HIFU Skin Tightening Consent Form

Treatment Information

High-Intensity Focussed Ultrasound (HIFU) is a non-surgical medical aesthetic skin treatment for face and/or body skin tightening. HIFU employs concentrated ultrasound energy at varying depths of the skin structure. This ultrasound energy creates controlled micro heat trauma, resulting in skin neocollagenesis and dermal skin tightening.  This action is created within the skin and leaves the surface (epidermis) of the skin intact. 

At Lumière MediSpa, we use the Medical CE-approved HIFU devices, Ultraformer III and ULFIT. 

Skin tightening treatments may require one to three treatments spaced three months apart, depending upon your age and skin laxity. In some circumstances, you may be advised to treat with dermal fillers to replace lost volume structures that support the skin. 

Before Your Treatment

You do not need to do anything, in particular, to prepare your skin before a HIFU skin tightening treatment. However, we advise that you do not drink alcohol or take NSAID medications such as ibuprofen for 48 hours before your treatment. This is to reduce the risk of bruising that can occur occasionally, particularly around the eyes. Prescribed medications should only be stopped under the guidance of your GP.

Treatment

Your practitioner will cleanse your skin and apply a layer of ultrasound gel in the treatment area to aid in the delivery of ultrasound energy. 

During the procedure, your practitioner will assess your comfort levels and adjust the treatment parameters where required. It is expected to experience some level of discomfort within the skin, and some areas may be more sensitive than others.

You may be able to see an initial tightening of skin laxity; however, this is not indicative of your result. The actual results of skin tightening are accumulated over a three-month period. 

Aftercare

There is no particular aftercare required following a HIFU skin tightening treatment, however you may wish to discuss appropriate homecare products that will improve your skin's regenerative properties.

We also advise drinking plenty of water during the first 48 hours. This helps to eliminate heat-related oxidative stress in the skin. 

Alternative Treatments

Other treatments for skin rejuvenation or skin tightening are available and may be discussed with your practitioner at any time. If you feel that the risks and side effects associated with HIFU treatments are not acceptable to you, you should consider discussing an alternative treatment with your practitioner or no treatment at all.

Contraindications:

You cannot have HIFU skin treatments if:

  • You have had roaccutane/Isotretinoin medication in the last six months.

  • You have an active infection or inflammation near the intended treatment area.

  • You have open wounds in the intended treatment area

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

  • You have a history of keloid or raised scarring.

  • You have uncontrolled diabetes or poor wound healing.

  • You have blood clotting problems or are taking blood thinning medications.

  • You are immunosuppressed.

  • You have any metal implants in the treatment area.

  • You have a pacemaker.

  • You have had facial fillers or botox in the intended treatment area under two weeks prior to HIFU.

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

Cautions:

You need to tell your aesthetic practitioner if:

  • You suffer from recurrent bouts of herpes simplex infections in the treatment area, as a HIFU treatment may encourage an outbreak.

  • You use retinol or retinoid prescription medications in the treatment area.

  • You have any dental implants/filling near the treatment area.

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:

  • Skin erythema (skin redness) is the most common and likely side effect of your treatment with HIFU. This is related to the rise of internal skin temperature, which is normal. This should subside within a few hours.

  • Skin swelling. You may experience transient skin swelling for a few days post-HIFU treatment. This will usually settle within a few days but can last longer. Cold compresses, medications, and soothing skin products available from the clinic can help. Please contact us should you experience this.

  • Tingling or tenderness. You may experience slight discomfort within the skin for a few days after treatment. 

  • Bruising welts or numbness. Bruising can occur as a result of HIFU treatments and can be extensive, particularly on individuals with very thin skin or those receiving body fat reduction HIFU treatments.

  • Skin burn. Although HIFU energy is delivered underneath the top layer of skin, there is a slight risk of a burn to the skin surface, which could lead to temporary or permanent scarring or marking of the skin. 

  • Temporary nerve inflammation. This will typically resolve in a few days or weeks. If a motor nerve has become inflamed, you may experience local muscle weakness. If a sensory nerve has become inflamed, you may experience skin numbness, discomfort, skin burning sensation (locally or distant from the treatment area).

  • Herpes (cold sores) reactivation. Treatments that stimulate a skin response, such as HIFU, carry the risk of an outbreak of herpes (fever blisters/cold sores/shingles) 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.

  • Failure to respond. Rarely do you achieve the results desired and discussed during your consultation. This is due to the nature of the treatment relying upon a biological response, which cannot always be predicted. You require additional treatments or an alternative combination of treatments to achieve the desired results at your own cost.

  • Excess Fat Loss. Very rarely, there have been reports of subdermal fat loss when treating for skin tightening, resulting in fat loss in the treatment areas and an unsatisfactory permanent result.

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.

Informed Consent:

This consent form is not meant to include all possible risks associated with HIFU 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 HIFU treatment.

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

Risks and complications

You have discussed the potential risks and benefits of a HIFU treatment 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 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 HIFU treatment and 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 serious 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 you have with your practitioner to your satisfaction. You consent to receive a HIFU Skin Tightening 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.