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Before Your Treatment

Consent Form

Glowtique client consent form

for the treatment of benign pigmented lesions with the Enlighten system

With a Glowtique consultation we keep you at the centre of the process. We learn all about your skin type, face shape, preferences and concerns—and our aesthetic experts will assist in tailoring a treatment solution just for you. We will explain the steps involved in your chosen procedure, including the benefits and any potential risks.

As our client you play a major role in the outcome of your treatments. It is important that you provide us with current and factual information in order for us to offer the best solution. It's also important that you understand your role in maintaining post-procedure care to achieve the best results.

Please read each statement below carefully, to make sure you understand and agree to all conditions required for your procedure to be carried out. If you have any questions at all, please stop and discuss with your Glowtique expert.

Client details

If you were referred by someone please add their name here so that we may thank them.

Disclosures

Treatment Authorisation and Acknowledgement *

I hereby authorise Nina Nguyen, Senior Aesthetic Specialist from Glowtique, to perform pigmented lesion treatment on me. I understand that this procedure treats pigmented lesions, age spots, and sun spots by targeting melanin with a laser. I understand I may not experience complete clearance, and that it may take multiple treatments. Some conditions may not respond at all and, in rare cases, may become worse.

Potential Risks and Adverse Effects *

I am aware the procedure may result in the following adverse experiences or risks:

DISCOMFORT – Mild discomfort is typical during the treatment of benign pigmented lesions. Topical and local anesthetic options may be available if required.

PURPURA – The area may appear to be bruised after treatment. The bruising will typically fade in 5-7 days.

BLISTERS/SCABS/CRUSTING – These may occur and usually take 4-10 days to heal.

PETECHIAE OR PINPOINT BLEEDING –Pinpoint bleeding is uncommon during treatment of benign pigmented lesions but may develop and will typically resolve within a few hours post-treatment.

HYPER/HYPOPIGMENTATION – Skin can develop temporary lightening or darkening after laser treatment. Hyperpigmentation can be worsened with sun exposure. Hypopigmentation usually occurs after multiple treatments. Pigmentary issues typically resolve with time but can be permanent.

TEXTURE CHANGES – Transient texture changes are often noted but usually resolve with time.

EDEMA AND ERYTHEMA – Swelling and redness often occur, but will subside in 2-5 days and can be reduced with regular ice application.

INFECTION – Despite good wound care, pain, swelling, oozing, and fever can indicate the development of an infection. Topical and/or oral antibiotics may be necessary. If signs of infection develop, such as pain, heat, or surrounding redness, please call our office.

SCARRING – Scarring is a rare occurrence, but it is a possibility if the skin's surface is disrupted. To minimise the chances of scarring, it is important that patients follow all post-treatment instructions. Good post-treatment care can help reduce the possibility of scarring.

PERSISTENCE OF PIGMENTED LESION – Multiple treatments are common, and complete clearing is not always possible.

DARKENING OF LESIONS – Lesions will darken post-treatment and will slough 5-21 days post-treatment.

SUN EXPOSURE / TANNING BEDS / ARTIFICIAL TANNING - May increase risk of side effects and adverse events.

EYE EXPOSURE – Protective eyewear (shields) will be provided to you during the treatment. Failure to wear eye shields during the entire treatment may cause severe and permanent eye damage.

Acknowledgement of Discussion and Alternatives *

I acknowledge the following points have been discussed with me:

  • Potential benefits of the proposed procedure, including the possibility that the procedure may not work for me.
  • Alternative treatments such as liquid nitrogen, topicals, or excision.
  • Reasonably anticipated health consequences if the procedure is not performed
  • Possible complications/risks involved with the proposed procedure and subsequent healing period.

Pregnancy Disclaimer *

For women of childbearing age: By signing below, I confirm that I am not pregnant and do not intend to become pregnant anytime during the course of treatment. Furthermore, I agree to keep Nina Nguyen and staff informed should I become pregnant during the course of treatment.

Photography Consent *

Photographic documentation will be taken. I hereby (do / do authorise the use of my photographs for teaching purposes.

Acknowledgement

By submitting this form, I acknowledge that I have read and fully understand the contents of this informed consent for light-based treatment of my pigmented lesions, and that I have had all my questions answered to my satisfaction by my healthcare team.

Have any questions? We're here to help you

We know that the thought of investing in facial aesthetic can be daunting. We want you to be absolutely informed, comfortable and able to decide whether it's a perfect fit for you. Please connect with our expert team — we'll listen to your concerns, advise you on the process and make sure that nothing is left unclear.

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