Aesthetica Activated Light Facials use a prescription lotion and intense pulsed light or LED technology to treat sun damage, precancerous lesions, fine lines, wrinkles, pigment, and acne. Patients can expect improvement in these areas as well as skin tone and texture after a series of three treatments. Treatments are minimally painful with numbing cream. Side effects include temporary redness, swelling, and darker pigmentation that fades within a few weeks. Risks are minimal but include infection and changes to skin pigment.

1. What are Aesthetica Activated Light Facials?
Aesthetica Activated Light Facials are skin treatments
performed with a Levulan Kerastick prescription lotion and a
high-energy, intense pulsed light(IPL) or LED technology.
• Treatments remove sun damage, precancerous lesions, fine
lines, and wrinkles.
• Treatments with the intense pulsed light device also remove
pigment and tighten the skin.
• The IPL device also effectively treats oily skin and acne and
rosacia.
How much improvement can I expect with Aesthetica
Activated Light Facial treatments?
Patients may see excellent improvement in:
• Sun damage
• Precancerous lesions
• Acne rosacea and acne
• You may also see improvement in the tone and texture of
your skin, scars, wrinkles, and large pores.
Are Aesthetica Activated Light Facials painful?
With the application of an anesthetic skin cream thirty
minutes prior to treatment, Activated Light Facials can be
performed with minimal discomfort.
What are the side effects of Aesthetica Activated
Light Facials?
• You may experience redness similar to a sunburn which can
last a few hours to several days after treatment.
• Since the Kerastick prescription lotion continues to work for
several hours after treatment,it is important that treated skin
be protected from both direct sunlight,indirect sunlight,and
artificial light for 48 hours after treatment or you may
experience a severe sunburn.
• You may experience temporary swelling, especially if your
skin is quite loose or if you have baggy eyelids.
• If your skin has scattered age spots or uneven pigmentation,
the pigmented spots will turn darker for approximately five
to ten days until they flake off.
• Any precancerous spots may crust and peel for a few days
to a few weeks after treatment.
• Blisters, scars and abnormal skin pigmentation are
rare side effects.
How many treatments will it take for me to see the
best results?
To achieve maximum improvement of pre-cancers, sun dam-
age, skin tone and texture, a series ofthree treatments is most
effective. Three treatments are also recommended for acne
and rosacea however more treatments may be necessary for
stubborn acne/rosacea followed by a few treatments each year
and other topical skin care treatments.
How do I get started?
A brief consultation is required before performing Aesthetica
Activated Light Facials. Call (518) 726-6272 today and
schedule your consultation to see what Aesthetica Activated
Light Facials can do for you.
Treatment
Activated Light Facial
AestheticaLaser& Skin Care • 675 Route 3,Plattsburgh NewYork 12901 • 518-726-6272 (0905)
Before
AcneTreatment AcneTreatment
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I understand that the purpose ofthis Aesthetica treatment with NdYag Laser treatment, as well as any
cosmetic procedure, is improvement, not perfection. I understand that medicine is not an exact science and
therefore, my response to and results from Aesthetica vein treatments cannot be guaranteed. I understand that
Aesthetica Laser treatments have risks that include redness, swelling, blistering, temporary or permanent
changes in the skin’s pigment, scarring, infection and failure to improve with treatment, return ofthe vein,
development of new veins. I understand that it may not be possible to correct my vein and it may not be
possible to correct any side effect that results from vein treatments.
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I understand that this is a multiple treatment process and that there is a charge for every treatment session.
I understand that payment is due at the time of service.
I understand that:
• The purpose of this Aesthetica treatment,as well as any cosmetic procedure,is improvement,not perfection.
• Medicine is not an exact science and therefore,my response to and results from Aesthetica Laser treatments
cannot be guaranteed.
• I understand that Aesthetica treatments have risks that include: redness, swelling, blistering, temporary or
permanent changes in the skin’s pigment, scarring, infection, welts, bruising, skin discoloration, blisters,
temporary or permanent brown streaking ofthe skin, skin ulcers that may leave scars, damage to the
underlying tissues, damage to blood vessels, damage to nerves, minor to severe allergic reactions, blood clots,
pulmonary embolism (lung obstruction), failure to improve and other unknown or unforeseeable side effects.
• I cannot have sclerotherapy treatments while I am pregnant.
• If I have any “permanent make-up”, micropigmentation or cosmetic tattooing in the areas I plan to have
treated, I need to notify the Aesthetica technician BEFORE my treatment. Light Facial lasers may remove
these types ofinks and pigment from my skin.
Multiple treatments may be necessary. The area should be treated delicately after treatment. I have been informed
that possible risks and complications ofthis procedure may be blistering, scarring, hypopigmentation
(lightening ofthe skin) and hyperpigmentation (darkening ofthe skin) and a hive like rash. I understand that
sun exposure and not adhering to the post care instructions may increase my chance of complications.
I understand that I can use topical anesthetic cream if I arrive 30 minutes before my appointment. I also understand
that topical anesthetic cream has a rare possibility of causing light-headedness, fainting and seizures if used
on large areas ofthe body for long periods oftime. I understand that the use oftopical anesthetic cream by
pregnant women is not recommended. If I use oral pain medication I will need a driver.
If you are sunburned or obviously tanned we may not be able to treat you.
Photographs may be taken throughout the course of the laser treatment so we may follow therapy progression. These
photographs may be used for educational purposes. In the event that the patient does not want photographs
to be published, the patient must put it in writing that photographs may not be used under any circumstances.
A brief medical history will be taken and an examination of your skin will be performed.
On the day ofthe treatment, you may be:
• required to wear comfortable clothes and shoes as well as white undergarments
• asked to remove eyeglasses or jewelry you may be wearing
• asked to lie on an examination table or sit in a chair.
A label or marker may be used to outline the area to be treated. This area may be photographed.
You will be asked to wear special eye goggles to protect your eyes against possible accidental exposure to laser light.The
area(s) ofthe skin will be exposed to various doses oflight from the laser system, and will be photographed
again. Ifthe area is not anesthetized, you may experience discomfort from the laser exposure, which has been
described as the sensation ofbeing "snapped with a rubber band". Bruising, called purpura may occur and
will fade within 2 or three weeks. Local swelling, crusting and redness may also result from the exposure.
Description of
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Treatment with the Nd Yag
Vein Treatment
AestheticaLaser&SkinCare•427MargaretStreet,Suite101,Plattsburgh,NewYork12901•518-726-6272 AESVT(0905)
Name
Address
Primary Care Doctor:
Date of birth
Occupation
Please indicate your contact preference:
Home phone ( )
Work phone ( )
Cell phone ( )
E-mail address
Emergency
contact:
Relationship
Home phone ( )
Cell phone ( )
Are you taking medications that
make you sensitive to the sun? Yes No
Please list any medication allergies:
What oral or topical medication(s) do you take routinely or
occasionally?
Birth control pills Accutane
Gold Cillins (penicillin family)
St.John’s Wort Tetracycline
Retinoids Claritin
Ibuprofen Aspirin
Creams/lotions:
Do you have any chronic skin conditions and/or have you
suffered from hives,swelling or unusual skin coloration?
Current medicine?
What service(s) are you interested in?
?tsapehtniaeradetaertuoyevahwoH:aerA:nrecnoC:knaR
Texture/Roughness
Red spots
Brown spots/Irregular skin tone
Fine lines/Deep wrinkles
Sagging/Loose skin
Pore size
Acne
Rosacea
Hair removal
Where did you live from birth
to 20 years of age:
What is your ethnic origin:
How would you describe your skin?
I. Always burns,never tans,light colored hair and eyes
II. Usually burns,tans with difficulty,light skin,
blue or light colored eyes
III. Sometimes burns but usually tans,eyes darker in color,
slight color to skin
IV. Rarely burns,tans easily,dark eye coloring,definite dark
color of skin
V. Very dark skin color,dark course hair,dark eyes
(example:African American)
Health Questionnaire
AestheticaLaser& Skin Care • 427 Margaret Street,Suite 101,Plattsburgh,NewYork 12901 • 518-726-6272 HQ(1205)
K E N T G A R D N E R • S i g n a t u r e N i n j a @ g m a i l . c o m • 8 0 2 . 9 1 7 . 1 9 2 0