Specific Informed Consent for MORPHEUS8 Treatments
This form is designed to give you the information you require to make an informed choice of whether or not to undergo treatment with M0RPHEUS8 technology.
If you have any questions before your treatment please feel free to ask.
• I hereby authorize Dr. Bedaj and/or such assistants as may be selected to perform the MORPHEUS8 procedure.
• The physician obtained my medical history and found me eligible for treatment.
• I have received the following information about the technology:
o MORPHEUS8 technology utilizes fractional radiofrequency (RF) indicated for facial/neck/ chest and back of hands, as well as small body areas.
o The M0RPHEUS8 treatment induces ablation, thus improving the appearance of rough texture, fine lines, wrinkles, and depressed scars, such as acne scars along with superficial pigments that will be ablated. The treatment also induces skin rejuvenation by heating of the dermis which stimulates collagen generation and replenishment, as well as the closure of superficial fine blood capillaries.
o The treatment requires anesthesia that involves topical cream, injections, or sedation according to the treatment parameters and the physician's discretion.
I understand that taking the treatment course is my choice and that I am free to withdraw at any time, without giving any reason.
• There may be alternative procedures or methods of treatment, such as fractional lasers for ablation (CO2) and lasers, IPL or RF-based systems for skin rejuvenation.
As of today, there are no systems in the market that can address the variety of lesions that MORPHEUS8 does. Details were explained to me.
• I was told about the possible side effects of the treatment including local pain, skin redness (erythema), swelling (edema), damage to the natural skin texture (crust, blister, burn), change of skin pigmentation (hyper- or hypo-pigmentation), and scarring. Although these effects are rare and expected to be temporary, redness and swelling may last up to 3 weeks and are part of a normal reaction to the treatment. Burns and resulting pigmentation change and scarring are rare and may happen in dark skin that is not taken care of according to instructions. Tiny scabs appear on the face for a few days as part of normal healing, however, make-up may be applied as soon as 1-3 days after the session to mask them and residual redness. Any adverse reaction should be reported immediately.
• I understand that the treatment involves a few sessions (1-5), a few weeks apart (3-6 weeks), according to treatment parameters and individual response.
• I understand that I have to comply with the treatment schedule, otherwise, results may be compromised.
• I recognize that during the course of the procedure, unforeseen conditions may necessitate different procedures than this above and I authorize the physician or assistants to perform such other procedures if they find them professionally desired.
• I understand that not everyone is a candidate for this treatment and results may vary. Therefore, there is no guarantee as to the results that may be obtained.
The procedures to be used to treat my conditions have been explained to me
1. I have had sufficient opportunity to discuss my condition and treatment. I believe I have adequate knowledge upon which to base informed consent.
2. Any questions I may have asked have been answered to my satisfaction.
3. I authorize before, during and after the procedure(s) the taking of photographs to be part of my patient profile that may be used for
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