Soft Surgery Consent Form

I am over the age of 18 and consent and hereby grant permission to Dr. Natale Desrochers and delegated staff at Binbrook Medical Aesthetics clinic to treat me with the Plexr, which is a plasma skin treatment.
This consent form may contain words that you do not understand. Please ask your specialist or physician to explain any words or information that you do not clearly understand.

Plexr plasma is an innovative medical device that was developed in Italy over 9-years ago and is used as an alternative to surgery. It uses the ionization of the gases in the air to form plasma, which creates a small electrical arc that treats problem areas. This is done without spreading unwanted heat to the surrounding skin, called “soft surgery”. Your Plexr specialist will mark a small grid to create a retraction of the skin in the epidermis by creating combustion of the skin on the stratum corneum, (the top layer of the skin), without damaging surrounding tissue. This creates fine grey-brown scales, called “carbon dust”, which disappear a few days after each session.

Plasma is the fourth state of matter … To put it very simply, plasma is an ionized gas. This means that plasma is a gas into which sufficient energy is provided to free electrons from atoms or molecules and to allow both ions and electrons to coexist. Plasma’s carry electrical currents and generate magnetic fields. Plasmas are the most common form of matter, comprising more than 99% of the visible universe.

The treatment is carried out under topical anesthesia (no needles) and can be used for numerous aesthetic concerns, lesions removal, treating loose facial skin, scarring, and to perform blepharoplasty (eye lifts). This technique has been used in Italy & Greece for many years.
Risk and Discomfort – with this treatment include, but are not limited to:
Pain – similar to snapping the skin with a rubber band
Reddening – may go away in 7-10 days or less
Swelling – may go away in 7-10 days or less
Pigment Changes – Although extremely rare, the treated area may heal with increased pigmentation (increased skin coloring). This occurs most often with darker skin types and after exposure of the area to sun. You may have experienced this type of reaction before and noticed it with minor cuts or abrasions. The treated area must be protected from exposure to both UV rays and indoor blue lights ( cell phones, computers etc). This type of reaction tends to gradually fade away and return to normal over a period of three to six months if left untreated.

*The following are only risks if post care not followed properly*
Scarring – There is a very small chance of scarring or abnormal raised marks. Scarring is a possibility because of the disruption of the skin’s surface. Compliance with aftercare is crucial for the prevention of scarring.
Bleeding – The treatment may cause some pinpoint bleeding which usually stops within a few hours after the treatment, without any lasting effect.
Infection – If bleeding is present as a result of removing the scabs prematurely, an infection of the wound is possible. Any indication that there might be infection please contact the office immediately.

It is important to know that for the patient to achieve the utmost results, blood (redness), swelling (water) and scabbing (crusty surface of healing skin) are necessary to build, repair and restore collagen. The first 48 hours after the treatment are the most important, as this is when the skin is rebuilding, and old skin will start to exfoliate.

I agree to notify the clinic of any of the following:
Delayed healing response or immunocompromised.
Allergy to topical numbing cream.
If I am a smoker (may affect healing and overall results).
History of post inflammatory hyperpigmentation.
Sensitivity to epinepherine.
Pacemaker or defibrillator.

Consent
I have read and understand the information contained within this consent form. I hereby release Binbrook Medical Aesthetics and their staff from all liability associated with this procedure. Further, my signature below indicates my consent to the treatment described and my agreement to comply with the requirements placed on me by this consent form.

The time it takes to heal can range dramatically from client to client. We aim to have you begin this journey with realistic expectations for your recovery.
Our goal is for you to make an informed decision and know what you’re getting into. A copy of this page will be given to you.
Day 0 (Treatment Day)
Expect feeling heat, redness, and tiny crusts. Stay absolutely dry for 48 hours. No gym/sauna. Do not pick.
Days 1–2 — PANIC STAGE #1
You will look your worst: swollen, red, “dotty” (eyes/mouth swell most). This is expected. Keep dry. Don’t pick. Sleep elevated. Clients will think “Why did I do this to myself?” This is normal.
Days 3–4
Swelling eases. Some clients take longer to ease swelling. That is normal for some. Keep crusts intact. Begin gentle cleanse per instructions. No steam/sweat. Still hands off. You’ll get through this. Many clients feel they’ve been damaged, scarred. This is not the case 99.8% of the time.
Days 5–7 — PANIC STAGE #2
The crusts will soften and lift on their own. Underneath is pink, new skin. It is NOT scarring. No picking.
Once all crusts are off, start mineral SPF 30+ (reapply diligently). You will be thinking that this is taking too long. You’re ready to get back to normal life. It is getting better; trust the process.
Week 2
Mostly peeled; still pink. Barrier care only. No retinol/acids/scrubs. SPF continues (3–4×/day). Pink areas are normal. This is new smooth skin. Some clients feel there are indents or scars. They are not. Your skin was like that or worse before the treatment and you’re looking very closely at yourself now. You may feel it’s taking too long to heal. This is normal. Stay with it.
Weeks 3–4
“Back to baseline” look returns. Pink blends. Makeup sits better. Avoid exfoliants until end of Week 4. Some clients still have pink areas. This is normal.
Weeks 6–12
Results keep improving as collagen remodels. Optional refinement (e.g., light microneedling) only if appropriate—discuss with Dr. Nat (Dr. Natale Desrochers).