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Lumecca IPL

Lumecca is a non-invasive IPL (Intense Pulse Light) technology that utilizes the technology for skin rejuvenation, pigmented and vascular lesions improvement. The Lumecca treatment sends beams of light into your skin tissue, which breaks up the discolored areas of your face by constricting facial veins close to the surface of your skin. Age spots, freckles, and other discolorations succumb to the multiple wavelengths the device uses to deliver energy into your pigment-producing cells. These cells absorb energy as heat, which destroys them. The IPL laser effectively constricts the blood vessels that cause vascular lesions. When the blood vessels constrict, blood is rerouted to healthier vessels. At the same time, your lymphatic system flushes away destroyed vessels. The result is a more even complexion. Most people see an improved skin appearance after their first session and can deliver optimal results after only two treatments.

Informed Consent for Lumecca

The purpose of this consent form is to provide written information regarding the risks, benefits and alternatives of treatment to Lumecca. This material serves as a supplement to the discussion you have with your Crawford Cosmetics provider. It’s important that you fully understand this material, so please read this information thoroughly. If you have any questions regarding the procedure, ask your Crawford Cosmetics provider prior to signing this consent form.

TREATMENT GOALS AND DESCRIPTION OF PROCEDURE Lumecca is a non-invasive IPL (Intense Pulse Light) technology that utilizes the technology for skin rejuvenation, pigmented and vascular lesions improvement. The Lumecca treatment sends beams of light into your skin tissue, which breaks up the discolored areas of your face by constricting facial veins close to the surface of your skin. Age spots, freckles, and other discolorations succumb to the multiple wavelengths the device uses to deliver energy into your pigment-producing cells. These cells absorb energy as heat, which destroys them. The IPL laser effectively constricts the blood vessels that cause vascular lesions. When the blood vessels constrict, blood is rerouted to healthier vessels. At the same time, your lymphatic system flushes away destroyed vessels. The result is a more even complexion.

TREATMENT RESULTS Most patients are pleased with the results of their Lumecca treatment. However, like any aesthetic procedure, there is no guarantee that you will be completely satisfied. I acknowledge that while good results are expected, I may be disappointed with the results of the procedure. I understand there is no guarantee of results of any treatment. Even though appropriate measures are taken to reduce side effects, they cannot be completely eliminated in every case. I understand that the treatment may involve risks of complication or injury from both known and unknown causes. I agree to follow the pre- and post-treatment instructions carefully. I understand that compliance with the recommended pre- and post-procedure guidelines is crucial for healing and reducing the risk of complications.

PRE LUMECCA INSTRUCTIONS

● Avoid any tanning for 6 weeks prior to treatment. This includes any form of self-tanners.

● Do not use any retinol products (or products containing tretinoin) or exfoliants on the area to be treated for one week prior to treatment.

● Avoid other irritant topical agents (Benzoyl peroxide, AHAs, BHAs) for 4 days prior to treatment.

● Avoid Accutane (or isotretinoin products) for 6 months prior.

● Let your practitioner know if you have a history of hyperpigmentation.

● Photosensitizing medications including doxycycline and minocycline should be discontinued three days prior to the treatment.

● Anticipate a social “downtime” of 2-3 days before any redness, swelling and sloughing of the sunspots has subsided.

● If applicable, please come clean-shaven in the areas to be treated (this usually means the face and neck).

POST LUMECCA INSTRUCTIONS

● You may have a mild sunburn (burning) sensation following the treatment, which is usually gone within a few hours.

● Skin redness is normal and may last a few days.

● There may be a slight amount of swelling.

● Crusting or blistering is uncommon but not serious.

● Pigmented areas may begin to flake after a few days.

● Cold compresses may be useful for the first 24 hours.

● Your skin will be fragile for 2-3 days. Use gentle cleansers, do not rub the skin, and avoid hot water during this time.

● Do not use any retinoids, tretinoins, alpha or beta hydroxy products, vitamin C products, scrub, exfoliate, or have chemical peels performed on the treated area for one week.

● Makeup can be applied immediately if the skin is not broken.

● Use sunblock with at least SPF30.

● Avoid excessive heat or friction to the treated area (heavy exercise, saunas).

● Sun spots and age spots will DARKEN with the treatments BEFORE they begin to respond and resolve. This is expected and a normal part of the process. Do not pick, scrub and exfoliate these spots. Allow them to shed on their own.

● Avoid prolonged exposure to the sun for a minimum of 2 weeks.

I will adhere to the aftercare instructions supplied to me during my visit.

FOLLOW-UP TREATMENT

● Pigmented lesions will become darker for a period of 1-2 weeks before starting to lighten.

● Local inflammation around the lesions, manifested as some redness and swelling may accompany the response, as part of the healing process.

● Blood capillaries will clot and appear darker for 1-2 weeks before disintegration.

● Some redness and swelling may accompany the response, as part of the healing process.

● Some skin tightening may occur immediately, which may decline for 1-2 months, but will improve then, as new collagen fibers are produced.

● All 3 lesions: brown, red and loose skin may improve simultaneously.

● No complete clearance is guaranteed

● Treatment requires a number of sessions, and the exact number of sessions is individual to each client.

● There may be some discomfort and transient redness and/or swelling associated with treatment.

POTENTIAL CONTRAINDICATIONS There are a few contraindications and patients with certain conditions may not be good candidates. Inform your provider if you have had any of the following conditions:

● Pregnancy or nursing

● Under 18 years of age

● Pacemaker or internal defibrillator or any electronic

● Implant such as glucose monitor

● Permanent implant in the treated area such as metal plates and screws, silicone implants or an injected chemical substance

● Current or history of cancer, especially skin cancer, or pre-malignant moles

● Impaired immune system due to immunosuppressive diseases such as AIDS and HIV, or use of immunosuppressive medications

● Severe concurrent conditions such as cancer, cardiac disorders, epilepsy, uncontrolled hypertension, and liver or kidney diseases

● Herpes Simplex (cold sores) in the treatment area (prophylactic treatment may be given).

● A history of diseases stimulated by heat, such as recurrent Herpes Simplex in the treatment area (prophylactic treatment may be given)

● Any active condition in the treatment area, such as sores, psoriasis, eczema and rash as well as excessively/freshly tanned skin

● History of skin disorders such as keloid scarring, abnormal wound healing, as well as very dry, cracked, ulcerated, infected and fragile skin

● Tattoos, permanent make-up, pigmented lesions (what want to be kept)

● Any medical condition that might impair skin healing

● Poorly controlled endocrine disorders, such as diabetes or thyroid dysfunction

● Any surgical, invasive, ablative procedure in the treatment area in the last 3 months or before complete healing

● Use of Isotretinoin (Accutane) within 6 months prior to treatment

POSSIBLE RISKS & COMPLICATIONS

● Local pain

● Skin redness

● Swelling

● Damage to the natural skin texture (crust, blister, burn)

● Change of pigmentation (hyper- or hypopigmentation)

● Scarring

PREGNANCY AND CONTRAINDICATED CONDITIONS I am not aware that I am pregnant. I am not trying to get pregnant. I am not lactating (nursing). I do not have any major illnesses which would prohibit me from receiving Lumecca. I do not have multiple allergies or high sensitivity to medications, including lidocaine.

ALTERNATIVE THERAPY I understand that Lumecca is an elective procedure with the goal of improved aesthetic appearance and that the main alternative to therapy is to observe and not receive any treatment. Details were explained to me.

PAYMENT I understand that this service is not covered by insurance, and payment is my responsibility and is expected at the time of treatment.

RIGHT TO DISCONTINUE TREATMENT I understand that I have the right to discontinue the Lumecca procedure at any time.

RELEASE OF LIABILITY I hereby indemnify Crawford Cosmetics, PLLC from any liability relating to the procedures that I have volunteered for. I understand that any treatment performed is between me and the doctor/ healthcare provider who is treating me and I will direct all post-treatment questions or concerns to the treating clinician. Furthermore, I hereby indemnify the facility/ meeting room/hotel where this treatment is being performed from any liability relating to the procedures that I have volunteered for.

CONSENT TO TREATMENT I hereby voluntarily consent to treatment with Lumecca as performed by my Crawford Cosmetics provider. I have read the above and understand it. I state that I read and write in English. I am not under the influence of drugs or alcohol. I have been fully informed by the provider/provider’s staff regarding the procedure, its possible side-effects, and pre & post-op care instructions, which are listed, but not limited to the articles listed above. It has been fully explained to me and my questions have been answered satisfactorily. I accept the risks and complications of this elective procedure and I understand that no guarantees are implied as to the outcome of the procedure. Please note this consent is valid for all future Lumecca treatments chosen to receive from Crawford Cosmetics

Our goal is to provide quality aesthetic treatments to all our clients in a timely manner. No-shows, late arrivals, and cancellations inconvenience not only our providers, but our other clients as well. Please be aware of our policy regarding missed appointments. Your appointments and well-being are very important to us. We understand that sometimes unexpected issues arise.

Appointment Cancellation

Our policy enforces a late cancellation fee for cancellations made with less than a 72-hour notice. It is important to understand that you will forfeit your deposit for any appointment cancelled inside the 72-hour cancellation window. If you no call/no show, in addition to forfeiting your deposit, you will be charged a fee of $100. We take No call/No shows very seriously. We make all efforts to avoid these fees for you by sending multiple texts and email reminders that allow ample time to cancel or reschedule your appt with us.

When you book your appointment, you are holding a space on our calendar that is no longer available to our other clients. To hold this appointment, we require a credit card on file, and partially refundable $75 deposit for appointments under 30 mins ($67.50 will be refunded), and $200 partially refundable deposit for appointments over 30 mins ($180 will be refunded). Shorter appointments with our estheticians require a smaller deposit and are partially refundable. Other appointment deposits many vary. The deposit will be applied toward the cost of your treatment and is partially refundable if you do not receive treatment at the time of your appointment. In order to be respectful of your fellow clients, please notify your Crawford Cosmetics provider as soon as you know you will not be able to make your appointment.

Please note, if you are more then 10 minutes late for your scheduled appointment, your appointment will be automatically cancelled, you will lose your deposit, and will be charged the additional no show fee of $100.

If cancellation is necessary, we require that you call, text, or cancel online at least 72 hours in advance. Appointments are in high demand, and your advanced notice will allow another client access to that appointment time. As we are closed over the weekend, if you have a Monday appointment, we require that you cancel the Wednesday before by 5pm. If you have a Tuesday appointment, we require that you cancel the Thursday before by 5pm at the latest. Appointments are in high demand, and your advanced notice will allow another client access to that appointment time.

How to Cancel Your Appointment

If you need to cancel your appointment and are enrolled in text message reminders, you can reply “no” to the reminder text that you will receive 4 days prior to the appointment. Other options are: cancel online, call or text the scheduling line, Port Huron (248) 285-9876 or Royal Oak (248) 221-1895, during regular business hours, or text your Crawford Cosmetics provider. If necessary, please leave a detailed voicemail message and we will return your call as soon as possible. Please note, if you cancel your appointment through our automatic text message reminder or online, you must reach out to us for the refund, as is not returned automatically and remains on file unless a refund is requested.

Late Cancellations vs. No-Shows

A cancellation is considered late when the appointment is cancelled with less than 72 hours’ notice. A no-show is when a client misses an appointment without cancelling.

It is important to understand that you will forfeit your deposit for any appointment cancelled inside the 72hour cancellation window. If you no call/no show, in addition to forfeiting your deposit, you will be charged a fee of $100. These fees will automatically be applied to the credit card on file. If the credit card is rejected, any fee that is owed must be paid in full prior to booking any future appointments.

I confirm that I have read, understand and agree to the above policy.

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