IPL Hair Reduction Consent Form
Treatment Information:
IPL hair reduction treatments are clinical procedures to reduce hair growth in unwanted areas. The Etherea MX IPL-SQ treatment is a proven procedure that can significantly reduce dark hair growth.
IPL energy is attracted to dark melanin (pigment/colour). During an IPL hair reduction treatment, an IPL applicator emits a light that is absorbed by the Chromophores (colour) (melanin) in the hair. The absorbed light energy is converted to heat, which damages the tube-shaped sacs within the skin (hair follicles) that produce hairs. This damage inhibits or delays future hair growth.
It is important to note that although IPL hair reduction effectively delays hair growth for long periods, it usually doesn't result in permanent hair reduction, as new hair follicles can activate to produce hairs.
Multiple IPL treatments are needed for initial hair reduction, and maintenance treatments might be needed as well. IPL hair reduction is most effective for people who have light skin and dark hair, but it can be successfully used on all skin types.
You will generally require six to eight treatments for facial hair reduction and five treatments for body hair reduction. This varies between individuals and should not be taken as exact. It is also important to note that minimal to no effect occurs in a small number of individuals, and no hair reduction is achieved.
Before an IPL Treatment
Before beginning an IPL hair reduction treatment program, you must first attend an assessment and information consultation with one of our Nurses or Aestheticians, during which your skin type, hair growth, expectations, and goals will be assessed and discussed. The estimated duration and cost of each session or series of sessions will also be provided to you during this time.
Test Patch
If you are a qualified candidate, you will need to undertake several test patches of IPL energy delivered in the indicated area at varying intensity levels. This allows your practitioner to understand how responsive your skin is and helps ensure a safer treatment is delivered in the future.
You must wait at least 24 hours after a test patch has been performed before receiving a full IPL treatment.
There is a risk that the test patch process itself could cause an adverse effect, such as those found below in the "Risks and Complications" section of this form.
You must not have tanned skin or have applied artificial tanning products on the treatment areas for at least three weeks before an IPL test patch. Failure to comply with this could result in serious harm (burned skin) and subsequent scarring of your skin.
You must not have UV-tanned skin for at least four weeks before an IPL test patch or treatment or have applied artificial tanning products to the treatment areas for at least two weeks before an IPL test patch or treatment. Failure to comply with this could result in serious harm (burned skin) and subsequent scarring of your skin.
Treatment
Your practitioner will cleanse your skin and may apply a layer of ultrasound gel in the treatment area.
You will be required to wear eye protection glasses during the treatment to protect your eyes from very bright flashes of light. It is also advised that you close your eyes during treatment.
During the procedure, your practitioner will assess your comfort levels and adjust the treatment parameters where required. It is normal to experience some level of discomfort within the skin; some areas may be more sensitive than others.
Aftercare
Following each Etherea MX IPL-SQ treatment, the skin may experience a minor degree of redness and puffiness, with some tingling or discomfort, which usually disappears in as little as 1 hour or up to 2 days.
You can return to your regular daily activities, usually with no downtime. If the skin is not sore or broken, makeup can be applied after several hours. However, we advise caution if the area is feeling sensitive. Remove makeup carefully, as rubbing the skin can cause irritation or infection. If the skin in the treatment area becomes broken, makeup should be avoided.
Care should be taken to avoid trauma to the treated area for 4 or 5 days afterwards: Avoid strenuous activities, sauna and steam, excessively hot baths, and massaging the area.
Wash and bathe as normal, but take cool showers rather than hot baths. The skin should be patted dry, not rubbed. Use aloe vera gel or aftersun cream to keep the area moisturised and protected. If there is any discomfort, treat the area as you would sunburn.
You must apply daily sun protection with UVA/UVB filters and an SPF of at least 30. We require you to commit to using this every day and avoiding sun exposure, artificial sun beds, and artificial tanning products on the treatment areas as a condition of the IPL treatments you receive with us.
Alternative Treatments:
Your practitioner will always advise you of the safest and most effective treatment based on your medical history and skin and hair appearance. However, you should also consider the option of no treatment at all. Other hair-reducing treatments are available, such as shaving, epilation, waxing, etc., and may be discussed with your practitioner. However, these treatments are not available at Lumiere Medispa.
Contraindications:
You cannot have IPL hair reduction treatments if:
You have tanned skin either from UV light exposure or artificial skin tanning products. (No UV-tanned skin for four weeks prior to treatment)
You have had roaccutane/Isotretinoin medication in the last six months.
You have photosensitive epilepsy
You have an active infection or inflammation near the intended treatment area, excluding active acne lesions.
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 a history of post-inflammatory hyperpigmentation
Have uncontrolled hormonal disorders
You have a pacemaker.
You have had facial fillers or botox in the intended treatment area under two weeks prior to IPL.
You think you could be pregnant, are pregnant, or are lactating/ breastfeeding.
You have a loss of sensation in the treatment area.
Cautions:
You need to tell your aesthetic practitioner if:
You have mobility issues.
You suffer from recurrent bouts of herpes simplex infections near the intended treatment area, as an IPL treatment may encourage an outbreak.
You use topical retinol or prescription retinoid medications in the treatment area. If you use these on the intended treatment area, you MUST stop using them five days prior to an IPL treatment.
You have a skin type 4, 5 or 6. There is a higher risk that natural skin colour could be removed (hyperpigmentation).
You take photosensitising medications/apply photosensitising skincare. You will have a higher risk of photosensitive skin burns. A test patch must be completed.
You have or have a history of malignant (cancerous) skin lesions.
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:
Photo-Sensitivity: IPL treatments leave your skin photosensitised for 48 hours after each treatment. You must avoid sunlight. Failure to do so will result in significant redness and swelling and may increase the rare risk of disfiguring and complications like blisters, scarring, or pigment changes.
Discomfort. IPL treatments are very well-tolerated. The cooling light guide tip integrated into the Etherea MX IPL-SQ applicator optimises patient comfort. Topical anaesthetic cream cannot be used as this may disguise an overheating of the skin. With each treatment, you may experience a minor and tolerable degree of burning and/or a tingling sensation.
Skin erythema (skin redness) and heat. This is the most common and likely side effect of your treatment with IPL. It is related to the rise in internal skin temperature and is normal. It can be managed by keeping the skin cool following your treatment. It should subside within a few hours. If it does not subside within a few hours, please contact your practitioner for further advice.
Swelling, tingling, or tenderness may occur. For a few days after treatment, you may experience slight discomfort (like mild sunburn) within the skin.
Bruising welts or numbness. Very rarely, some patients may experience this.
Skin wounds. It is exceedingly rare for IPL treatments to cause a blister or skin wound. However, this is more of a risk in darker or tanned skin types. If a blister or skin wound develops, it may take 5 to 10 days to heal and, in extremely rare instances, may lead to a noticeable whitening or darkening of the skin or, even more rarely, a scar. Blisters or skin wounds are much more common if you do not follow the recommended avoidance of sunlight, artificial tanning products, UV light exposure, and fluorescent light exposure post-treatment.
Scarring. Scarring occurs in less than 0.1% of patients. If you have developed a wound and a scar, the scar may become flat and white (hypotrophic) or large and red (hypertrophic), or it may extend beyond the margins of the injury (keloid). Subsequent treatment or surgery may be required to improve the appearance of the scar. In some cases, the scar may be permanent. Failure to follow pre- and post-treatment care instructions may increase the likelihood of a skin wound or scar.
Infection. Because IPL treatments involve no actual cutting, surgery, or skin penetration, infection is exceedingly rare. However, a blister or wound that has formed as a result of IPL treatments may become infected. To avoid infection, it is important to contact your practitioner if you ever experience a blister or wound following an IPL treatment.
Pigment changes. With the IPL energy used in Etherea MX IPL-SQ treatments, there is a small risk (less than one per cent) of temporary hyperpigmentation (increased pigment or brown discolouration) or hypopigmentation (whitening of the skin). Usually, these pigment effects are temporary and resolve over several weeks or months. Permanent hyperpigmentation or hypopigmentation is very rare and may occur in less than one per cent of cases. The majority of patients will be advised to use sun protection products throughout their IPL treatment course. The use of these products is important to obtain optimal results and reduce complications.
Herpes (cold sores) reactivation. Treatments that induce heat within the skin/hair follicle, such as IPL, 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.
Dissatisfaction. Whilst the overwhelming majority of patients who have undergone Etherea MX IPL-SQ treatments report a noticeable hair reduction, the success and amount of hair reduction are subject to variation. Although rare, there is a risk that you may not see an appreciable improvement in hair reduction.
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 an IPL hair reduction 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 an IPL hair reduction treatment.
By signing this consent form, you acknowledge and confirm the following:
Risks and complications
You have discussed the potential risks and benefits of an IPL hair reduction 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 you 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 an IPL hair reduction 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 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 an IPL hair reduction 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.
