Thermoclear Consent Form

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I understand that I will undergo the Radio Frequency (RF) treatment known as Thermoclear service.

 

The RF treatment may dramatically reduce darkly pigmented sunspots, skin tags, milias, sebaceous hyperplasia, cholesterol deposits, unwanted hair and small spider veins. More than one RF session may be necessary to achieve desired results. However, other treatments, including skin care products, are often needed to blend color, reduce sun damage, and give the best results.

 

 


There is no warranty or guarantee made to me as a result of this procedure and the final result cannot be guaranteed. There are no refunds for this procedure, as results will vary and individual results are not guaranteed.

 

 

The skin treated may be red and swollen with fine, thin scabs. Keep the treated areas covered with Caladryl, Polysporin and/or Bacitracin until the thin scab fall off. This process can take anywhere from 1-3 weeks to heal completely. It could take as long as 1-3 months in some rare cases. DO NOT scratch the scabs, as that can cause scarring and prolong the healing time.

 

You must be off of Accutane for more than 6 months to resume treatment. Individuals using anti-coagulants should be noted.

 

 

The following problems may occur with treatment:

  • Micro scarring: The RF system can create a bruise and/or a moderate burn or blister to the skin. For an effective treatment, the RF energy may cause the skin to scab up, then the healing time can make the skin red. There is a slight risk of micro scarring.
     
  • Hyper-pigmentation (browning) and Hypo-pigmentation (whitening) have been noted after treatment, especially with individuals with thin/frail skin and darker complexions. This usually resolves within weeks, but it can take as long as 1-3 months in some rare cases. Permanent color change is also a rare risk. If you have a lot of color in your skin, a skin lightening cream will be advised to reduce the melanin in your skin before the treatment. Avoiding sun exposure after the treatment is crucial to reduce the risk of color change.
     
  • Allergic reactions: In rare cases, local allergies to tape, preservatives used in cosmetics or topical preparations, have been reported. Systemic reactions (which are more serious) may result from prescription medicines. Allergic reactions may require additional treatment.
     
  • Bleeding: Pinpoint epidermal bleeding is rare but can occur following RF treatment procedures. Should bleeding occur, additional treatments might be necessary.
     
  • Infection: Although infection following RF treatment is unusual, bacterial, fungal, and viral infections can occur if the area is picked or not kept clean. Herpes simplex virus infections around the mouth can occur following a RF treatment. Should any type of skin infection occur, additional treatment including antibiotics might be necessary. If you have a history of herpes simplex virus in the treated area we recommend preventative therapy.
     
  • Skin Tissue Pathology: Energy directed at skin lesions may potentially vaporize the lesion. Only clearly benign pigmented lesions can be treated. Check with your dermatologist for clearance for the treatment, if the lesion has changed in color, size, extremely elevated or is painful to the touch.
     

 

I will wear sunscreen of SPF 25 or greater on the treated area after the RF treatment to protect my skin.

 

 

I understand I may need multiple treatments for the desired outcome.

 

 

Compliance with the aftercare guidelines is crucial for healing, prevention of scarring, hyper-pigmentation and hypo-pigmentation.

 

 

I understand the pricing for this service is $75 for 15 minutes of treatment. The size of the service area treated will be dependent on whether the technician can service multiple skin deficiencies.

 

 

By signing below, I assume any risk, harm or injury which may occur as a result of the RF treatment service. I release SOS WAX and Skincare and its technicians of any liability and waive any claims I may have related to the service.


Signee Information

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By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.