CoolSculpting Treatment Consent Form

The CoolSculpting® procedure uses a non-invasive vacuum applicator to draw in tissue and deliver controlled cooling

at the surface of the skin. The procedure is for spot reduction of fat. It is not a weight-loss solution and it does not replace

traditional methods such as liposuction. Someone who is overweight can expect to see less visible improvement than

someone who has smaller fat deposits. Clinical studies have shown that CoolSculpting will naturally remove fat cells

but, as with most procedures, visible results will vary from person to person. Initial: 

The suction pressure may cause sensations of deep pulling, tugging and pinching. You may experience intense stinging,

tingling, aching or cramping as the treatment begins. These sensations generally subside as the area becomes numb

The treated area may look or feel stiff after the procedure and transient blanching (temporary whitening of the skin) may

occur. You may feel a sense of nausea or dizziness as your body naturally warms and sensation returns to your

treatment area. These are all normal reactions that typically resolve within minutes.

Bruising, swelling, and tenderness can occur in the treated area and it may appear red for a few hours after the

applicator is removed

You may feel a dulling of sensation in the treated area that can last for several weeks after your procedure. Other

changes – including deep itching, tingling, numbness, tenderness to the touch, pain in the treated area, strong cramping,

muscle spasms, aching and/or soreness – also have been reported after a CoolSculpting treatment

Patient experiences will differ. Some patients may experience a delayed onset of the previously mentioned occurrences.

Contact us immediately if any unusual side effects occur or if symptoms worsen over time

You may start to see changes as early as three weeks after CoolSculpting, and you will experience the most dramatic

results after one to three months. Your body will continue naturally to process the injured fat cells from your body for

approximately four months after your procedure

You may decide that additional treatments are needed to reach your desired outcome

In rare cases, patients have experienced vasovagal symptoms during the treatment, and reported freeze burn,

darker skin color, hardness, discrete nodules or enlargement of the treatment area. Surgical intervention may be

required to correct the enlargement. I understand that these and other unknown side effects may also occur

Pictures will be obtained for medical records. If pictures are used for education and marketing purposes, all identifying

marks will be cropped or removed