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| Informed Consent |
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LASER-CHEMICAL PEEL
INSTRUCTIONS
This is an informed consent document which has been prepared to assist your plastic surgeon inform you about skin peel and skin treatment procedure(s), its risks, and alternative treatment.
It is important that you read this information carefully and completely. Please initial each page, indicating that you have read the page and sign the consent for surgery as proposed by your plastic surgeon.
INTRODUCTION
Chemical skin-peeling and other skin treatments have been performed for many years to treat a variety of skin disorders. Conditions such as sun damage, wrinkling, and uneven pigmentation may be treated with these non-invasive techniques. There are many different techniques and regimens for the application of chemical peeling and skin treatment medications. In some situations, chemical peels may be performed at the time of other surgical procedures.
Chemical skin-peeling procedures are not an alternative to skin tightening surgery when indicated.
ALTERNATIVE TREATMENT
Alternative forms of management include not treating the skin with chemical peeling agents or other medications. Improvement of skin lesions and skin wrinkles may be accomplished by other treatments such as dermabrasion, laser treatment, or surgery to tighten loose skin. Risks and potential complications are associated with alternative forms of treatment.
RISKS of CHEMICAL SKIN-PEELING/SKIN TREATMENTS
There are both risks and complications associated with chemical skin-peels and skin treatments. An individual's choice to undergo a procedure is based on the comparison of risk to potential benefit. Although the majority of patients do not experience these complications, you should discuss each of them with your plastic surgeon to make sure you understand the risks, potential complications, and consequences of chemical skin-peeling and other forms of skin treatment.
INFECTION
Infection is unusual. Bacterial and viral infections can occur. If you have a history of Herpes Simplex virus infections around the mouth, it is possible that an infection could recur following a chemical peel. Specific medications must be prescribed prior to the skin peeling procedure in order to suppress an infection from this virus. Should any type of skin infection occur, additional treatment including antibiotics may be necessary.
SCARRING
Although normal healing after the procedure is expected, abnormal scars may occur both in the skin and deeper tissues. In rare cases, keloid scars may result. Scars may be unattractive and of different color than the surrounding skin. Additional treatments may be needed to treat scarring.
COLOR CHANGE
Chemical peeling agents can permanently lighten the natural color of your skin. There is the possibility of irregular color variations within the skin including areas that are both lighter and darker. Permanent darkening of skin has occurred after chemical peels. A line of demarcation between normal skin and skin treated with chemical peeling can occur. Redness after a chemical peel may persist for unacceptably long periods of time.
POOR RESULT
There is the possibility of a poor result from these procedures. Skin-peel and skin treatment procedures may result in unacceptable visible deformities, skin slough, loss of function, and permanent color changes in the skin. You may be disappointed with the final results of chemical skin-peel or other skin treatments.
SKIN LESION RECURRENCE
Skin lesions in some situations can recur after a chemical peel or skin treatments. Additional treatment or secondary surgery may be necessary.
SKIN CANCER /SKIN DISORDERS
Skin-peels and skin treatment procedures may not offer protection against developing skin cancer or skin disorders in the future.
ALLERGIC REACTIONS
In rare cases, allergies have been reported to drugs and agents used for chemical peeling or skin treatments. In rare cases, local allergies to tape, preservatives used in cosmetics or topical preparations have been reported. Systemic reactions which are more serious may occur to drugs used during surgery and prescription medicines. Allergic reactions may require additional treatment.
SUNBURN
Certain types of chemical peeling agents may permanently leave the skin very prone to sun burn. Skin after a chemical peel may lack the normal ability to tan (darken) when exposed to sunlight.
LACK OF PERMANENT RESULTS
Chemical peel or other skin treatments may not completely improve or prevent future skin wrinkling. Neither technique can reverse the signs of skin aging. Additional surgical procedures may be necessary to further tighten loose skin. You may be required to continue with a skin care maintenance program after a chemical peel procedure.
DELAYED HEALING
It may take longer than anticipated for healing to occur after a chemical skin-peel or other treatments. Skin healing may result in thin, easily injured skin. This is different from the normal redness in skin after a chemical peel.
HEART PROBLEMS
Chemical peeling preparations have been reported to produce abnormal heart beats that may require medical treatment should they occur during the procedure. This is a potentially serious problem.
UNKNOWN RISKS
There is the possibility that additional risk factors of chemical skin-peeling and skin treatments may be discovered.
SURGICAL ANESTHESIA
Both local and general anesthesia involve risk. There is the possibility of complications, injury, and even death from all forms of surgical anesthesia and sedation.
ADDITIONAL TREATMENT OR SURGERY NEEDED
There are many variable conditions which influence the long term result of chemical skin-peeling and other skin treatments. Even though risks and complications occur infrequently, the risks cited are the ones that are particularly associated with these procedures. Other complications and risks can occur but are even more uncommon. Should complications occur, additional surgery or other treatments may be necessary. The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee or warranty expressed or implied, on the results that may be obtained.
FINANCIAL RESPONSIBILITIES
The cost of chemical skin-peeling involves several charges for the services provided. This includes fees charged by your doctor, the cost of surgical supplies, laboratory tests, and possible outpatient hospital charges, depending on where the procedure is performed. Depending on whether the cost of surgery is covered by an insurance plan, you will be responsible for necessary co-payments, deductibles, and charges not covered. Additional costs may occur should complications develop from the surgery. Secondary surgery or hospital day-surgery charges involved with revisionary surgery or treatments would also be your responsibility.
DISCLAIMER
Informed consent documents are used to communicate information about the proposed surgical treatment of a disease or condition along with disclosure of risks and alternative forms of treatment(s). The informed consent process attempts to define principles of risk disclosure that should generally meet the needs of most patients in most circumstances.
However, informed consent documents should not be considered all inclusive in defining other methods of care and risks encountered. Your plastic surgeon may provide you with additional or different information which is based on all the facts in your particular case and the state of medical knowledge.
Informed-consent documents are not intended to define or serve as the standard of medical care. Standards of medical care are determined on the basis of all of the facts involved in an individual case and are subject to change as scientific knowledge and technology advance and as practice patterns evolve.
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