FRACTIONAL LASER CONSENT FORM

PATIENT INFORMATION:

MEDICAL HISTORY

Procedure Description:

I understand that I am receiving fractional laser treatment, a non-surgical skin resurfacing procedure designed to improve skin texture, tone, and overall appearance.

Fractional laser technology works by delivering microscopic columns of laser energy into the skin, creating controlled micro-injuries while leaving surrounding tissue intact. This process stimulates the body’s natural healing response and promotes the production of new collagen and healthy skin cells.

Depending on the type of fractional laser used (ablative or non-ablative), the treatment may target both the outer and deeper layers of the skin to address concerns such as fine lines, wrinkles, acne scars, pigmentation, enlarged pores, and uneven skin texture.

During the procedure, a topical numbing cream may be applied to reduce discomfort. I may experience sensations of heat or a mild stinging feeling during treatment.

Following the procedure, I understand that there may be a period of redness, swelling, and skin peeling or flaking as the skin heals and regenerates. Recovery time varies depending on the intensity of the treatment.

I understand that multiple sessions may be required for optimal results and that improvements occur gradually over time.

Benefits and Risks:

I have been informed that the potential benefits of fractional laser treatment may include:

• Improvement in skin texture and smoothness
• Reduction in fine lines and wrinkles
• Improvement in acne scars and other types of scarring
• More even skin tone and reduction in pigmentation
• Stimulation of collagen production for long-term skin rejuvenation
• Reduction in pore size and overall skin refinement

I understand that there are potential risks and side effects associated with fractional laser treatment, including:

• Moderate redness, swelling, and sensitivity following treatment
• Peeling, flaking, or crusting as the skin heals
• Temporary darkening or lightening of the skin (hyperpigmentation or hypopigmentation)
• Dryness, itching, or tightness of the skin
• Increased sensitivity to sunlight

I understand that serious complications are uncommon but may occur in rare cases.

Aftercare:

I agree to follow the post-treatment instructions provided by the clinician to ensure the best possible results and minimize any risks. I understand that failure to adhere to these instructions may increase the likelihood of complications.

Consent for Treatment:

I hereby consent to undergo a Fractional Laser treatment. I acknowledge that the clinician has explained the procedure, its benefits, and potential risks to me. I have had the opportunity to ask questions, and all of my concerns have been addressed to my satisfaction. I understand that the results of a Fractional Laser treatment can vary, and multiple sessions may be required for optimal results.

Release of Liability:

I release The Abram, its employees, and representatives from any liability associated with the Fractional Laser treatment, except for cases of negligence or intentional misconduct.

Human Error Acknowledgment:

I understand that aesthetic treatments are performed by qualified clinicians using professional equipment and established protocols. However, I acknowledge that, as with any procedure involving human involvement, there is a possibility of unintended outcomes due to human or technical error. By signing this consent, I accept this inherent possibility and agree that The Abram and its staff shall not be held liable for minor or unintentional errors occurring during the course of treatment, provided that reasonable care and professional standards are followed.

Photographs and records:

I understand that videos and photos will be taken for medical documentation purposes and will be used only for treatment comparisons and tracking progress milestones.

I agree that all the above information is true and accurate to the best of my knowledge