INFORMED CONSENT for LASER RESURFACING PROCEDURE OF SKIN
This document contains information about laser skin resurfacing, including risks and alternative treatments. Read each paragraph completely. If you have questions or see words you don’t know, ask Dr. Laverson. Your signature at the end confirms your understanding of this information and your request for the laser resurfacing procedure.
Lasers have been used by plastic surgeons for decades. Laser energy can be used to cut, vaporize, or remove surface skin layers. There are many types of lasers. Characteristics of the laser beam such as wavelength, frequency, power, duration, and spot size are adjusted for a variety of applications. Lasers are used to obliterate pigmented lesions, surface blood vessels, hair, tattoos, and other skin abnormalities.
Conditions such as wrinkles, sun damaged skin, scars, surface irregularities, and some types of skin lesions/disorders may be treated with the CO2 laser. Some procedures use the CO2 laser as a cutting instrument. Laser treatments may be performed at the time of other surgical procedures.
Skin treatments may be recommended before and after laser skin resurfacing to enhance the results.
Alternatives include not undergoing the proposed laser skin resurfacing procedure, chemical peel, dermabrasion, or possibly excisional surgery. These treatments have their own risk profile, and each has advantages and disadvantages compared with laser skin resurfacing. Resurfacing procedures are often performed in combination with other treatments such as surgery and Botox®.
RISKS OF LASER RESURFACING PROCEDURES OF SKIN
There are both risks and complications associated with all laser treatment procedures of the skin. Risks involve both the use of laser energy as a form of surgical therapy and the specific procedure performed. An individual’s choice to undergo a procedure is based on the comparison of risk to expected benefit. Most patients do not experience these complications, but they can be unpredictable. Please address any specific questions about these possible outcomes to Dr. Laverson.
Scarring– Although normal healing after the procedure is expected, abnormal scars may occur both in the skin and deeper tissues. In rare cases, keloid scars may result. Scars may be unattractive and of different color than the surrounding skin. Additional treatments may be needed to treat scarring.
Color change– Laser resurfacing may potentially change the natural color of your skin. Skin redness usually lasts 1-3 months and occasionally 6 months following laser skin resurfacing. There is the possibility of irregular color variations within the skin including areas that are both lighter and darker. A line of demarcation between normal skin and skin treated with lasers can occur.
Infection– Although infection following laser skin treatment is unusual, bacterial, fungal, and viral infections can occur. Herpes simplex virus infections around the mouth, can occur following a laser treatment. This applies to individuals with a past history of Herpes simplex virus infections and also to individuals with no known history of Herpes simplex virus infections in the mouth area. Specific medications may be prescribed and taken both prior to and following the laser treatment procedure in order to suppress an infection from this virus. Should any type of skin infection occur, additional treatment including antibiotics may be necessary.
Burns– Laser energy can produce burns. Adjacent structures including the eyes may be injured or permanently damaged by the laser beam. Burns are rare, yet represent the effect of heat produced within the tissues by laser energy. Additional treatment may be necessary to treat laser burns.
Accutane (isotretinoin)– Accutane is a prescription medication used to treat certain skin diseases. This drug may impair the ability of skin to heal following treatments or surgery for a variable amount of time even after the patient has ceased taking it. Individuals who have taken this drug are advised to allow their skin adequate time to recover from Accutane before undergoing laser skin treatment procedures.
Fire-Inflammable agents, surgical drapes and tubing, hair, and clothing may be ignited by laser energy. Laser energy used in the presence of supplemental oxygen increases the potential hazard of fire. Some anesthetic gases may support combustion.
Laser smoke (plume)– Laser smoke is noxious to those who come in contact with it. This smoke may represent a possible bio-hazard.
Bleeding– Bleeding is rare following laser skin resurfacing procedures. Should bleeding occur, additional treatment may be necessary.
Skin tissue pathology-Laser energy directed at skin lesions may potentially vaporize the lesion. Laboratory examination of the tissue specimen may not be possible.
Visible skin patterns– Laser treatment procedures may produce visible patterns within the skin. The occurrence of this is not predictable.
Patient failure to follow through-Patient follow through following a laser skin resurfacing procedure is important. Post operative instructions concerning appropriate restriction of activity, use of dressings, and use of sun protection need to be followed in order to avoid potential complications, increased pain, and unsatisfactory result. Your physician may recommend that you utilize a long-term skin care program to enhance healing following a laser skin resurfacing.
Distortion of anatomic features-Laser skin treatments can produce distortion of the appearance of the eyelids, mouth, and other visible anatomic landmarks. The occurrence of this is not predictable. Should this occur, additional treatment including surgery may be necessary.
Lack of permanent results– Laser or other resurfacing treatments may not completely improve or prevent future skin disorders, lesions, or wrinkles. No technique can completely reverse the signs of skin aging. Additional surgical procedures may be desired to further tighten loose skin.
Damaged skin– Skin that has been previously treated with chemical peels or dermabrasion, or damaged by burns, electrolysis (hair removal treatments), or radiation therapy may heal abnormally or slowly following treatment by lasers or other surgical techniques. The occurrence of this is not predictable. Additional treatment may be necessary.
Unsatisfactory result– There is the possibility of an unsatisfactory result from these procedures. Although rare, laser resurfacing procedures may result in unacceptable visible deformities, skin slough, loss of function, and permanent color changes in the skin. You may be disappointed with the final result from laser resurfacing.
Skin cancer/skin disorders– Laser skin resurfacing procedures may not offer protection against developing skin cancer or skin disorders in the future.
Pain– Very infrequently, chronic pain may occur after laser skin resurfacing procedures.
Allergic reactions– After plastic surgery or laser skin rejuvenation, local allergies to tape, preservatives used in cosmetics, or topical preparations have been reported. Systemic reactions which are more serious may result from drugs used during surgery and prescription medicines. Allergic reactions may require additional treatment.
Delayed healing-It may take longer than anticipated for healing to occur after laser treatments. Skin healing may result in thin, easily injured skin. This is different from the normal redness in skin after a laser treatment.
Unknown risks– There is the possibility that additional risk factors of laser skin resurfacing may be discovered. The results of performing skin tightening surgery and laser resurfacing is unknown in terms of the combination effect of the two procedures and potential complications, depending on the area treated. Skin slough, delayed healing and poor surgical outcome may occur.
Anesthesia– Both local and general anesthesia involve a small amount of risk. Although very unusual, there is the possibility of complications, injury, and even death from anesthesia and sedation.
ADDITIONAL TREATMENT OR SURGERY NECESSARY
There are many conditions which influence the long term result of CO2 laser skin treatments. Even though risks and complications occur infrequently, the risks cited are those particularly associated with laser skin treatment. Other complications can occur but are even less likely. Should complications occur, additional surgery or other treatments may be necessary. The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee or warranty expressed or implied with respect to the final result.
The cost of laser skin resurfacing involves several charges. This includes fees charged by Dr. Laverson, the anesthesiologist, pre and post-operative medications, surgical supplies, laser equipment and personnel, laboratory tests, and possible outpatient surgery center charges, depending on where the procedure is performed. It is unlikely that cosmetic surgery costs would be covered by an insurance plan. Even if there is some insurance coverage, you will be responsible for necessary co-payments, deductibles, and charges not covered. Additional costs may be incurred should complications develop from the surgery. Secondary surgery or hospital day-surgery charges involved with revision surgery or treatments may also be your responsibility.
Please understand the above information before signing your consent below.
CONSENT FOR LASER SKIN RESURFACING / LASER SKIN REJUVENATION
1. Dr. Steve Laverson is requested and authorized to perform LASER SKIN RESURFACING OF THE FACE AND/OR PORTIONS OF THE FACE upon me. I have read the above risks, alternatives, possible complications, and understand this information applies to my laser skin resurfacing procedure.
2. Rarely, during plastic surgery, unforeseen circumstances may (rarely) necessitate different procedures than those planned above, or additional procedures. Dr. Laverson is authorized to perform such other procedures that are in the exercise of his professional judgment necessary, desirable, and in my own best interest. The authority granted under this paragraph shall include all conditions that require treatment and are not known at the commencement of surgery.
3. I consent to the administration of such anesthetics considered necessary or advisable. All forms of anesthesia involve a small risk and the possibility of complications, injury, and extremely rarely, death.
4. No guarantee has been expressed or implied by anyone with respect to the final result.
5. I consent to the disposal of tissue and medical devices removed from me during the procedure.
6. IT HAS BEEN EXPLAINED TO ME IN A WAY THAT I UNDERSTAND:
a. LASER SKIN RESURFACING / LASER SKIN ABLATION / REJUVENATION
b. ALTERNATIVE PROCEDURES OR METHODS OF TREATMENT
c. RISKS OF LASER SKIN RESURFACING, AND POSSIBLE COMPLICATIONS
I CONSENT TO LASER SKIN RESURFACING AND THE ABOVE LISTED ITEMS (1-6).
I AM SATISFIED WITH THE EXPLANATION.