Consent Form


I declare:
SDL have explained the advantages and possible initial side effects when undergoing a cosmelan depigmentation treatment.

  1. The purpose of this technique is to remove the most superficial layers of the skin in order to stimulate cell renewal and as a final result, to obtain an even cutaneous tone and / or the elimination of hyperpigmentation.
  2. The treatment consists of the elimination of the outmost layers of the skin by the application of chemical agents, to create a superficial burn and subsequent reepithelialisation.
  3. It has been explained to me by the clinician / therapist, that in order to obtain best results, I must strictly follow the home protocol for a minimum of 6 months.
  4. I understand that some side effects can appear such as swelling, pain, high sensitivity, itching, scaling, superficial desquamation, erythema, acne or herpes simplex breakout, hyper or hypo pigmentation of the area treated. The downtime can last up to five days.

The clinician / therapist has warned me to avoid direct sun exposure after each session and I understand the high importance of applying mesoprotech melan 130 pigment control and the cosmelan maintenance cream after the treatment.

The protocol to follow is: 2 daily applications of cosmelan maintenance cream during the first month, 1 daily application for the next five months. Alternatively, I will receive a different protocol from my clinician / therapist.

I have been informed that the final result depends upon strictly following the home maintenance protocol, applying hydra vital factor k as many times as necessary during a minimum of six months. This is to restore the hydrolipidic film of the skin.

I understand that due to the nature of the treatment individual results may vary and cannot be guaranteed, and in very rare cases there may not be a visible result at all.

Rouse Hill

We have decided that cosmelan is the most convenient treatment for my particular case, although other alternatives are possible. My clinician / therapist has discussed these alternatives.

The cosmelan procedure has been explained to me. My questions regarding the treatment, its alternatives, its complications and risks have been answered by the clinician / therapist, or by written information.

I understand all the information given to me. I understand the risks and initial side effects as well as the downtime of the treatment.

My questions have been fully and completely answered. I have read this document and understand its contents.

I give my permission to take photographs of all treated sites for diagnostic purposes and to accurately document the treatment in the usual and customary manner. I agree that these photographs are the property of the clinic.

I will not make any claims or complaints either to the business owners, the employees or the manufacturer.