1. Purpose of CO₂ Fractional Laser Treatment
CO₂ fractional laser treatment is a skin resurfacing procedure that uses laser energy to target fine lines, wrinkles, scars, pigmentation, and overall skin texture. The laser creates microscopic injuries to stimulate collagen production, leading to skin rejuvenation and tightening.
2. Procedure
• A topical anesthetic will be applied to the treatment area to minimize discomfort.
• The laser will be used to create controlled micro-injuries in the skin.
• Patients may experience a warming sensation during the procedure.
• Post-treatment redness, swelling, and peeling are expected as part of the healing process.
3. Risks and Potential Complications
I acknowledge that CO₂ fractional laser treatment involves risks, including but not limited to:
• Redness, swelling, and discomfort lasting several days to weeks
• Skin peeling, scabbing, or temporary hyperpigmentation
• Hypopigmentation (lightening of the skin)
• Infection, if post-care instructions are not followed
• Scarring or prolonged healing in rare cases
• Reactivation of cold sores (herpes simplex virus) in prone individuals
I understand that while every effort will be made to achieve the best results, outcomes cannot be guaranteed and multiple sessions may be required.
4. Contraindications & Medical History
I understand that CO₂ fractional laser treatment may not be suitable if I have:
• Active skin infections, including cold sores or acne breakouts
• A history of keloid scarring or poor wound healing
• Recent use of Accutane (within the last 6–12 months)
• Uncontrolled diabetes or other medical conditions that impair healing
• Pregnancy or breastfeeding
• Recent excessive sun exposure or tanning
I certify that I have provided my full medical history and disclosed all medications, allergies, and health conditions to the provider.
5. Pre-Treatment & Post-Treatment Care
I agree to follow all pre- and post-treatment care instructions provided by my provider, including:
• Avoiding sun exposure and using SPF 30+ sunscreen daily
• Refraining from picking or peeling skin during healing
• Using prescribed or recommended skincare to aid recovery
• Avoiding harsh treatments (chemical peels, retinoids, exfoliation) for the recommended period
I understand that failure to follow these instructions may increase my risk of complications.
6. No Guarantees & Multiple Sessions
I acknowledge that results vary based on individual skin type and condition. Multiple treatments may be required to achieve the desired outcome, and no specific result is guaranteed.
7. Payment Responsibility
I understand that CO₂ fractional laser treatment is an elective cosmetic procedure not covered by insurance. I agree to be financially responsible for all costs associated with my treatment, and I understand that no refunds will be issued once the procedure has begun.
8. HIPAA Compliance & Privacy
I acknowledge that my personal health information will be kept confidential and protected under the Health Insurance Portability and Accountability Act (HIPAA). My information will only be shared with healthcare professionals involved in my care or as required by law.
9. Release of Liability & Hold Harmless Agreement
I voluntarily consent to CO₂ fractional laser treatment and release BEAUTY MD and its staff from any liability related to potential side effects or complications, except in cases of gross negligence.
10. Voluntary Consent
I have read and fully understand this consent form. I have had the opportunity to ask questions and have received satisfactory answers. I voluntarily consent to CO₂ fractional laser treatment and acknowledge that I can withdraw my consent at any time before the procedure.
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