EndyMed PRO Application Guide
|
|
- Alexander McLaughlin
- 5 years ago
- Views:
Transcription
1 EndyMed PRO Application Guide Guidelines for the EndyMed PRO User Page 1
2 Copyright EndyMed, 2010 All rights reserved. Document number: Rev. August, 2011 No part of this publication may be reproduced in any material form (including photocopying, or storing it in any medium by electronic means whether or not transiently or incidentally to some other use of this publication) without the prior written permission of the copyright owner, or under the terms of a license issued by the copyright owner. The information contained in this document is subject to change without notice. EndyMed is neither responsible for nor liable to anyone in connection with this document. Contact Information: EndyMed Medical Ltd. 7 Bareket St. North Industrial Park. P.O. Box 3582, Caesarea 30889, Israel Tel: Fax: European Authorized Representative Mr. Alfred Eckert Zum Klosterbruhl 32 D Tholey, Germany Tel: Fax: Page 2
3 Table of Contents 1 INTRODUCTION DOCUMENT CONVENTIONS SAFETY INTENDED USE PATIENT SAFETY... 5 Contraindications... 5 Adverse Events... 6 Disclaimer PATIENT SELECTION AND EXPECTATIONS MANAGEMENT FACE AND BODY SKIN TIGHTENING FRACTIONAL SKIN RESURFACING THE ENDYMED PRO TIGHTENING/CONTOURING TREATMENT PREPARING FOR TREATMENT... 9 Marking the Treatment Area... 9 Measuring Body Circumference Before and After Pictures Positioning the Patient for the Procedure PERFORMING THE ENDYMED PRO TIGHTENING/CONTOURING TREATMENT THE ENDYMED PRO FRACTIONAL SKIN RESURFACING (FSR) PREPARING FOR TREATMENT Before and After Pictures Skin Preparation Marking the treatment Area Using the FSR Template PERFORMING THE ENDYMED PRO FSR TREATMENT CLINICAL EVENT REPORT CLINICAL EVENT FORM Page 3
4 1 INTRODUCTION 1.1 Document Conventions The following messages in this manual indicate for the reader to pay special attention to specific points: Warning A warning indicates precautions and instructions which, if not followed may result in serious body injury or death Caution A caution indicates instructions, or cautionary notes which, if not followed, may result in a damage to the equipment or to the quality of measurements Note Notes contain helpful information and tips Page 4
5 2 SAFETY Warning Personnel operating or maintaining the device are REQUIRED to read the User Manual and to become thoroughly familiar with all its safety requirements and operating procedures BEFORE attempting to use or operate the system. 2.1 Intended Use The EndyMed Pro Skin Treatment System is a non invasive device intended for use in dermatologic and general surgical procedures. 2.2 Patient Safety Contraindications Treatment with the device is contraindicated for patients with any of the following conditions. General contraindications: Subjects with implanted pacemakers, arrhythmias or any other severe known heart disorder. Subjects on any medication that would affect the characteristic of the skin (medical or hormonal), such as Isotretinoin (Accutane) within the past two months. Pregnant or lactating Subjects. Subjects who suffer from autoimmune disorders or diabetes. Subjects using blood thinning medications. Subjects with clotting disorders. History of any kind of cancer Impaired immune system due to immunosuppressive diseases such as AIDS and HTV, or use of immunosuppressive medications. Patients with history of diseases stimulated by heat, such as recurrent Herpes Simplex in the treatment area, may be treated only following a prophylactic regime. History of skin disorders, keloids, abnormal wound healing, as well as very dry and fragile skin. Use of non-steroidal anti-inflammatory drugs (NSAIDS, e.g., ibuprofen containing agents) one week before and after each treatment session. Page 5
6 Local treatment area contraindications: Subjects with any implantable metal device in the treatment area. Subjects who have any form of suspicious lesion on the treatment area. Subjects with body piercing (in the treated area). Any active condition in the treatment area, such as sores, Psoriasis, eczema, and rash. Face lift or eyelid surgery within a year prior to treatment. Facial dermabrasion, facial resurfacing, or deep chemical peeling within the last three months, if face is treated. Botox /collagen/fat injections or other methods of augmentation with injected material in the treated area within one month prior to treatment. Having received treatment with light, RF or other devices in the treated area within one month prior to treatment. Any surgical procedure in the treatment area within the last 3 months or before complete healing. Treating over tattoo or permanent makeup. Excessively tanned skin from sun, tanning beds or tanning creams within the last two weeks. Adverse Events The EndyMed PRO has proven to be safe when used properly. No significant adverse events have been reported in clinical trials or commercial use. As with other energy device minor adverse events such as prolonged redness or minor skin burns may rarely occur. Patients should be advised of the possibility of mild adverse events prior to treatment. Methods to reduce the occurrence of these events are discussed in detail in the sections: Positioning the Patient for the Procedure; Performing the EndyMed PRO Tightening/contouring Treatment and Performing the EndyMed PRO FSR Treatment of this Application Guide. Regulatory requirements mandate that unanticipated adverse events be reported. We therefore ask that providers notify EndyMed and record the details of certain adverse events. A mild degree of discomfort, or erythema (redness) lasting less than 24 hours, are known to occur and may be anticipated. Any other unintended effects, such as skin burns or blisters, should be documented and reported to EndyMed. For your convenience, a sample Adverse Event form is attached to this manual. The most commonly expected effects of the device are light and temporary erythema (redness) in the treatment area and small scabs that appear after using the FSR Handpiece. These scabs fall off within a few days after the treatment. These types of events do not require reporting. Page 6
7 Disclaimer The physician is responsible for defining the eligibility of a patient for treatment and defining the treatment area. The physician will perform a thorough history and physical examination and any additional testing he/she feels is needed to corroborate the health status of the prospective patient. The physician will rely on his/her medical expertise and judgment in determining treatment candidates. Criteria for determining authorized operators are restricted according to local regulations. Page 7
8 3 PATIENT SELECTION AND EXPECTATIONS MANAGEMENT 3.1 Face and Body Skin Tightening It is important to remember that the EndyMed PRO is intended for face and body reduction of wrinkles and skin tightening. The system does not provide general slimming or weight loss. Keeping this in mind will help you select patients who will have the best results and will also help you to gear their expectations. Setting clear expectations is the key to patient satisfaction. Patients who present with a large abdomen may have most of their fat in visceral (deep) deposits rather than subcutaneous deposits. These patients might derive less benefit from the EndyMed treatment, unless combined with another fat-reducing modality (liposuction, diet, and exercise). 3.2 Fractional Skin Resurfacing The EndyMed Pro Fractional Skin Resurfacing (FSR) System is a minimally invasive device intended for use in dermatological procedures requiring ablation and resurfacing of the skin. Doctors around the world have reported that the effect of the FSR treatment improves the appearance of wrinkles, enlarged pores, acne scars and overall texture and vitality of the skin. Experience has demonstrated that the FSR has improved the appearance of pigmentation in some cases; however, since RF energy is "color Blind" one should not expect a complete or any removal of any kind of pigmentation marks. Page 8
9 4 THE ENDYMED PRO TIGHTENING/CONTOURING TREATMENT 4.1 Preparing for treatment Marking the Treatment Area 1. When treating the body it is recommended to mark the treatment area in order to achieve optimal coverage. 2. To attain the best position for viewing the body accurately and reproducibly, ask the patient to stand up straight and look straight ahead. 3. Divide the treatment area into 10cmx10cm squares, using a skin marker (Figure 1). It is enough to mark the corners of the squares. If 10cmx10 cm squares are not possible because of the size of the treatment area (e.g., arms, knees) use rectangles of approximately the same area. Figure 1: Marking the Treatment Area During the treatment make sure that there is a full overlap of the treatment squares, so all the area is covered homogeneously. When treating the face there is no need to use skin marker. Treatment areas should be chosen in accordance to patient s needs. Page 9
10 Measuring Body Circumference For body contouring and body tightening measure the patient s body circumference in the relevant area. In order for the measurements to be reproducible, we recommend the following: The measurement tape should be parallel to the floor during the measurement. To assure that the measuring tape is parallel to the floor, mark several reference points around the treatment area and place the measuring tape in such a way that it is aligned with them. Always place the measuring tape either under or over the marked reference points. Note Consider using more than one reference line in large areas such as the abdomen and thighs. Consecutive measurements should be performed at the same height. To enable the operator to return to the same point at next treatment or at follow-up make a note in the patient file of the height of the measurement. Whenever possible, measure the circumference of each thigh separately to provide a more representative measure of the change resulting from the treatment. Before and After Pictures Photographs of the treated area should be taken before procedure and at each follow-up visit to assess the apparent changes in body contour qualitatively. It is important that the photographs are taken prior to the marking of the treatment area. In general, photographs should be taken at standardized distances, camera height, position and lighting. Tips for consistent photography: To provide an accurate record of pre- and post-operative patient appearances, the relative positions of patient and camera must be kept constant. Maintain constant lighting every time you photograph. Use the same lights (overhead or side lamps) and have the patient stand at the same position relative to the lights, to maintain similar shadows from photo to photo. If possible, always photograph on the same background. A dark wall or a dark (blue or black) cloth hung on the wall will bring greater attention to the body you are photographing and will accentuate the body contours. Page 10
11 Reduce all distracting items from the frame such as office furniture, body jewelry, clothing (other than undergarments), arms (have the patient stand with hands on their head to reduce distraction and for reproducible positioning), etc. Ideally, produce a floor marking that contains 45 rotating axes and a straight line denoting the camera axes. The patient will rotate on the 45 axes and the camera can move forwards and backwards on the camera axes according to the appropriate distance relevant to the body area of interest. Holding the camera, sit, stand or kneel at one of the positions marked along the camera axis. For greater stability, the camera may be mounted on a tripod. Camera height is adjusted to match the height of the target area, with the lens barrel always parallel to the floor. It is important not to tilt the camera up or down. Face Patient Preparation: Pull hair off face and behind ears (use headband or small clips that hold hair without pulling), remove jewelry and eyeglasses, remove heavy makeup, cover shirt collar with black drape. Patient Positioning: Seat patient on a stool adjusted to a comfortable height and placed in front of the camera. Patient should sit up straight. When turning for oblique and lateral views, patient should rotate entire body (shoulders and feet). Framing: Center ears vertically in all views. For frontal and oblique views, center entire head horizontally. For lateral views, place front of face 1/4 frame from edge (Figure 2). Figure 2: Framing the Face Page 11
12 Abdomen Patient Preparation: Remove gown completely. Patient should wear paper panties. The front portion of the underwear must be below the treatment area. Patient Positioning: Patient standing comfortably erect with arms folded above breasts. Feet should be aligned with the marking on the floor denoting photographic angle. Framing: Position infra-mammary fold at top of frame. Center the torso horizontally (Figure 3) Hips/Thighs Figure 3: Framing the Abdomen Patient Preparation: Remove gown completely. Patient should wear paper panties. Patient Positioning: Patient standing comfortably erect with arms folded above breasts. Feet should be at approximately shoulder width, aligned with the marking on the floor denoting photographic angle. Framing: Position the knees at bottom of frame. Center the hips horizontally. (Figure 4) Special Notes: The distal leg should not be visible in lateral views. Figure 4: Framing the Thighs Page 12
13 Positioning the Patient for the Procedure If the treatment table is height adjustable, change the height according to the treatment area. Treating the Face Place the patient in supine position. Ask the patient to fully turn their head so one cheek is almost parallel to the treatment table (Figure 5). Figure 5: Facial Treatment The cheek and temple are considered one treatment square. For peri-oral and peri-orbital areas that are very sensitive, reduce the power and use additional gel. Treating the Neck and Submental Areas Place the patient in supine position. Ask the patient to fully turn their head so the cheek does not interfere with the treatment. Figure 6: Neck Treatment For the submental area, extend the patient's head backwards. A small round pillow placed below the neck could be helpful to increase patient's comfort. Page 13
14 Treating the Arms Place the patient in supine position. The upper arm is divided into 3 longitudinal sections; Proximal, distal and lower, each is composed of a rectangle of approximately 100cm 2 area. Overlap of adjacent rectangles is recommended. The proximal part is treated with the arm lying on the treatment table and bent in a comfortable position (Figure 7). The distal part is treated with the arm bent on the chest. Use a pillow, if needed (Figure 7). The lower part is treated with the arm bent upwards towards the head (Figure 7). Figure 7: Treating the Arms Due to difference in fat and muscle thickness in different zones of the arm, adjust power level to fit appropriate temperature range of C. Treating the Abdomen When the patient is standing straight, divide the abdomen into 10cmx10cm squares and mark them with skin markers: 2-3 squares for lower abdomen 1-2 squares for upper abdomen If skin laxity in the umbilical area is prominent, add an additional square around the umbilicus. Place the patient so that he / she are lying on the back with the legs extended. In this position, the abdomen is fully accessible and treatment can be easily performed (Figure 8). Figure 8: Treating the Abdomen Page 14
15 Treating the Flank Area Divide the entire flank to be treated into 10cmx10cm squares (or rectangles of equal area) while the patient is standing. Depending on the area to be treated, the patient should be positioned face down with the treatment area raised on a pillow. Figure 9: Treating the Flank Area Treating the External Thigh Area ("Saddlebag") Divide the entire area to be treated into 10cmx10cm squares (or rectangles of equal area) while the patient is standing. Position the patient face down, with the leg to be treated folded towards the chest ("frog leg" position). For patient comfort you may support the leg on a pillow (Figure 10). Figure 10: Treating the External Thigh Page 15
16 Treating the internal thigh area Divide the entire area to be treated into 10cmx10cm squares (or rectangles of equal area) while the patient is standing. Position the patient in supine position, with the leg to be treated folded (Figure 11). Figure 11: Treating the Internal Thigh Page 16
17 4.2 Performing the EndyMed PRO Tightening/contouring Treatment To perform the EndyMed PRO tightening/contouring procedure: After marking the squares in the region of treatment (See Marking the Treatment Area, page 9), lay the patient on the treatment bed and position them according to the treated area (See Positioning the Patient for Procedure, page 13). Perform the procedure according to the directions described in detail in the User Manual. You may also refer the EndyMed Training video. After completion of the treatment use a soft cloth, moistened with enzymatic detergent solution such as 0.5% ANIOSYME DD1, to clean the Handpiece. Use the enzymatic solution according to manufacturer's instructions. Use a soft cloth, moistened with water to remove detergent residuals, followed by a soft cloth, moistened with 70% Isopropyl alcohol, to disinfect the handpiece. Dry the handpiece with a clean towel. The tightening/contouring treatment protocol includes 6 treatments: 4 treatments at 1 week interval, followed by 2 treatments at 2 weeks interval (totally, approximately 2 months). Additional treatments may be given for maintenance or according to need. Page 17
18 5 THE ENDYMED PRO FRACTIONAL SKIN RESURFACING (FSR) The EndyMed PRO Fractional Skin Resurfacing (FSR) application may be used for treatment of generally sun-exposed body areas such as the face, neck, cleavage and hands and areas susceptible to acne scarring. The treatment is recommended for sun-damaged skin, improvement of skin texture, decreasing the appearance of wrinkles and treatment of acne scars. 5.1 Preparing for treatment Before and After Pictures Photograph the treated area before the procedure and at each follow-up visit to assess the apparent changes in body contour qualitatively. It is important that the photographs are taken prior to the marking of the treatment area. In general, photographs should be taken at standardized distances, camera height, position and lighting. Tips for consistent photography: If clinical photos are to provide an accurate record of pre- and post-operative patient appearances, the relative positions of patient and camera must be kept constant. Maintain constant lighting every time you photograph. Use the same lights (overhead or side lamps) and have the patient stand at the same position relative to the lights, to maintain similar shadows from photo to photo. If possible, always photograph on the same background. A dark wall or a dark (blue or black) cloth hung on the wall will bring greater attention to the body you are photographing and will accentuate the body contours. Try to eliminate all distracting items from the frame: office furniture, body jewelry, clothing (other than undergarments), arms (have the patient stand with hands on their head to reduce distraction and for reproducible positioning), etc. Ideally, produce a floor marking that contains 45 rotating axes and a straight line denoting the camera axes. The patient will rotate on the 45 axes and the camera can move forwards and Page 18
19 backwards on the camera axes according to the appropriate distance relevant to the body area of interest. Hold the camera and sit stand or kneel at one of the positions marked along the camera axis. For greater stability, the camera may be mounted to a tripod. Adjust the camera height to match the height of the target area, with the lens barrel always parallel to the floor. It is important not to tilt the camera up or down. Face Patient Preparation: Pull hair off face and behind ears (use headband or small clips that hold hair without pulling), remove jewelry and eyeglasses, remove makeup, cover shirt collar with black drape. Patient Positioning: Seat patient on a stool adjusted to a comfortable height and placed in front of the camera. Patient should sit up straight. When turning for oblique and lateral views, patient should rotate entire body (shoulders and feet). Framing: Center ears vertically in all views. For frontal and oblique views, center entire head horizontally. For lateral views, place front of face 1/4 frame from edge (See Figure 2). Skin Preparation 1. Wash the treatment area thoroughly with water and soap to remove lotion and makeup. Dry the skin using a paper towel. 2. Clean the skin thoroughly with 70% alcohol to dry it for better absorbance of anesthetic cream. 3. Apply Emla (or similar anesthetic cream) for min. Occlude the area with a plastic wrap for better absorption of the anesthetic cream. 4. Clean the Emla residual gently with 70% alcohol and dry the skin. Marking the treatment Area Using the FSR Template The FSR Template enables easy positioning of the FSR Handpiece during treatment to ensure uniform coverage of treatment area. Follow the steps below. 1. Place the Template on the intended treatment area. 2. Use a light, oil-free make-up base and a small sponge to spread the make-up through the Template holes, creating a uniform matrix grid on the skin. Page 19
20 3. Position one corner of the lower edge of the FSR tip on one of the outside dots of the grid, so the surface of the tip covers the first area to be treated. Deliver pulse. 4. Lift the FSR Handpiece and position the same tip corner on the next grid dot so that the lower edge of the tip now covers the next area. Deliver pulse. 5. Repeat Step 4 for full and uniform coverage of treatment area. 5.2 Performing the EndyMed PRO FSR Treatment Perform the procedure according to the directions described in detail in the User Manual. You may also refer the EndyMed Training video. General Guidelines for power and pulse duration adjustments: To increase deep dermal heating with minimal increase in microablation: To increase extent of microablation: Increase pulse duration Increase power To increase both microablation and deep dermal heating: Increase both power and pulse duration Fine tuning: After first 2-3 pulses, inspect the skin for at least 5 minutes Skin Effect Patient's sensation Mild to moderate erythema and edema Mild to supportable discomfort Continue with same settings Skin Effect No erythema / edema Increase pulse duration by 10 msec Patient's sensation Skin Effect Patient's sensation Treatment not felt at all In case of severe edema or over bony areas (Jaw, Zigomatic arch, temples) High level of discomfort and try again. Increase power by 1 W and try again. Decrease pulse duration by 10 msec and try again. Decrease power by 1 W and try again. Page 20
21 6 CLINICAL EVENT REPORT Dear EndyMed customer, EndyMed is committed to the satisfaction of its customers, patients, and physicians alike. To this end, the attached form will help us ensure that all cases of adverse events are reported to the company. Based on our experience from clinical trials, there are minimal adverse events occurring from the use of EndyMed PRO system. EndyMed is dedicated to minimizing the number of adverse events, and your help in this matter is crucial. The attached Form assesses some of the parameters that might contribute to an adverse event. Please provide us with as much detail as possible on the particular procedure and the clinical event. EndyMed will analyze the reports and learn from you what factors may predispose to these mild adverse events. Thanking you in advance for your collaboration, With best regards, The Applications and Medical Affairs Teams Page 21
22 6.1 Clinical Event Form Date of the Event: / / dd mm yy Clinic Name: Address: Tel No.: Case Number: (to be filled in by EndyMed) Please describe the visible skin lesion. Use descriptive terms as much as possible (blister, redness, abrasion, etc.) Clinical Parameters Patient age years Patient gender Male Female Patient weight Patient height kg cm Known skin sensitivity or allergy? No Yes: Skin color Fair Olive Dark Area treated Application/Handpiece in use? Abdomen Flanks Thighs Face Other (specify): Was a Test Pulse performed? (FSR only) No Yes Did the patient have any implanted metal in the area? Power Used Pulse length used (FSR only) No W msec Yes: Page 22
23 Final skin temperature after the pulse/pulse series? º C Did the patient complain of discomfort or excessive heat? No Yes, discomfort Excessive heat Was there anything unusual during the treatment? Did the patient have previous liposuction in the area? No No Yes, specify: Yes, specify (including time of the procedure): Did the patient have recently another aesthetic treatment in the area? No Yes, specify (including time of the procedure): Occurrence of the event When did the event resolve? During treatment After treatment: hours/days Not resolved Resolved after: days Without scar With scar, describe: Please provide EndyMed with photographs of the area. Completed by Signature Date Page 23
Pearl Fusion Technique
Pearl Fusion Technique Combined Treatment Advanced Technique General Considerations The Pearl Fusion Technique is an advanced procedure intended for operators with previous knowledge and experience with
More informationAREA OF BODY TATTOO IS SITUATED?
CLIENT CONSULTATION LASER TATTOO REMOVAL FORM Address: Date of Birth: Suburb: State: Postcode: Telephone: Work: Mobile Home: Other: Email Address: How did you hear about us? Tattoo Removal Colours in tattoo
More informationForename Surname... SOPRANO ICE SHR LASER CONSULTATION FORM
Forename Surname... SOPRANO ICE SHR LASER CONSULTATION FORM 1 SOPRANO ICE SHR PERSONAL INFORMATION Gender: Male/Female Date of birth.age. Home address..postcode.. Telephone..Mobile.. Email address.. GP
More informationIPL CONTRAINDICATIONS
IPL CONTRAINDICATIONS CONTRAINDICATIONS AND EXCLUSION CRITERIA FOR IPL APPLICATOR TREATMENTS CONTRAINDICATIONS - Please initial that you don t have any of these conditions. Superficial metal or other implants
More informationTreatment Guide Version 2.0. Reform Your Youth. Micro and Macro Focused Ultrasound Non-surgical Lifting, Tightening & Contouring System
Treatment Guide Version 2.0 Reform Your Youth Micro and Macro Focused Ultrasound Non-surgical Lifting, Tightening & Contouring System Table of Contents Introduction 1. Introduction of the ULTRAFORMER III
More informationEVERYONE WILL NOTICE. No One Will Know.
THE WORLD S #1 SELLING DERMAL FILLER COLLECTION EVERYONE WILL NOTICE. No One Will Know. Get the natural-looking, long-lasting results you desire. Ask your aesthetic specialist about JUVÉDERM today. Actual
More informationIPL CONSULTATION AND LIABILITY DOCUMENTATION
Name...... Address:... Date of Birth:... Suburb:... Postcode:... Home Phone:... Mobile:... Email Address:... How did you hear about us?... Contact in case of emergency:... Place a tick in the areas of
More informationComplete Dermal Integration. Proven Duration.
Complete Dermal Integration. Proven Duration. Introducing BELOTERO BALANCE Dermal Filler. BELOTERO BALANCE Dermal Filler is uniquely manufactured with CPM Technology to give you precision to treat a wide
More informationBrilliant Bodywork. Name: Date: Address: City: State: Zip: Home Phone: Business Phone: Cell Phone: Date of Birth: address:
Brilliant Bodywork Skin Care History Questionnaire and Waiver Please answer the following questions so that your Skin Care Specialist may have a better understanding of your general health and lifestyle,
More informationNEWS RELEASE. CONTACTS: Investors: Lisa DeFrancesco (862) Media: Mark Marmur (862) Ember Garrett (714)
NEWS RELEASE CONTACTS: Investors: Lisa DeFrancesco (862) 261-7152 Media: Mark Marmur (862) 261-7558 Ember Garrett (714) 246-3525 JUVÉDERM VOLBELLA XC APPROVED BY U.S. FDA FOR USE IN LIPS AND PERIORAL RHYTIDS
More information(Injection of collagen, hyaluronic acid or other filler materials) INFORMED CONSENT FOR DERMAL FILLER
INFORMED CONSENT FOR DERMAL FILLER (Injection of collagen, hyaluronic acid or other filler materials) INTRODUCTION Dermal fillers are injected just under the skin s surface in order to temporarily correct
More informationTouch Up-Color Refresh Policy
Touch Up-Color Refresh Policy All Full Price New Procedures clients receive one Follow up visit for $50 with your initial price per procedure. You must wait at least 30 days before you can be touched up.
More informationLaser Skin Resurfacing what to expect
Laser Skin Resurfacing what to expect Laser skin resurfacing is a treatment to reduce facial wrinkles and skin irregularities, such as blemishes or acne scars. The technique directs short, concentrated
More informationCLEAR TOE INTAKE INFORMATION
CLEAR TOE INTAKE INFORMATION Name: Today s Date: Last First MI Street address: City: State: Zip: Date of birth: Age: Sex: Female Male Home Phone: Cell Phone: Leave messages at: Home Cell Other: Email address:
More informationSALIBIAN MOSSI. Name Last First Middle. Address Apt. City State Zip. Home Phone Cell Phone Work Phone. Address
Name Last First Middle Address Apt. City State Zip Home Phone Cell Phone Work Phone Email Address Age Date of Birth Sex Height Weight Marital Status Drivers License # Social Security # Employer Occupation
More informationFULL USER MANUAL. About GLO-ME
About GLO-ME FULL USER MANUAL Your decision to purchase the GLO-ME Gentle Diamond Peel To Go has set you on the path to healthier and glowing skin. In order to fully benefit from your new GLO-ME device,
More informationClient Information & Health History
Client Information & Health History Name: Address: City: State: Zip Code: Cell#: Work#: Home#: Email: Preferred method of contact: email cell# work# home# Date of Birth: Occupation: How did you hear about
More informationMassey Medical. Medical History (Dermal Filler) MEDICAL INFORMATION: I am interested in the following services: Juvederm: Botox:
Medical History (Dermal Filler) Name: Date: _ Date of Birth: Phone: _ MEDICAL INFORMATION: I am interested in the following services: Juvederm: Botox: NO YES Allergies history of severe allergy or anaphylaxis.
More information513 Maple Ave West, Vienna, VA
CLIENT INFORMATION AND CONSENT FORM: SKIN CARE Name Date of Consultation Address City State Zip Home phone ( ) Cellular phone ( ) E-mail Date of birth Emergency contact and telephone number How did you
More informationSkin remodeling from the inside out CONSULTATION GUIDE
Skin remodeling from the inside out CONSULTATION GUIDE Achieve younger looking skin with Secret RF Secret RF microneedling is an innovative new aesthetic treatment that improves signs of aging skin including
More informationClient Intake Form. Name: Date: Address: City: ST: Zip: Phone:
Client Intake Form Name: Date: Last First Address: City: ST: Zip: Email: Phone: How did you hear about Skin Renew Day Spa? What are your main concerns? How long have you been experiencing your current
More informationEast Hill Medical Group
Name: of Birth: Address: City: State: Zip: Home Tel. #: Cell #: Employer: Occupation: Emergency Contact: Relationship: Phone: Email: How Referred: Parents Ethnic Background: Previous Treatments Year: Area(s):
More informationdirect brow lift Lift your spirits procedure using the fixation device
direct brow lift procedure using the fixation device Lift your spirits What is upper eyelid rejuvenation? In general, aging around the eyes is exhibited in two areas: The eye lids and the eyebrows. The
More informationContact Information. Idaho Falls. Idaho Falls, ID (208) (307) NAME. City / state / zip
Contact Information NAME physical street address City / state / zip Home phone cell phone email address want monthly specials? date of birth Age gender Male female How did you hear about us? WHICH AREAS
More informationInformed Consent for Dermal Filler
Informed Consent for Dermal Filler NAME: DATE OF BIRTHG: ADDRESS: CELL PHONE: EMAIL: www.medicaleyecenter.com Please initial all of the following sections confirming that you have read and understand each
More informationInformed Consent For Facial Rejuvenation/Collagen Remodel
Informed Consent For Facial Rejuvenation/Collagen Remodel Client s name: Date: I authorize SilkySkin Laser Centers to perform the laser procedure. You will be treated with the Cynosure Elite TM laser,
More informationAreas of Concern. Patient s Name Last First Date
Areas of Concern What are your main concerns for today s visit? Please check the problem areas that concern you. Include anything you wish to discuss, even if it is not the main reason for your visit.
More informationQ: What Topical Treatments Should I Use In Conjunction With Microdermabrasion?
FAQS Q: What Is Microdermabrasion? A: Microdermabrasion is an effective, non-surgical way to get rid of acne scars, fine wrinkles and sun spots by exfoliating the top layers of the skin. No chemicals or
More informationPersonal Profile and Health History
--CAPITAL AESTHETICS Personal Profile and Health History Name: Home Phone: Address: Work Phone: City/State/Zip: Date of Birth: Age: Gender: M F Occupation: Email address: How did you hear about us? What
More informationHEALTH HISTORY INFORMATION
HEALTH HISTORY INFORMATION Name: Today s Date: Last First MI Street address: City: State: Zip: Date of birth: Age: Sex: Female Male Home Phone: Cell Phone: Leave messages at: Home Cell Other: Email address:
More informationInformed Consent for Light Energy Tattoo Removal
Dr. Joseph G. Protain 813 Kentwood Dr. Boardman, OH 44512 (330)953-3515 Informed Consent for Light Energy Tattoo Removal Customer s name: Date: I, consent to and authorize and members of his/her staff
More information5504 Backlick Road Springfield, Virginia
Name: Address: Phone: City: Zip Code: Cell: Phone: Text Cell Phone email How did you hear about us: General Health State: Contact me by 1. Rate your level of stress: (5 = highest, 1= lowest) 5 4 3 2 1
More informationCosmetic Surgery: Eyelid Surgery (Blepharoplasty)
Cosmetic Surgery: Eyelid Surgery (Blepharoplasty) This is a guide for people who are considering an eyelid surgery. We advise that you talk to a plastic surgeon and only use this information as a guide
More informationQ-switched Nd:YAG Carbon Laser Facial Further treatment possible using your Tattoo Removal Laser
Q-switched Nd:YAG Carbon Laser Facial Further treatment possible using your Tattoo Removal Laser Carbon Laser Peel plus a mild form of Skin Rejuvenation Course Topics What is a Carbon Laser Facial? How
More information513 West Maple Ave West, Vienna, VA
`MEDICAL HISTORY FORM Last Name: First Name: Address: City: State: Zip Code: Telephone: Home: Work: Cell: Date of Birth: Sex: Female Male Family Doctor: Phone: Pharmacy: Phone: Emergency Contact: Phone:
More information. DEFY LINES. along the sides of your nose and mouth ON YOUR FACE.
. DEFY LINES. ( PARENTHESES HAVE NO PLACE) ON YOUR FACE. n Instantly smooths away the deeper lines along the sides of your nose and mouth n Provides natural-looking results Actual patient. Results may
More informationPeri-Orbital Non-Invasive and Painless Skin Tightening-Safe and Highly Effective Use of Multisource Radio-Frequency Treatment Platform
Journal of Cosmetics, Dermatological Sciences and Applications, 2015, 5, 206-211 Published Online September 2015 in SciRes. http://www.scirp.org/journal/jcdsa http://dx.doi.org/10.4236/jcdsa.2015.53025
More informationCOSMETIC INTEREST QUESTIONNAIRE
COSMETIC INTEREST QUESTIONNAIRE Patient Name: Date: General appearance or products of interest to you (please check all that apply). Skin care consult Facial veins Neck elasticity Skin care products Facial
More informationNewport Cosmetic Center
Shirin Afrasiabi, M.D, Inc. 2301 Newport Blvd, Costa Mesa, Ca 92627 (949) 548-5700 Appointment: Initial. We require a valid Credit Card at the time of booking to secure your appointment Cancellation and
More informationImbue Aesthetics & Wellness PATIENT REGISTRATION FORM
Today's Date Legal Name Marital Status Sex DOB Age Mailing Address Preferred Phone Number Email Do we have your permission to add you to our email list to receive newsletters and promotions? YES NO Emergency
More informationDesigned for. What kind of fullness do you desire? Natrelle Gel breast implants are. increased fullness, classic fullness, and shaped fullness.
What kind of fullness do you desire? Natrelle Classic Style 15 Individual results may vary. Natrelle 410 Style FM Individual results may vary. Natrelle INSPIRA Style SRM-310 Individual results may vary.
More informationTREATMENT GUIDELINES. September 2012 D0592 Rev. B Cutera 3240 Bayshore Boulevard Brisbane California PH:
TREATMENT GUIDELINES September 2012 D0592 Rev. B Cutera 3240 Bayshore Boulevard Brisbane California 94005 PH: 415.657.5500 www.cutera.com Pearl Treatment Guidelines The following guidelines are based on
More informationAlani Medical Spa Medical History and Information
Alani Medical Spa Medical History and Information Birth date: _/_/_ SS#/_/_Email_ Today s Date: _/_/_ Name: (Mr.) (Mrs.) (Miss) Home Address: _ Work Address: _ Home Phone: ( ) Work Phone: ( ) _ Phone Number
More informationMaya Med Spa 6330 Broadway Blvd. Suite B, Garland, TX Name: Date of birth: Address: Pharmacy of your choice:
Client Consultation Name: Date of birth: Address: Home Phone: Cell Phone: Business Phone: E-mail address: Married: Yes No If yes, anniversary date: Employer: Occupation: Pharmacy of your choice: Does your
More informationPRODUCT YES / NO BRAND NAME PRODUCT NAME FREQUENCY OF USE
Consultation Form Today s Date: Name: Your Birthday: Spouses Name: Spouses Birthday: Anniversary: Address: City: St: Zip Home Phone: Office Phone: Cell Phone: Email Address: Purpose for visit: How did
More informationby Bee Stunning Shine Bright Like a Diamond! TM MICRODERMABRASION USER MANUAL
TM by Bee Stunning Shine Bright Like a Diamond! TM MICRODERMABRASION USER MANUAL WELCOME TO BEE STUNNING Congratulations on receiving your DiamondBuff Microdermabrasion tool! This tool has been long treasured
More informationInstruction of B108 Portable Diamond Dermabrasion Unit
Instruction of B108 Portable Diamond Dermabrasion Unit Preface The Micro-crystal Dermabrasion was designed by Italian Florence's Mattioli at first, until now had over 20 years history. This kind of technology
More informationDate: Date of Birth: Gender: Male Female. City: State: Zip: Caucasion a African-American Hispanic Asian East Indian American Indian
Contact Information: Date: Date of Birth: Gender: Male Female Name: Address: City: State: Zip: Home Phone: Work/Day Phone: Cell: Email: Emergency Contact: Emergency Contact Phone: Medical Background Ethnic
More informationEnhancing your appearance with a facelift
PROCEDURE FACT SHEET PLASTIC SURGERY FACELIFT This is a guide for people who are considering a facelift surgery. We advise that you talk to a plastic surgeon and only use this information as a guide to
More informationpresents: A new orbital skin resurfacing technology with mechanical micropulsations
presents: A new orbital skin resurfacing technology with mechanical micropulsations VERSION 2009 Advantages of Face Up Orbital Abrasion crystal free - no inhalation or irritation vacuum free - no dragging
More informationLaser Resurfacing Post Op
Laser Resurfacing Post Op RECOVERY TIMETABLE: Approximate recovery after laser resurfacing surgery is as follows: DAY 1: Return home. keep treated areas moist by reapplying ointment or vaseline frequently.
More informationTEOSYAL PEN: Personal experience after 12 months on 285 consecutive patients
TEOSYAL PEN: Personal experience after 12 months on 285 consecutive patients Dr. Dell Avanzato Roberto AMWC 2016, 14 th Aesthetic & Anti-aging Medicine World Congress 31 March, 1 2 April, 2016 BACKGROUND
More informationPatient Information Leaflet. Dermal Filler
Patient Information Leaflet Dermal Filler When considering treatment with dermal fillers we want you to have a safe treatment. Some risks are unavoidable and out of your control. The following information
More informationINFORMED CONSENT Juvederm INJECTION
INSTRUCTIONS This is an informed-consent document which has been prepared to help Dr. Jennifer Geoghegan inform you concerning Juvederm (Non-Animal Stabilized Hyaluronic Acid, Allergan Aesthetics) tissue
More informationBrow and Beauty Bar - Permanent Makeup
General Consent and Procedure Permit Clients Full Name Mr/Mrs/Miss/Ms Address e-mail I hereby authorize Erin Exline to perform upon myself permanent cosmetic enhancement. If any unforeseen condition arises
More informationPage 1 of 7. Hand-Held High Frequency C9220T
Page 1 of 7 Hand-Held High Frequency C9220T Universal Companies, Inc. 2005 All rights reserved for copyright purposes. No reproductions by print or photocopies are allowed without written permission. Page
More informationMicroblading Consent and Release Agreement
Microblading Consent and Release Agreement This form is designed to give information needed to make an informed choice of whether or not to undergo a Microblading semi-permanent make up application. If
More informationCLINICAL FORMS AND CHARTING
CLINICAL FORMS AND CHARTING CLINICAL Lira Clinical forms to help you chart, analyze and evaluate your client for a successful skin care plan. 110 110 NAME TREAMENT DATE PROFESSIONAL RESURFACING TREATMENT
More informationThere are few side-effects in mesotherapy. In most cases, they are minor and reversible:
Firmzon Inci: Aqua, Carnitine, Cynara Scolimus, Melilot, Socium Hyaluronate, Organic Silicium, Caffein, Troxerutin, Leucine, Valine, Arginine, Glutamine. Properties: Recommended for the treatment of cellulite
More informationPre Treatment Advice and Procedures
Pre Treatment Advice and Procedures 1. Since delicate skin or sensitive areas may swell slightly, or redden, it is advised not to make social plans for the same day. Lip liner may appear crusty for up
More informationAGELESS SKIN BEGINS HERE
AGELESS SKIN BEGINS HERE USER MANUAL For your safety and for the success of your treatment program, please read this user manual prior to use. It will provide you with important information about using
More informationClient Medical History Form
Client Medical History Form Date Birthdate Name Address Phone Email Emergency Contact Person Phone Do you have or previously had any of the following: (Circle YES or NO) YES NO History of MRSA YES NO Botox
More informationAdvanced Skin Rejuvenation Wrinkle Enhancement and Skin Resurfacing Procedures
Advanced Skin Rejuvenation Wrinkle Enhancement and Skin Resurfacing Procedures Note: Prior to reading this section, you should have read Parts I and II of this book, in particular, the section beginning
More informationSTATEMENT OF CONSENT AND RECITALS: Please read and initial all lines. Signed
STATEMENT OF CONSENT AND RECITALS: Please read and initial all lines Aftercare instructions have been explained to me and a written copy will be given to me to retain in my possession, which I will follow
More informationWelcome to Medspa 1064, Connecticut s Premier Center for Cosmetic Laser Medicine
MedSpa 1064 Suites at Somerset Square 140 Glastonbury Blvd. Glastonbury, CT 06033 860.657.1064 Welcome to Medspa 1064, Connecticut s Premier Center for Cosmetic Laser Medicine This form is to introduce
More informationWould you like to receive informational updates, specials and newsletters? Yes No
Patient Contact Information Name Home Phone Work Phone Cell Phone Home Address City State Zip E-Mail Date of Birth Emergency Contact Name and Phone Who Referred You To This Clinic? Would you like to receive
More informationPDF of Trial CTRI Website URL -
Clinical Trial Details (PDF Generation Date :- Tue, 02 Oct 2018 21:40:33 GMT) CTRI Number Last Modified On 26/12/2012 Post Graduate Thesis Type of Trial Type of Study Study Design Public Title of Study
More informationHair To Bare South. Client Name: Date:
Hair To Bare South Client Name: Date: I authorize Rachelle Stokes (Hair To Bare South) to perform the treatments. The purpose of these treatments is to diminish or remove unwanted hair. The quantity of
More informationLegal Notice. Copyright 2016 Home Skinovations Ltd. All rights reserved. Print date: 08/2016
Copyright 2016 Home Skinovations Ltd. All rights reserved. Print date: 08/2016 Legal Notice Home Skinovations Ltd. reserves the right to make changes to its products or specifications to improve performance,
More informationTHE VENUS VIVA EXPERIENCE
THE VENUS VIVA EXPERIENCE Decrease visible pores for even skin texture Reduce signs of aging for a fresher, more youthful look Even out textural irregularities for refined looking skin Reduce acne scars
More informationChameleon Medical Spa NEW CLIENT HISTORY
NEW CLIENT HISTORY This information will allow your professional skincare specialist to provide the optimum products and services. First Name: Last Name: Date: Birth date: Address: City: State:_ Zip code:
More informationCOLORADO AESTHETIC CENTER
COLORADO AESTHETIC CENTER 9320 Grand Cordera Parkway, Suite #250 Colorado Springs, CO 719.387.7800 Skin and Health Questionnaire Please answer the following questions thoroughly, as this provides a better
More informationT R A I N I N G M O D U L E IPL 1
TRAINING MODULE IPL 1 Remington's i-light PRO+ Face & Body gently removes unwanted hair in the comfort and privacy of your own home. Permanent results in just 4 weeks * *Individual results vary. In clinical
More informationCLIENT QUESTIONNAIRE TODAY S DATE: SPECIFIC CONCERNS REGARDING YOUR SKIN (CHECK ALL THAT APPLY) I AM INTERESTED PRIMARILY IN:
CLIENT QUESTIONNAIRE TODAY S DATE: NAME: DATE OF BIRTH: SPECIFIC CONCERNS REGARDING YOUR SKIN (CHECK ALL THAT APPLY) Fine Lines/Wrinkles Dark Circles Puffy Eyes Blotchiness/Discoloration Uneven Skin Tone
More informationFULL PRICE LIST. Please note: All prices may be subject to change without notice SPA TREATMENTS
FULL PRICE LIST Please note: All prices may be subject to change without notice SPA TREATMENTS Elemis Touch: Skin Solutions 1hr 60 ELEMIS Superfood Pro-Radiance Facial ELEMIS Sensitive Skin Soother Facial
More informationNew Patient Registration
New Patient Registration Today s Date: Social Security Number: Name: Last First MIddle How do you like to be addressed: Date of Birth: Address: Street City State Zip Email Address: Preferred Contact Number:
More informationClient Information Sheet
Esthetic Laser Clinic 8381 Old Courthouse Road Suite 300 Vienna, VA 22182 (703) 288 0085 www.elaserclinic.com Client Information Sheet Last Name First Name: Address City State Zip Code D.O.B. (MM/DD/YY)
More informationHEALTH HISTORY. Name Date DOB Age. Home Phone Work Mobile Other
HEALTH HISTORY To ensure both the effectiveness and the safety of your treatment, please complete this health history as accurately as you can. PERSONAL INFORMATION Name _ Date DOB Age Address _ City State
More informationCOMMON CONTRAINDICATIONS FOR FACIALS
COMMON CONTRAINDICATIONS FOR FACIALS Ms. Wade Cosmetology Department Fullerton College PREVENTION The following conditions cannot receive a facial treatment: Viruses Bacterial Infections Fungal Infections
More informationVider Itzhak MD2, Harth Yoram MD2,, Elman Monica MD, Gottfried Varda PhD3, Shemer Avner MD4, Beit Harofim
EFFECTIVE AND SAFE TREATMENT OF FACE, ARMS AND NECK, WRINKLES, RHYTIDES AND SKIN LAXITY USING A MULTISOURCE PHASE CONTROLLED RADIOFREQUENCY DEVICES 1234 Vider Itzhak MD2, Harth Yoram MD2,, Elman Monica
More informationGUIDELINES FOR BEAUTY INDUSTRY
www.kpdnkk.gov.my Ministry of Domestic Trade, Co-operatives and Consumerism No. 13, Persiaran Perdana, Precinct 2, 62623 Putrajaya, Malaysia. Hotline: 1-800-886-800 Tel: 603-8882 5500 Fax: 603-8882 6490
More informationPre- & Post Hair Removal Instructions and Home-Care Regimen
Pre- & Post Hair Removal Instructions and Home-Care Regimen Pre-Hair Removal Regimen: Avoid sun exposure or tanning beds to the area being treated. The laser may be less effective on burned or tanned skin.
More informationInstructions for Use DO105625B
Instructions for Use DO105625B 1 Treating with Silk n FaceFX for the First Time The skin should be, clean, dry and free of any powder, gel or cream. If necessary a light oil based serum may be applied
More informationMAXIMUM POWER TRIPLE MODE Q-SWITCHED, LP AND QLP ND:YAG LASER SYSTEM 3 PULSE DURATIONS 4 DISTINCTIVE WAVELENGTHS MULTIPLE INDICATIONS
ALMA-Q MAXIMUM POWER TRIPLE MODE Q-SWITCHED, LP AND QLP ND:YAG LASER SYSTEM 3 PULSE DURATIONS 4 DISTINCTIVE WAVELENGTHS MULTIPLE INDICATIONS INTRODUCTION ALMA-Q presents the most powerful triple mode Nd:YAG
More informationINFORMED CONSENT HYLAFORM INJECTION
INSTRUCTIONS This informed-consent document has been prepared to help inform you about Hylaform (animal-origin, stabilized hyaluronic acid, INAMED) tissue-filler injection therapy, its risks, and alternative
More informationChapter 22 Hair Removal
Chapter 22 Hair Removal Although fate presents the circumstances, how you react depends on your character. Anonymous Objectives Describe the elements of a client consultation for hair removal. Name the
More informationInformation and Consent for Ultra-lift Treatment. Ultrasound
Information and Consent for Ultra-lift Treatment What is Ultra-lift? This is the latest and most effective combination skin treatment package to offer safe and proven skin tightening and rejuvenation to
More informationEase of Use. restore for face and body. refine for more superficial treatments
Thank you for choosing MD Pen TM, the latest innovation in fractional microdermal needling. MD Pen TM revitalizes the skin by initiating cellular regeneration, and aiding in the absorption of cosmetic
More informationPhone [850] Fax [850] Web Send s to: Search Millseye to download App Page 1 of 5
I hereby authorize David M. Mills, MD, FACS and/or any assistants as may be appointed to perform the following procedure or treatment: Lumenis Encore Ultrapulse Fractional CO 2 Laser Skin Resurfacing Informational
More informationMedication Name Reason Taken Dosage Last Date Taken
CLIENT HISTORY FORM Print Name Location of Service: Email Birth Date Age Gender @ Female Address City State / Male Emergency Contact Name and Number Home Phone ( ) Cell Phone ( ) Today s Procedure Description:
More informationPatient Contact Information. Name. Home Address. City State Zip
Patient Contact Information Name Home Phone Work Phone Cell Phone Home Address City State Zip E-Mail Date of Birth Emergency Contact Name and Phone Who Referred You To This Clinic? Would you like to receive
More informationEndoscopic Brow Lift Post Op
Endoscopic Brow Lift Post Op RECOVERY TIMETABLE: Approximate recovery after endoscopic brow lift is as follows: DAY 1: Return home, leave any surgical dressing undisturbed until it is removed in the office.
More informationBlue Diamond SKIN CLEARING LED DEVICE. Instruction Manual
Blue Diamond SKIN CLEARING LED DEVICE Instruction Manual Congratulations! You have taken the first step towards having a more beautiful, radiant and youthful complexion. With continuous use, you will achieve
More informationCan I remove the hair from my nipples? Absolutely, the flash represents no risk. Caution is advised on dark nipples.
F r e q u e n t l y A s k e d Q u e s t i o n s Clinical topics I want to remove all hair from the bikini zone, are there any risks? E>One is safe to use on every part of the body, without exception. Therefore,
More informationAn average of 6-10 treatments is recommended for best results.
LASER LASER HAIR REMOVAL We offer the latest laser hair removal technology from Syneron Candela. Our laser treats light and darker skin types, faster and in fewer sessions. Client discretion and comfort
More informationConsent and Release Agreement
Consent and Release Agreement This form is designed to give information needed to make an informed choice of whether or not to undergo a 3D Eyebrow Embroidery Semi-permanent make up application. If you
More informationMicroblading Consent Form Client Medical History: Date Birthdate Age Name Form of Id # Address
Microblading Consent Form Client Medical History: Date Birthdate Age Name Form of Id # Address Phone Email Emergency Contact Person Phone Do you have or previously had any of the following: (Circle YES
More informationINFORMED CONSENT SOFT TISSUE FILLER INJECTION
INSTRUCTIONS This informed-consent document has been prepared to help inform you about Hylaform (animal-origin, stabilized hyaluronic acid, INAMED) tissue-filler injection therapy Restylane (Non-Animal
More informationClient Questionnaire Skin & Health
Client Questionnaire Skin & Health Please answer the following questions thoroughly and completely, as this provides a better understanding of your general health, lifestyle and skin care concerns; thereby
More informationNEW CLIENT GENERAL INFORMATION FORM
NEW CLIENT GENERAL INFORMATION FORM First Name: Last Name: Email: Date of Birth: Occupation: Home Phone: Cell Phone: Carrier: Gender: Female Male Preferred Staff Gender: Female Male Preferred Staff Member:
More information