Cooltech Consent Form

CRYOADIPOLYSIS / COOLTECH CONSENT FORM

PLEASE READ THE INFORMATION BELOW BEFORE YOUR COOLTECH TREATMENT

THEN COMPLETE THE FORM

 

 

The Cooltech procedure uses a non-invasive vacuum applicator to deliver controlled cooling at the surface of the skin. The procedure is for spot reduction of fat. It is not a weight-loss solution and it does not replace traditional methods such as liposuction. Someone who is overweight can expect to see less visible improvement than someone who has smaller fat deposits. Clinical studies have shown that the Cooltech procedure will naturally remove fat cells but, as with most procedures, visible results will vary from person to person.

Clients with small fat deposits will respond better than those who are overweight. For this reason, more than one treatment session in the same area is sometimes required to achieve the desired contouring. It is recommended to wait a minimum of 6 weeks to repeat the treatment on the same area, although the adipose tissue reduction can last up to three months. Up to 3 areas can be treated on the same day.

In general, the purpose of the treatment is:
A. To improve my physical appearance.
B. To redefine my body contour.

I HEREBY DECLARE THAT: For the present document I give my consent to Southend Laser to carry out the Cryoadipolysis treatment for fat removal through the direct effect of cold applied by means of a suction applicator.

I UNDERSTAND that the results will be directly proportional to the ability of my tissues to remove the treated fat and renew the collagen, an effect that may be diminished in very damaged or aged skin, in which case it is possible that the results may not be as expected.

I UNDERSTAND that medicine is not an exact science and that absolute and definitive perfection cannot be guaranteed. I have been informed that each patient will have an individual response and that this treatment is not a solution for weight loss, nor does it replace traditional methods such as liposuction.

What you can expect:

  • The suction pressure of a vacuum applicator may cause sensations of deep pulling, tugging and pinching. A surface applicator may cause sensations of pressure. You may experience intense stinging, tingling, aching or cramping as the treatment begins. These sensations generally subside as the area becomes numb.
  • The treated area may look or feel stiff after the procedure and transient blanching (temporary whitening of the skin) may occur. You may feel a sense of nausea or dizziness as your body naturally warms and sensation returns to your treatment area. These are all normal reactions that typically resolve within minutes.
  • Bruising, swelling, and tenderness can occur in the treated area and it may appear red for a few hours after the applicator is removed.
  • You may feel a dulling of sensation in the treated area that can last for several weeks after your procedure. Other changes – including deep itching, tingling, numbness, tenderness to the touch, pain in the treated area, strong cramping, muscle spasms, aching and/or soreness also have been reported after treatment procedure.
  • Client experiences will differ. Some patients may experience a delayed onset of the previously mentioned occurrences. Contact us immediately if any unusual side effects occur or if symptoms worsen over time.
  • You may start to see changes as early as three weeks after your Cooltech procedure, and you will experience the most dramatic results after one to three months. Your body will continue naturally to process the injured fat cells from your body for approximately three to four months after your procedure.
  • You may decide that additional treatments are needed to reach your desired outcome.
  • In very rare cases, clients have experienced vasovagal symptoms during the treatment, and reported freeze burn, darker/lighter skin colour, hardness, discrete nodules or enlargement of the treatment area. Surgical intervention may be required to correct the enlargement.
  • Treatment may cause new hernia formation or exacerbate pre-existing hernia in the treatment area, which may require surgical repair. I understand that these and other unknown side effects may also occur but is very rare.

 

 

CONSENT FORM: