Thermal skin Injury from Laser may include: mild sunburn-type discomfort or pain, erythema (redness), oedema (swelling), itching, and/or blistering. The laser may result in transient textural changes such as weeping, crusting, scabbing, or flaking of the treated areas.
    • Scarring is a rare occurrence, but it is a possibility when the skin’s surface is disrupted. To minimize the chances of scarring, by following all the post-treatment instructions carefully.
    • If I carry the herpes simplex virus and receive treatment near the affected area, that I may have a “flare-up” of their condition. I will notify your practitioner before my treatment if I have a history of fever blisters.
    • Skin infection is a possibility anytime a skin procedure is performed.
    • The potential benefits of the proposed procedure, the probability of success, and possible complications/risks involved with the Moxi Laser and Clear & Brilliant laser procedure and subsequent healing period, have been communicated with me.
    • I have read, and fully understand the contents of this consent for Laser treatments, and that the disclosures referred to herein were made to me.
    • I have received or had access to all of the post-treatment care instructions and agree to abide by all of them.
    • I understand that not adhering to the post-treatment instructions provided to me may increase my chance of complications.
    • I hereby authorise a Trained Practitioner at Saphira Clinic to perform the proposed procedure.
    • I have had the opportunity to ask any questions, and all of my questions have been answered to my satisfaction.
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