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Clear+Brilliant® Informed Consent

What to Expect

Clear + Brilliant is a gentle treatment that uses fractional laser technology to address and prevent the early signs of aging skin. The treatment is optimized for improved skin tone and texture and enhanced skin permeability for added benefits of topical skincare products when applied immediately after treatment. The treatment works by creating millions of microscopic treatment zones in the upper layers of the skin, which replaces damaged skin with healthy tissue and yields younger looking skin. Clear + Brilliant treatments are great for women and men who are looking to prevent and fight the early signs of aging or maintain their youthful appearance.

The number of treatments is tailored to your concerns and skincare desires. In recent studies, consumers reported visible improvements after 4-6 treatments, though many patients choose to have routine treatments as part of their overall skin care regimen. Your skin care provider will discuss a personalized treatment regimen with you.

Possible Side Effects and Risks

  • Discomfort may be experienced during the procedure. The sensation of the treatment may be uncomfortable and may feel like a moderate to severe prick or a sensation of heat which lasts for only a few seconds.
  • During the healing process, there is a possibility of the treated area becoming either darker (hyperpigmented) or lighter (hypopigmented) in color than the surrounding skin. This is usually temporary, but on rare occasion, it may be permanent.
  • Transient epidermal (skin) injury manifested with symptoms including mild sunburn-type pain, erythema (redness), edema (swelling), itching, and/or blistering may be experienced. The laser may result in transient textural changes such as weeping, crusting, scabbing, or flaking of the treated areas, which may require up to one to three weeks to heal. Once the skin surface has healed, it may be pink and sensitive to the sun for an additional two to four weeks. Bruising of the treated area may occur. Acne or milia formation may occur.
  • Scarring is a rare occurrence, but it is a possibility when the skin’s surface is disrupted. To minimize the chances of scarring, it is important that you follow all the post-treatment instructions carefully. Persons with a history of keloid scar formation may be more prone to scarring after any skin trauma, including laser/light treatments, therefore caution is advised. 
  • Skin infection is a possibility anytime a skin procedure is performed.
  • Those who carry the herpes simplex virus and receive treatment near the affected area, on their upper lip, chin, lower cheeks, or bikini line, may have a “flare-up” of their condition. Please notify your provider before your treatment if you have a history of fever blisters as a preventative medication may be prescribed.
  • Protective eye wear will be provided. During laser treatment it is important to keep the eyewear on at all times during the treatment in order to protect your eyes from accidental exposure

I understand that with all laser/light-based treatments carry possible side effects and risks. By initialing, I certify that these disclosures referred to herein were made to me.

Results

The results of Clear + Brilliant treatment are both immediate and progressive. Within a week or two after one treatment, your skin will start to feel softer, look brighter and show more even tone. Results can last for months depending on age, skin condition, and how you protect your skin. While treatments are effective in most cases, no guarantee can be made that a specific client will benefit from the procedure. Additionally, the nature of laser/light based procedures may require multiple treatments in order to achieve the desired results, or to determine that treatments may not be completely effective in treating the client’s particular condition.

Topical Anesthetic Advice

Procedure For the Clear+Brilliant® procedure, a numbing agent is used. The products are formulated to be safe and are prescribed for topical numbing for cosmetic procedures. The anesthetic is placed over the treatment area for 20-30 minutes then carefully removed prior to procedure. As a result of the treatment, combined with use of the anesthetic, you can expect to experience some redness or swelling that can last 1-4 days. You should always follow your post-procedure and aftercare guidelines for best results.

Allergic Reaction may occur from any anesthetics used during the procedure. Pure Cosmetics will provide the patient with application of a 20% benzocaine, 6% lidocaine and 4% tetracaine numbing agent. If you know that you are allergic to any of these ingredients, please notify your technician prior to procedure. If you do suffer from an allergic reaction, you should contact your doctor immediately. Allergic reaction responses may show through redness, swelling, rash, blistering, dryness or any other symptoms associated with an allergic reaction.

Numbness We cannot accept responsibility if the area to be treated does not respond to the numbing agent. Each individual is different. Some clients report the area to be completely numb, while others may experience some discomfort.

I understand that a topical numbing agent will be used by my technician for my comfort. I understand it is my responsibility to notify my technician if I have a known allergy and/or that I need to contact my doctor immediately if I present with any allergic reaction symptoms.

Important Safety Information

The following contraindications are routine for many laser treatments and may also be associated with non-ablative Clear + Brilliant Laser System treatments. Please let Pure Cosmetics know if you have been diagnosed with any of the following, as you may not be an appropriate candidate for a treatment if you:

  • Have been diagnosed with or possibly have actinic keratosis, melasma, rosacea, or other significant skin conditions (e.g., skin cancer, active infections, cold sores, open wounds, rashes, burns, inflammation, eczema, psoriasis);
  • Are predisposed to keloid formation or excessive scarring;
  • Have a condition that may compromise the immune system, such as HIV, lupus, scleroderma, or systemic infections;
  • Have a known sensitivity to light or if you are taking photosensitizing agents or medications;
  • Are on systemic steroids (e.g., prednisone, dexamethasone), which should be rigorously avoided prior to and throughout the course of treatment;
  • Are using retinoids, which should be avoided for at least 2 weeks prior to and during treatment;
  • Are undergoing isotretinoin acne treatment or taking drugs in a similar class;
  • Have skin that is still recovering from a cosmetic procedure, such as a chemical or mechanical peel, or laser resurfacing; and
  • Have had botulinum toxin injections, or dermal fillers (such as collagen or hyaluronic acid) within the past 2 weeks.

I certify that I do not have any of the above contraindications for treatment. While treatments are effective in most cases, no guarantee can be made that a specific client will benefit from the procedure. Additionally, the nature of laser/light based procedures may require multiple treatments in order to achieve the desired results, or to determine that treatments may not be completely effective in treating the client’s particular condition. By my signature below, I hereby certify that I understand the risks and alternatives involved with the proposed procedure. I understand that not adhering to the post-treatment instructions provided to me may increase my chance of complications. I have had the opportunity to ask any questions, and all of my questions have been answered to my satisfaction.

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Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
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By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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