CLIENT INFORMATION

Ultraformer MPT Contraindications

Ultraformer MPT may not be suitable for individuals with:

Severe Skin Conditions: Eczema, psoriasis, dermatitis, open wounds, severe acne, or active skin infections.

Certain Medical Conditions: Pregnancy, breastfeeding, autoimmune diseases (e.g., lupus, scleroderma), uncontrolled diabetes, or neurological disorders.

Metal Implants or Medical Devices: Pacemakers, defibrillators, metal implants, silicone implants, or dermal fillers in the treatment area.

Keloid Scarring: A history of keloid or hypertrophic scarring increases the risk of adverse skin reactions.

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ABOUT ULTRAFORMER MPT

Ultraformer MPT treatment promotes non-surgical face lifting and skin tightening to a number of problem areas, including the difficult-to-treat sub-mental zone, i.e., the area under the chin. It can also be used for skin tightening on small problem areas of the body and limbs.

During Ultraformer treatment, low amounts of Micro-Focused Ultrasound energy are delivered into precise skin depths, without damaging the surface of the skin. The MFU energy creates heat, which stimulates tissue remodeling. The result, over time, is a natural skin lifting, tightening and rejuvenation.

WHAT TO EXPECT DURING AND AFTER YOUR ULTRAFORMER TREATMENT

  • You can expect to experience some discomfort as the ultrasound energy is delivered. Your practitioner will agree a plan to optimise your comfort during the procedure.

  • Ultraformer treatment is efficient. For example, a treatment for the full face and neck will last approximately 30-45 minutes.

POSSIBLE SIDE EFFECTS FROM ULTRAFORMER TREATMENT

  • Your skin may appear red for a few hours after Ultraformer treatment.

  • You may experience slight swelling, tingling or tenderness for a few days after treatment. Rarely, some patients may experience temporary bruising welts or numbness.

  • As with any heat-based treatment, there is a slight risk of burning the skin.

  • Temporary nerve inflammation will resolve in a few days or weeks.

  • If a motor nerve has become inflamed, you might experience some temporary local muscle weakness. There could be some temporary numbness if a sensory nerve has become inflamed.

CONSENT FOR ULTRAFORMER TREATMENT

PATIENT’S DECLARATION

I have read and understood all the information provided and I have had the opportunity to ask any questions concerning the nature of the treatment, its expected results, and its possible risks and complications.

It has been explained to me that the results of Ultraformer treatment can vary from patient to patient. I am aware that occasionally the collagen that builds in the deep layers of the skin, providing support for the skin structure and helping to counter the effects of gravity, might not have a visible effect on the surface of the skin. I also understand that the results will be seen gradually over a period of 3 to 6 months, and that some patients will benefit from more than one treatment.

The nature of treatment has been explained to me. I understand that just as there may be benefits from the procedure, all procedures involve risk to some degree. I am aware that other unexpected risks or complications may occur and that no guarantees or promises have been made to me concerning the results of the procedure.

It has also been explained that during the course of the proposed procedure, unforeseen conditions including underlying medical conditions and medications may limit the body’s ability to respond to treatment. My questions regarding this treatment, its alternatives, its complications, risks and expected results have been explained by my practitioner and/or his or her staff including non-responders to treatment. Less than 10% of patients may only observe small noticeable improvement from treatment or no response to treatment, a second treatment may be required to see a visual improvement following review.

I understand that Ultraformer treatment is a non-invasive treatment. It is not designed to produce the same results as an invasive surgical procedure.

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TERMS OF USE: This form should be reviewed periodically to ensure that its contents are current. Cryomed Australia cannot and does not recommend standard operating procedures related to the practice of medicine. Cryomed does not accept liability for its contents. It is essential that each clinic customize the consent form according to treatment procedure, state law requirements, and language. Cryomed does not make any representation, guarantee or warranty, express or implied or assume any liability or responsibility for the accuracy or completeness of the contents of this sample form. You should seek your own legal advice independently or through your insurance policy provider along with insurance advice. Practitioners and staff are responsible to ensure that patients receive accurate information concerning the nature, risks and costs associated with a given procedure or treatment.

DISCLAIMER: This form is for general information purposes only and not intended as legal advice. The sample consent form is provided for your convenience and should be reviewed and edited to ensure that its contents comply with your local regulatory (legal) and institutional requirements.