Cautery Skin Tissue Removal Consent Form

Product/Treatment Information

Cautery skin tag and skin lesion removal involve the use of a specialised device that applies controlled heat to remove unwanted skin tags or lesions. This procedure aims to improve cosmetic appearance or address any discomfort associated with these skin abnormalities.

Description of the Procedure

Before removing the cautery skin tag or skin lesion, a local anaesthetic may be applied to minimise discomfort. Please inform your practitioner if you have a known allergy to Lidocaine.

Your practitioner will carefully use a cautery device to remove the targeted skin tags or lesions. The cautery device works by applying heat to the tissue, causing it to coagulate and be removed. Whether or not a Lidocaine anaesthetic is used, you may still feel a strong, burning sensation during the procedure.

Dressing Application

After the procedure, a small dressing may be applied to areas that are susceptible to rubbing or irritation. If you have any plaster or dressing materials allergies, please inform your practitioner before the treatment begins.

Open Air Drying

Treated areas that are not prone to rubbing by clothing or body parts will be left uncovered to allow for natural air drying. It's important to note that the wound has already been cauterised and sealed during the procedure.

Aftercare

You can remove any dressings after 24 hours.

Following treatment, you will have marked scabs on the treatment area, which will detach after 2-3 weeks, revealing pink healed skin. 

At times, additional treatment may be necessary to achieve the desired results. You have been scheduled for a follow-up appointment within 2-4 weeks after your initial treatment. It is crucial to attend this follow-up session to evaluate the final outcome. Any refinement treatment provided during the review of the same lesion is covered within your initial payment.

What NOT to do after treatment

  • DO NOT get the treated areas wet for 24 hours

  • DO NOT touch, wear make-up or apply perfume in the treated areas for 24 hours.

  • Avoid strenuous or excessive exercise and swimming for 24 hours

  • DO NOT touch or pick at the treatment areas/scabs, as this may lead to scarring or infection.

  • Avoid extended sun and UV exposure (including sun beds) for 2 weeks.

  • Avoid swimming or using saunas and steam rooms for 2 weeks.

What to watch out for after treatment

  • Severe pain or increasing swelling is NOT normal and should be reported to the clinic immediately.

  • Redness spreading from the treatment site must be reported to the clinic immediately.

  • Weeping wounds after 24 hours.

Alternative Treatments

Other treatment alternatives may involve leaving the skin tags or lesions untreated, opting for freezing (cryotherapy), excision, or considering laser therapy. Please note that these specific treatments are not offered at Lumiere Medispa. If you are interested in exploring these alternatives, it is recommended to discuss them with your practitioner, who can provide guidance and potentially refer you to an appropriate specialist or facility.

Contraindications:

You cannot have cautery skin lesion removal if:

  • You are under 18 years of age.

  • You have a medical history of skin cancer. You must have the lesion confirmed as benign in order to have removal of any skin lesions.

  • You have an active infection or inflammation near the intended treatment area, including active acne lesions.

  • You have an active outbreak of herpes simplex infection (Cold sores) near the treatment area.

  • You have a history of keloid or raised scarring.

  • You have uncontrolled diabetes or poor wound healing.

  • You are immunosuppressed.

  • You think you could be pregnant, are pregnant, or are lactating or breastfeeding.

Cautions:

You need to tell your aesthetic practitioner if:

  • You have an upcoming important event. You will have a visible mark on the skin and may experience bruising for several days. You should plan your treatment and social/work diary around this and allow at least 2 weeks between treatment and the event.

  • You suffer from recurrent episodes of herpes simplex (cold sores) infections near the intended treatment area. Cautery skin lesion removal may encourage an outbreak. Patients with a history of cold sores may be given an antiviral three days before treatment.

  • You are taking blood thinning medications.

  • You are taking retinoid medications.

  • You are on immunosuppressive therapy, or therapy used to decrease the body’s immune response.

  • You have diabetes.

Material Risk (the level of significance you personally apply to the risks, side effects or complications of this treatment within your own circumstances):

As with any medical procedure, this treatment carries the risk of side effects or complications. Discuss these risks with your practitioner to fully comprehend their implications. Consider the risks in relation to your personal circumstances, including your health, lifestyle and career and decide if they are acceptable. If not, discuss alternatives or take more time to decide.

Associated Risks:

  • Pain or discomfort: Some discomfort may be experienced during or after the procedure.

  • Bleeding: Minimal bleeding may occur, and in rare cases, excessive bleeding may require further intervention.

  • Herpes (cold sores) re-activation. There is a risk of an outbreak of herpes cold sores, in individuals who already carry the herpes virus. You should manage this as you would normally, such as using over the counter cold sore medication. Please contact your practitioner if you experience a severe outbreak following treatment, where a prescription medication may be required.

  • Scarring. There is a risk that the areas treated may scar the skin which could be temporary or permanent. Depending upon the size of lesions to be removed, these scars could be large or small and may be indented or raised above your skin surface.

  • Hyperpigmentation and/or hypopigmentation. Any trauma to the skin can cause a discolouration in the area, including darker than your natural skin, or lighter than your natural skin colour. It is essential to avoid UV exposure to the treated area for at least 2 weeks.

  • Infection. As with any procedure that involves a break to the skin’s surface, a cautery treatment carries the risk of infection.  You should inform your practitioner if swelling, heat and/or discomfort occurs in the treated area for longer than a few days. This may require medical intervention, such as antibiotic therapy, which your Nurse practitioner will need to assess.

  • Recurrence: There is a chance that skin tags or lesions may recur after removal.

  • Malignant Tissue removal. Please be aware that, owing to the cosmetic nature of cautery, we do not send any skin tissue for biopsy or lab analysis. This approach comes with the inherent risk of potentially removing atypical cancerous tissue, which could obscure early diagnosis. If, during the procedure, the removed tissue exhibits any suspicious characteristics, your practitioner may advise seeking an alternative treatment that involves biopsy, possibly at another medical facility. This precaution ensures a thorough and accurate assessment of any concerning tissue, allowing for a more comprehensive understanding of your skin health. If you have any questions or concerns, do not hesitate to discuss them with your practitioner.

This consent form is not meant to include all possible risks associated with a cautery skin lesion removal treatment, as there are both known and unknown side effects and complications associated with any medical treatment. We have written this consent form to ensure you are fully informed of the procedure, the reasons why you may not be able to receive treatment, and the known risks of a cautery skin lesion removal treatment.

Photographs:

We need to take photos of the treatment area to document the original condition before treatment begins and to monitor results and potential changes throughout the treatment process. These photos will become part of your medical aesthetic treatment record at Lumiere Medispa.

You have the right to refuse consent for these photographs. However, please be aware that without this consent, we will not be able to treat you for medico-legal reasons.

If we wish to use your photos for any other purpose, we will always seek separate written consent from you. You have the right to refuse this additional use of your photos, and it is not mandatory to consent to any other photo usage to receive treatment.

By signing this consent form, you acknowledge and confirm the following:

Risks and complications

You have discussed the potential risks and benefits of cautery skin lesion removal with your practitioner, and your questions have been answered satisfactorily. 

You understand that medical attention may be required to resolve any complications associated with your treatment. In most cases, except those in an emergency, you should contact your practitioner for advice/treatment. 

Medical History

To the best of your knowledge, you have provided the details of your past medical history and will inform your practitioner if this changes before any future treatments. 

You understand that withholding aspects of your medical history could lead to serious physical and mental harm.

Contraindications & Cautions 

You are not pregnant or possibly pregnant, lactating or nursing, and you will inform your practitioner if this changes before any future treatments.

Fees & Charges 

You understand and agree that all services rendered will be charged directly to you, and you are personally responsible for payment. 

You further agree, in the event of non-payment, to bear the cost of collection, court costs, and reasonable legal fees, should they be required. 

Refunds

Fees charged for treatment are for the delivery of a treatment and the accompanying service, which is inclusive of the following; 

-Consultation and assessment 

-The provision of information and advice 

-The provision of the treatment itself, as described above

-Follow-up appointments and aftercare advice and support as appropriate

Whilst we undertake to provide excellent service, factual, honest, and ethical advice, safe, expert treatment in experienced hands, and only the best products, we cannot guarantee your results. We cannot offer refunds if the results achieved fail to meet your expectations. The successful outcome varies by degree, and how long these effects last varies from one individual to another and cannot be guaranteed. 

You understand that whilst you have been advised of a probable result, this should not be interpreted as a guarantee.  

You will contact your practitioner if you are unsatisfied with your treatment outcomes.

Aftercare

You have verbally discussed the aftercare required following a cautery skin lesion removal treatment, and you have been informed that you will also receive this via email. You understand the importance of following the post-treatment advice and agree to follow it. 

You understand that failure to follow this advice could lead to severe physical and mental harm.

Photograph Use Consent:

You understand that receiving treatment at Lumiere Medispa requires photographs to be taken of the treatment area. These photographs may be taken before, during, and after each treatment and will form part of your legal medical record at Lumiere Medispa. By signing below, you freely give your consent for your photos to be used solely for this medico-legal purpose. If we wish to use your photos for any other purpose, we will always seek separate written consent from you, and you have the right to refuse.

Valid Consent

By signing below, you acknowledge that you have read and understood this consent form and have had the opportunity to discuss any questions with your practitioner to your satisfaction. You consent to receive a cautery skin lesion removal treatment under the terms of this consent form and understand that you have the right not to consent to this treatment and that your consent is voluntary.