Consent Form


I declare:
I understand and agree to follow the post care information:

  • Avoid heat inducing activities for 24-48 hours post treatment (avoid hot baths, massage, sun and UV exposure, scratching, excessive sweating, etc)
  • All mechanical and thermal exposure to the treated area must be avoided.
  • Avoid unprotected UV exposure If an exposed area is treated, sun block should be used routinely for a minimum 3 weeks following the treatment.
  • Active ingredients perfumed creams on the treatment area for approx. 5 days or as instructed.
  • Avoid make up for 12 – 24 hours (mineral make up is advised if you must apply it for down time)


I agree to follow the post care instructions discussed with me and authorise Sydney Dermal Lounge to perform LUMECCA IPL treatment and understand the treatment is of a cosmetic nature.

I understand Lumecca is a non invasive IPL (intense pulse light) technology that uses light to treat conditions in the skin such as Pigmentation, textural irregularities, vascular lesions etc

I agree to wear protective eye protection through out the treatment to protect my eyes.

I understand post treatment I may experience some side effects and the following has been explained to me.

Erythema (redness) is expected for 1-3 days, for more aggressive treatments this may last longer.

Mild to moderate edema (swelling) and a mild to moderate sunburn sensation (lasting 1-3 days depending on the treatment)

Micro crusting post IPL pigmentation treatment is desirable and will subside within 2 weeks on the face 2-4 weeks on the body

Blood capillaries will coagulate and may appear darker, slight bruising can be expected in more severe cases and will subside with in 3-7 days

Do not pick or pull at any areas of crusting as you may increase your chance of infection

Bland skin care should be used post treatment, apply recommended skin care for 1-3 days

Treat the skin gently, avoid scrubbing or trauma to the treated area.

Complications are uncommon and will be managed 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


I understand that treatment with this system involves a series of treatments and the fee structure has been fully explained to me.

I certify that I have been fully informed of the nature and purpose of the procedure, expected outcomes and possible complications, and I understand that no guarantee can be given as to the final result obtained.

I am fully aware that my condition is of cosmetic concern and that the decision to proceed is based solely on my expressed desire to do so. I confirm that I have informed the staff regarding any current or past medical condition, disease or medication taken.