Venus Velocity Laser Hair Reduction Informed Consent Booklet

INSTRUCTIONS

This Informed Consent Booklet has been prepared by Medical Aesthetics Bar to help inform you about the potential benefits,

associated risks and alternatives of the Velocity Laser (Hair Reduction) Treatment.

During your consultation and medical assessment, a Medical Aesthetics laser technician will have reviewed with you the potential

benefits, associated risks and alternatives of the Velocity Laser that are outlined in this booklet. They will have also

provided you with answers to any and all questions you may have had about the procedure.

It is important that you read the information contained in this booklet carefully and completely. Only when all of your questions and concerns about the procedures have been addressed should you then sign this consent form, indicating that you have read and fully understood all of the items that this booklet discusses. When you reach the end of the booklet,

please read and sign the “Consent for Procedure and/or Treatment“ page as proposed by Medical Aesthetics Bar .

If you have any remaining questions or concerns about the potential benefits, associated risks or alternatives of the Velocity, do not sign the consent for procedure without speaking with a Medica Aesthetics Bar laser technician.

INTRODUCTION

Velocity Laser (Hair permanent Reduction) Treatments are advanced, proven, high-tech hair permanent reduction procedures. Published studies

indicate that Laser Treatments can significantly reduce the appearance of unwanted hair with very little maintenance.

Velocity Laser treatment consists of directing laser energy at the skin. The energy disables the growth center of the hair,

called the hair follicle. This is possible through a process of “selective photothermolysis”, whereby the energy injures

only those tissues around the target, which is absorbed by it.

At the base of the hair follicle and hair shaft are

pigmented cells. The light emitted from the laser has a specific energy level and lasts a specific duration such that its absorption is maximized by the pigment in the hair follicle. When the energy is absorbed, the heat released is sufficient to disable the hair follicle, which interrupts its ability to produce a hair shaft (selective photothermolysis). While

delivering the energy to the hair follicle, it is important to cool the skin to avoid injury. An advanced cooling crystal is

integrated in the applicator to ensure comfort and safety.

Following Velocity Laser (Hair Permanent Reduction) treatments, there may be a minor degree of redness and puffiness to the skin,

with some tingling discomfort that usually disappears within 1 hour to 2 days. Post treatment discomfort is normally

mild, and you may return to regular activities immediately. Avoid sun exposure and put on a broad spectrum SPF-30+

sunscreen. For the first two days following treatment it is advised that you avoid strenuous activities, sports, swimming,

hot baths/showers, saunas, Jacuzzis (hot tubs) and pools (bacteria in them can cause an infection). If you have any

crusting or blistering avoid any activity that can rub or irritate the area until the skin is healed and clear. It is best to also

avoid applying ice or cooling compresses as the heat response is the body’s natural healing response. However, if

significant swelling, extreme heat or discomfort is evident, use ice or cold compresses wrapped in a soft cloth to sooth

the area. Makeup and deodorant/antiperspirant (for those having their underarms treated) may be worn on the

treatment area after the first 48 hours in the absence of crusting or blistering. If makeup is to be used, it must be

applied and removed with extreme caution to avoid injury, which can result in infections. Make sure you do put on a

broad spectrum SPF-30+ sunscreen. It is highly recommended you discuss a maintenance program to maintain the

cosmetic improvements you obtain with your Velocity Laser treatments.

Before beginning a Velocity Laser treatment program you must first attend an Assessment and Information consultation

(laser consultation) with a Treatment Professional, during which your skin type, hair concerns, expectations and goals

will be assessed and discussed. The Treatment Professional will work with you to select the best treatment or

combination of treatments for your unwanted hair concerns, expectations and aesthetic goals. The estimated duration

and cost of each session or series of sessions will also be provided to you. If you are a candidate you may schedule your

treatments 48 hours after the test spots at the time of this initial laser consultation.

POTENTIAL BENEFITS OF VELOCITY LASER HAIR REMOVAL TREATMENTS

The most obvious potential benefits are a long term reduction of unwanted hair.

RISKS ASSOCIATED WITH VELOCITY LASER HAIR REMOVAL TREATMENTS

Although the vast majority of Velocity Laser (Hair Removal) treatment clients never experience any of these

complications, you should discuss each of them with a Treatment Professional to ensure you fully understand the

alternatives, risks, potential complications and average outcomes of Velocity treatments.

Discomfort: The Velocity Laser (Hair Removal) treatments are very well tolerated in-office treatments. Client

comfort may be optimized with the use of a topical anesthetic cream and a skin chiller, but the integrated parallel

cooling tip on the Velocity applicator often provides an acceptable level of comfort during the procedure. With

these treatments you may experience a minor and tolerable degree of heat and/or tingling discomfort with each

treatment, especially when many active hair follicles are present.

Skin Wound: It is exceedingly rare for Velocity Laser (Hair Removal) treatments to cause a burn, blister or skin

irritation/wound. This is more of a risk in darker or tanned skin types. If a burn, blister or skin wound develops it

may take 5-10 days to heal, and, in extremely rare instances, may leave a noticeable whitening or darkening of the

skin or, even more rarely, a scar. Burns, blisters or skin wounds are much more common if you do not follow the

recommended use of a broad spectrum SPF-30 + sunscreen and avoidance of sunlight, self-tanners, UV light and

fluorescent light exposure after treatment.

Scarring: Occurs less than 0.1%. If you have developed a wound and a scar, the scar may end up being flat and

white (hypotrophic), large and red (hypertrophic) or extend beyond the margins of the injury (keloid). Subsequent

treatment or surgery may be required to improve the appearance of the scar. The scar may be permanent. Not

following pre and post treatment instructions may increase the likelihood of a skin wound or scar.

Pigment Change: With the laser energy used in Velocity (Hair Removal) treatments, there is a small risk of <1% of

temporary hyperpigmentation (increased pigment or brown discolouration) or hypopigmentation (whitening of the

skin). Usually these pigment effects are temporary and resolve over several weeks or months. Permanent

hyperpigmentation or hypopigmentation is very rare and may occur in less than 1% of cases.

Sun Exposure: Sun exposure to the treatment area immediately after treatment and for one month following the

treatment may also increase the risk of pigmentary changes in the treatment area.

Bruising: It is exceedingly uncommon to have any skin bruising following treatment. If bruising occurs, it can be

camouflaged after 48 hours and will usually resolve in 8-10 days. As the bruising fades, there may be a rust-brown

discoloration of the skin (hyper pigmentation) that may take special creams to fade away.

Infection: Velocity Laser (Hair Removal) treatments involve no cutting, surgery or skin penetration, and thus

infection is exceedingly rare.

Excessive Redness and Swelling: Rarely, a minor degree of redness and/or puffiness of the skin may follow

treatment and usually lasts 1-2 hours. This may persist, in rare instances, for 1-2 days. A mild steroid cream (0.5%

hydrocortisone available at the clinic) use ice or cold compresses wrapped in a soft cloth, will usually settle this.

Velocity Laser (Hair Removal) treatments will leave your skin photosensitized for 48 hours after each treatment and

you must avoid sunlight/UV light. Failure to do so could result in significant redness and swelling that may be quite

disfiguring and may increase the rare risk of complication, such as blisters, scarring and pigmentation changes.

Fragile Facial Skin (hair removal on the face): The skin overlying the treatment area may become quite fragile.

Although uncommon, the fragile skin can become reddened and the outer layer may peel off, much like a blister.

This usually settles in 8-10 days. Fragile skin or blisters may be more common if post-care instructions are not followed.

If you are subject to cold sores, please notify your Treatment professional, as cold sore eruptions can be common

with laser treatments, you may need to go on an anti-viral medication during your treatment.

Accutane – An oral acne medication that must be discontinued 3 months prior to treatments.

Additional Treatment – Effectiveness of laser hair removal treatments will vary from person to person. Factors such

as hair regrowth rates, response to treatment or hormonal changes among other reasons may result in some

unwanted hair reappearing after a successful course of treatments. In most instances, there is significant reduction

of unwanted hair in the treated area. Some clients may not need any maintenance while others may have a

maintenance session every 3-12 months or more after completion of the initial course to maintain their results.

Lack of Satisfaction – Your response is subject to variation as not all patients or hair will respond the same, but on

average, almost 100% of patients who have undergone treatment report a noticeable reduction in their unwanted hair

beginning after the first treatment. However, there is a risk that you may not see an appreciable reduction in the area of

unwanted hair.

Pregnancy - Although no known adverse reactions upon a fetus are known to result we do not recommend proceeding

with treatment if you are known to be pregnant.

There are many variable conditions in addition to risks and potential complications listed above that may influence the

long-term result from Velocity Laser (Hair Removal) treatments. Even though risks and complications can occur

infrequently, the risks cited in this booklet are particular for Velocity Laser (Hair Removal) treatments.

Other complications and risks can occur but are even less common. Should complications occur, additional surgery or

treatments may be required. The practice of medicine is not an exact science. Although good results are expected,

there is not a guarantee or warranty expressed or implied as to the results that may be obtained. Infrequently, it is

necessary to perform additional treatment to improve your results.

ALTERNATIVES TO THE VELOCITY LASER

Medical Aesthetics Bar does not provides waxing and sugaring for hair removal.

HEALTH INSURANCE

Unwanted hair is a cosmetic concern and poses no medical or health care threat. Most health insurance companies,

including OHIP, exclude coverage for these treatments.

Complications that may occur from such treatments are usually considered a health care concern and may be covered

by health insurance. Please carefully review your health insurance subscriber-information pamphlet, if you have a

private insurance carrier.

FINANCIAL RESPONSIBILITES

You will be responsible for necessary payments and any additional costs that may occur should complications develop

from treatment. There are no refunds once a treatment has been performed. If you are unable to come in for a

scheduled appointment you need to inform us 48 hours before your scheduled time to avoid a cancellation fee. The

appointment cancellation or no show fee is $100 for each 15 minutes of the scheduled appointment duration with a

minimum charge of $100. Clients also need to shave 12-24 hours prior to treatment.

DISCLAIMER

Informed Consent Booklets are used to communicate information about the proposed treatment of a condition along

with disclosure of risk and alternative treatment(s). The informed consent process attempts to define principles of risk

disclosure that should generally meet the needs of most patients in most circumstances.

What a Medical Aesthetics Bar laser technician has discussed with you and has been included in this booklet are the material risks

both common and uncommon that Medical Aesthetics Bar feels a reasonable person would want to know, understand and consider

in trying to decide if the proposed treatment of a condition is something they would like to proceed with.

However, Informed Consent Booklets should not be considered all-inclusive in defining other methods of care and risk

encountered. Medical Aesthetics Bar may provide you with additional or different information that is based on all the facts in your

particular case and the state of medical knowledge.

Informed-consent documents are not intended to define or serve as the standard of medical care. Standards of medical

care are determined on the basis of all of the facts involved in an individual case and are subject to change as scientific

knowledge and technology advance and as practice patterns evolve.

It is important that you read the above information contained on this and all preceding pages carefully and have all of

your questions answered by the Medical Aesthetics Bar laser technician before signing the consent on the last page.

Consent for Procedure and/or Treatment

I have received the following information/informed consent booklet for:

VENUS VELOCITY LASER HAIR REMOVAL

I hereby authorize Medical Aesthetics Bar and/or such assistants as may be selected to perform the procedure or laser hair reduction in the area of my desired.

I recognize that during the course of the procedure/treatment unforeseen conditions may necessitate different

procedures than those above. I therefore authorize the above technician and/or assistants or designees to perform

such other procedures that are in the exercise of his or her professional judgment necessary and desirable. The

authority granted under this paragraph shall include all conditions that require treatment and are not known to my

physician at the time the procedure is begun.

As part of the requirements of the procedure, my chart may be subject to a peer review for quality control.

I acknowledge that no guarantee has been given by anyone as to the results that may be obtained.

I consent to the photographing of the procedure(s) to be performed, including appropriate portions of my body, for

medical, scientific or educational purposes, provided they do not reveal my identity. These photographs may be

used for medical meetings, advertising, or any promotional or public relations purposes.

For purposes of advancing medical education, I consent to the admittance of observers to the treatment room.

IT HAS BEEN EXPLAINED TO ME BY MY PHYSICIAN AND/OR ASSISTANTS IN A WAY THAT I UNDERSTAND:

THE ABOVE TREATMENT OR PROCEDURE TO BE UNDERTAKEN

THERE MAY BE ALTERNATIVE PROCEDURES OR METHODS OF TREATMENT

THERE ARE RISKS TO THE PROCEDURE/TREATMENT PROPOSED

ANY QUESTIONS I MAY HAVE ASKED HAVE BEEN ANSWERED TO MY SATISFACTION

I CONSENT TO THE PROCEDURE AND/OR TREATMENT OF VENUS VELOCITY

I AM SATISFIED WITH THE EXPLANATION AND ACCEPT RISKS ASSOCIATED WITH TREATMENT

.

You will be responsible for necessary payments and any additional costs that may occur should complications

develop from treatment. There are no refunds once a treatment has been performed. If you are unable to come

in for a scheduled appointment you need to inform us 48 hours before your scheduled time to avoid a

cancellation fee.

Client or Person Authorized to Sign for Client