I duly authorize Lotus by MDs @ Queensway to perform the PLUS90 treatment
I understand that the Plus90 is an RF device used for the remodelling of tissue. It has been explained to me that although RF vaginal treatments have been very effective there is no guarantee that I will
benefit from this treatment. I understand the most common side effects and complications from this treatment are the following:
1. Pain: you may experience pain during or after the procedure. If you feel significant discomfort after the treatment, you may use over-the-counter pain medications after the procedure.
2. Swelling: there may be swelling in the treatment areas after the treatment which can last up to one week in duration.
3. Bruising: you may experience temporary bruising in the treated area which will subside with healing.
4. Ecchymosis & Purpura: you may experience some temporary bruising or purple discoloration in the treatment area which will subside with healing.
5. Blistering / Bullae: you may experience some temporary blistering/bullae in the treatmentvarea which will subside with healing.
6. Burn: you may experience a burn which can be mild, moderate or severe to different degrees in the treatment area. Minor burns generally heal without difficulty but more
severe burns, though rate, can lead to scarring, sensory or pigmentary changes.
7. Pigmentary changes: you may experience lightening of the skin which may be temporary or permanent (hypopigmentation). You may experience temporary or permanent darkening of the skin (hyperpigmentation).
8. Scarring: the risk of this complication is minimal but it can occur whenever the surface of the skin is disrupted. Strict adherence to all post-operative instructions will minimize the possibility of this occurring.
9. Allergic reactions: it is possible to experience an allergic reaction to an anesthetic, topical cream or oral medication.
10. Herpes Eruption: it is possible, even with antiviral prophylaxis, to experience a herpes eruption if you are an HSV carrier. Inform your doctor immediately if you experience pain, skin eruptions or blistering post-treatment so that the proper treatment can be initiated.
11. Infection: this treatment has the potential to cause skin damage, so infection is possible, including a urinary tract infection. Infection is unlikely, but can be life-threatening if it does occur and is left untreated; signs and symptoms of infection are redness, fever, pain, pus
and swelling. Should an infection occur, you should contact your doctor for immediate
evaluation and treatment.
It is important that you tell your doctor if you experience any of these side effects.
I understand that clinical results may vary depending on individual factors, including but limited to medical history, skin type, patient compliance with pre/post-treatment instructions, and individual response to treatment.
I certify that I have been fully informed of the nature and purpose of the procedure, expected outcomes and possible complications, and I understand that no guarantee can be given as to the final result obtained. I am fully aware that my condition is of cosmetic concern and that the decision to proceed is based solely on my expressed desire to do so.
I confirm that I have informed the staff regarding any current or past medical condition, disease or
medication taken. I confirm that I have had an up-to-date normal PAP test and that I have
communicated these results.
I consent to the taking of photographs and authorize their anonymous use for the purpose of
medical audit, education and promotion.
I certify that I have been given the opportunity to ask questions and that I have read and fully
understand the contents of this consent form.
By signing below, I acknowledge that I have read the foregoing informed consent and agree to the treatment with its associated risks. I hereby release the doctor prescribing Latisse and the facility from liability associated with this procedure.
