Skip to main content

1-905-471-8118

Map

Our Location

50 McIntosh Drive, Unit 239
Markham, ON L3R 9T3
5 Swan Lake Blvd, Unit 7
Markham, ON L6E 0K7
50 McIntosh Drive, Unit 239
Markham, ON L3R 9T3

mother-baby-happy-bubbles-1280x480
Home » Consent Forms » Dry Eye Treatment with IPL

Dry Eye Treatment with IPL

Intense pulsed light (IPL) is a noninvasive treatment that can help improve various skin conditions and provide relief from dry eye symptoms. At Markham Eye and Vision Care, we now offer the Lumecca-I device for IPL treatments.

This innovative technology delivers gentle pulses of light to stimulate the production of collagen, help reduce inflammation around the eyes, and improve the function of tear glands. By targeting the underlying causes of dry eye, IPL can provide lasting relief and improve your overall eye health.

Experience the transformative power of Lumecca-I and say goodbye to dry, irritated eyes. Contact us to schedule your appointment today.

IPL Informed Consent Form ( LUMECCA)

PRETREATMENT QUESTIONS: (Please check YES or NO to the following questions)

LUMECCA is an Intense Pulsed Light treatment used to reduce appearance and treat skin indications associated with redness and pigmentation. I am aware that skin preparation is advisable and agree to answer the following questions honestly.
1. Have you completed/updated your medical history form?
2. Are you taking any new medication, blood thinners, fish oil or turmeric?
3. Are you pregnant or breast feeding?
4. Do you suffer from cold sores or any active infection in the area being treated? ( if Yes, prophylactics may be recommended.)
5. Do you have any current or history of cancer or impaired immune system?
6. Have you had recent sun exposure?
7. Do you have any tattoos/cosmetic tattoos in the treatment area?
8. Have you applied a fake tan in the past 2 weeks?
9. Have you had a recent skin check?
10. Have you commenced using strong actives in the past 2 weeks?
11. Have you had previous laser/IPL treatment?
12. Do you have any known allergies?
13. Do you have Keloid scars (Raised scars)

TREATMENT

Lumecca Treatment time is approximately 30 minutes per area. (please note this will depend on the size of the person and the treatment area). Your skin will be cleaned to remove any excess product, moles and tattoos covered, eye protection provided and cool Ultrasound gel applied to the treatment site ready for treatment. During the Lumecca IPL treatment, it is normal to feel a mild to moderate warm flicking sensation, areas with dense pigment or bony areas you may report more heat. This is normal, please communicate with your provider if you experience pain or feel the treatment is too hot.

POST TREATMENT

I understand post treatment I may experience some side effects and the following has been explained to me. 1. Erythema (redness) is expected for 1-3 days, for more aggressive treatments this may last longer. 2. Mild to moderate edema (swelling) and a mild to moderate sunburn sensation (lasting 1-3 days depending on the treatment). 3. Micro crusting post IPL pigmentation treatment is desirable and will subside within 2 weeks on the face 2-4 weeks on the body. 4. Blood capillaries will coagulate and may appear darker, slight bruising can be expected in more severe cases and will subside within 3-7 days. 5. Complications are uncommon and will be managed by the treating clinic according, potential complications are: PIHP (post inflammatory hyper or hypo pigmentation) in most cases this will resolve with time, a prescription cream can be provided to aid the recovery. Burns, blisters, uneven treatment.
Consent(Required)
Name(Required)
MM slash DD slash YYYY
Clear Signature

x