I was informed about the nature and purpose of the treatment, the doctor answered all my questions about it.
I understand and accept that this treatment involves some risks and complications. The risks of the treatment have been explained to my satisfaction. I have also read the list of the most frequent side effects.
The ENDOLIFT® procedure is a minimally invasive technique used to stimulate skin restructuring and reduce skin laxity. It uses an extremely fine optical fiber that is introduced into the superficial hypodermis, where laser energy is transmitted to stimulate the deep and superficial layers of the skin, to tighten and retract the connective tissues, to stimulate the cells that are responsible for the formation of new collagen.
CONTRAINDICATIONS THE PATIENT MUST NOT:
- Have permanent devices (silicone, methacrylate, goretex, threads, etc.) in the treatment area; - Have edema, infection or inflammation or a known allergy to light; - Be pregnant.
) in the treatment area;
- Have edema, infection or inflammation or a known allergy to light;
- Be pregnant;
- Take medications that affect coagulation during the two weeks preceding the treatment;
- Have pathologies related to coagulation;
- Have pathologies related to collagen.
- Patients who have had an injection of botulinum toxin or other similar
treatments in the area to be treated must be evaluated on a case-by-case basis.
- The patient with significant muscle laxity is not an ideal candidate.
- Avoid the thyroid area.
- Transient edema
- Small bruises and hematomas.
- Transient tingling and paresthesia.
- Mild pain.
I declare that I am not pregnant, that I do not have any known allergy or acute or chronic dermatological disease, that I have not previously had a herpes infection, that I do not have any methacrylate inserts in the area to be treated, and that I am taking a prescription anti-herpes treatment.
I declare that I do not suffer from any disease that, according to the criteria of the attending physician, could contraindicate this type of procedure.
I confirm that I have read this form and that I understand and accept the information in the document. I have received, read and understood the information on post-treatment care. It has been clearly explained to me that the dermis heats up during the ENDOLIFT® session, inducing contraction of the dermal collagen, and that I will experience a feeling of tension and warmth in the treated area. I have also been properly informed about other alternative procedures.
I consent to photographs being taken to evaluate the effectiveness of treatment, for medical education and training. No photographs revealing my identity will be used without my consent.
Pre- and post-session instructions were discussed with me as well as any contraindications to the treatment.
The treatment and its potential benefits and risks were all explained to my satisfaction. All my questions have been answered. I freely consent to the proposed treatment.
I certify that the practitioner has informed me of all known risks inherent to this procedure.
I acknowledge that I was able to ask him all the questions concerning this operation and that the explanations were clear and understanding, and that I informed the practitioner of my medical history, the operations, care and treatments I have received and have undergone to date,
I give my free and informed consent to the above mentioned act.