You may visit your surgeon as many times as you wish to have all of your questions answered. At your final preoperative visit, your final questions will be answered and you will confirm that you have understood the procedure to be performed, that this material has been explained to you, that you have read and understand these information sheets, and that you accept the risks by signing the informed consent forms. You will be given information on skin care products, prescriptions for antiviral medications, pain pills, antibiotics and instructions for their use. Certain laboratory tests will also be required within two weeks of surgery. If you are over the age of 50, you will have to obtain a cardiogram from your doctor’s office or any certified laboratory. You may have blood drawn by our office nurse during your final preoperative visit, or, if you prefer, at your family doctor’s office or any state licensed laboratory (e.g. Kaiser Hospital, etc.). All patients will be asked to stop smoking at least a month prior to surgery in an effort to maximize your body’s ability to heal the incisions following the operation.

Patients being treated with Acutane® for active acne should not consider a skin resurfacing procedure until they have stopped with Acutane for at least twelve months prior to any skin resurfacing procedure. If you have darker skin, your surgeon might prescribe a bleaching cream prior to surgery. For four weeks prior to the skin resurfacing procedure, the patient is asked to wash the face with soap and water each evening, then to dry the face thoroughly and apply a generous layer of Retin-A® or Renova® as prescribed by your surgeon. You should wash your face in a normal fashion in the morning and apply your skin care products, sun block and makeup. The office staff will discuss skin care products with you anytime you wish to do so.
To minimize the possible development of “cold sores” or herpes infections around the mouth, your surgeon will prescribe Acyclovir® (800 mg.) three times daily, which you are to begin three days prior to surgery and continue for seven days after surgery.

For a period of five days prior to the procedure, thoroughly cleanse your face three times a day, using any bland soap or a cleansing cream. Sun block, makeup and glycolic acid may be applied between these cleansings.

The evening before and the morning of treatment, wash your face, neck, ears and hair thoroughly for five minutes. There is no need to set or style your hair, but you may do so if you wish. Do not wear any makeup to the office on the day of treatment. Likewise, moisturizers should not be applied to the face on the day of the procedure.

It will be necessary to arrive at the Laguna Hills Surgery Center with an empty stomach. Do not eat or drink anything after midnight prior to the procedure, but do take any medications prescribed by our physicians.
If you develop any signs of infection, pustules or boils on the face prior to the operation, please notify the office; it may be necessary to reschedule your procedure.

Arrangements must be made to have someone bring you to the Surgical Center and to take you home following the procedure. When you arrive at the Surgery Center, let the receptionist know who is to be called to take you home. If you receive any intravenous sedatives or a general anesthetic, you MUST have someone spend the first night with you, and preferably the second day and night as well, after you return home. Usually, your anesthesiologist will call you the night before surgery to discuss the anesthetic care plan with you. But if you miss the call or your anesthesiologist does not call you, do not worry as you will be able to discuss your anesthesia and have all your questions answered in the morning, at the Surgery Center, prior to your procedure.

An anesthesiologist will be present to administer the sedatives (or a light general anesthetic) and to monitor all patients to ensure your safety and comfort.

The facial skin is cleaned with a drying and degreasing lotion. The areas to be treated are treated sequentially with the laser light beam, swabbed with the medical mixture or dermabraded and then covered with ointment or dressing as determined by your surgeon. You will be instructed to return to the office immediately after discharge for the first of your Oxy-Mist treatments which expedite your recovery. Initially, you will come to the office daily for your Oxy-Mist treatments and skin care.

There will be a stinging in the treated areas for the first six to eight hours. This will be managed with the proper analgesics. If the entire face is treated, a significant amount of swelling and soupiness are expected – some patients will decide to spend the first night with a registered nurse to assist with the wound care. Do not consume any alcoholic beverages while on the prescribed medications. A variety of products are available and appropriate products will be recommended to each patient depending on their skin type and healing ability.

Beginning the morning after your procedure, you are to wash your face gently with water and cleansers recommended by our skin care specialists, our aesthetician or registered nurse, a minimum of twice a day. You may shower. Crusting can be expected throughout the treatment areas. Do not rub the crusts and dead skin too vigorously as this may cause bleeding and subsequent scarring. Apply a generous layer of the recovery complex ointment as directed by your physician or the office skin care specialists. In general, products recommended by the office staff or products such as Aquaphor or Vaseline work well for this purpose – we recommend that you avoid medications such as Neosporin, Bacitracin and Polysporin ointments as some patients will have serious allergic reactions to these. Specific instructions on care of the treated area will be given at each office visit.

You are to go home and rest for the first few days. During these first few days you may even require assistance walking to the bathroom because of the effect of the medication and because of swelling around the eyes.

If the treatment has been around the mouth, you may prefer a diet through a straw initially (until you can chew comfortably). You can expect severe swelling in the area of the treatment. If the laser treatment or peel has been to the eyelids, the lids may be swollen shut and the eyelashes stuck together for the first one to three days. This can be relieved by having your caretaker cleanse the lashes with hydrogen peroxide on Q-tip® applicators. As you are healing you will receive instructions to apply various medications and ointments to the treated areas. The swelling will subside gradually over a few days. The crusts usually come off within seven to ten days after the initial procedure.

The skin will initially appear quite pink and have the appearance of sunburned skin. This color is normal and will fade with time. You must avoid tanning your face for six months or until the redness fades, and preferably forever! A sun block (SPF 20 or higher, reapplied every 90 minutes while outdoors) MUST be used whenever you are going out in to the sun. With the sun block in place, however, there is no reason not to continue enjoying outdoor activities. Excessive sun exposure in the early post-operative period could lead to noticeable pigmentary changes.

Soon after the crusts have come off, you may resume wearing hypoallergenic makeup. The office will be glad to assist you in makeup and sunscreen application. The office staff can also help you establish a long-term skin care program employing glycolic acid and other products. You are encouraged to call the office, should any questions or problems arise.

Every activity in life, whether driving automobiles or having surgery, is associated with risk. The following inherent risks must be understood and assumed by you, the patient, if we are to proceed with this treatment.
A change in skin pigmentation occurs in every instance. Sometimes this pigmentation change becomes permanent. For some patients, this necessitates daily makeup applications. The incidence of complications is infrequent, but the following may occur: irregularities in surface contour (i.e. bumpiness of the skin); irregularities in pigmentation either causing the treated areas to be darker or lighter than the surrounding skin, which may be temporary (up to a year) or even permanent; full-thickness burns, which may result in permanent scarring; nausea and/or vomiting from a reaction to the medication. A permanent, unsightly scar may result or a scar that cannot be improved with surgery or other treatment modalities. These complications may necessitate wearing heavy makeup permanently to camouflage skin discolorations or scarring.

Perhaps the most disturbing post-operative event is a failure to meet the patient’s preoperative expectations. These treatments tend to be much more effective for treating wrinkles and surface discoloration than acne scars. For patients with very deep wrinkles or acne scars, less than 25% will see a very significant improvement. Another 25% will be disappointed and see very little (if any) improvement. The remaining 50% will see an improvement, but may feel that their results were below their expectations.

It is not possible to list every conceivable complication. The foregoing is not designed to frighten or upset you, but to enable you to make your decision from an informed position.

All fees will be discussed freely in advance by the office staff and they will assist you with financing if desired. The surgeon’s fee will vary with the extent of the area to be treated. Additional costs will be incurred for Surgery Center fees, anesthesiologist services, preoperative laboratory tests and subsequent procedures. It is important that you understand that the patient is responsible for all costs associated with secondary surgical procedures.

In compliance with suggestions adopted by the American Society of Plastic Surgeons, it is customary for the patient to pay all fees for cosmetic surgery prior to the desired operation. This insures that the patient is sincere in her motivation and can afford the surgery, thus creating a better patient/physician relationship. A non-refundable deposit will be required to secure your desired surgery date. The remainder of the fees must be paid prior to the surgery, usually at the time of the preoperative visit, but never later than one week before surgery. Additional fees are also required for laboratory tests, surgical facility fees, the anesthesiologist, and if necessary, mammography. If additional surgical procedures become necessary, additional facility, laboratory, anesthesia, implant costs and professional fees will be incurred. The surgical facility and anesthesiologist fees quoted will be based on our best faith estimate; the final fee may vary as these fees are based on surgical time, and it is not always possible to predict exactly how long a procedure will take to complete. It is important that you understand that the patient is responsible for all costs associated with all secondary surgical procedures or for the treatment of any complications that may arise as a result of this elective surgery.

IF YOU HAVE ANY QUESTIONS, DO NOT HESITATE TO CALL THE OFFICE DURING BUSINESS HOURS (949-888-9700) OR AFTER HOURS, CALL YOUR SURGEON – DR BUNKIS CELL PHONE NUMBER IS (949) 500-8856, OR REGISTERED NURSE, TRACEY PRESCOTT’S NUMBER IS (949) 338-6072.

WITH AN EMERGENCY THAT REQUIRES IMMEDIATE ATTENTION, CALL 911 BUT PLEASE HAVE YOUR FAMILY NOTIFY DR. BUNKIS OF ANY PROBLEMS YOU MAY HAVE!

I, ________________________________________________ certify that I have read and understand the “Laser Skin Resurfacing/Chemical Peel/Dermabrasion” information sheets dated March 2008, that my surgeon has answered all of my questions to my satisfaction, and that I give my informed consent for this procedure.

Patient Signature_______________________ Date__________________

Witness_______________________________ Date__________________

I certify that I or a member of my staff has discussed all of the above with the patient and have offered to answer any questions regarding the procedure. We believe that the patient fully understands the explanation and answers.

Surgeon’s Signature_____________________ Date_________________

Initial if copy requested/given to patient____________________________
Copy placed in chart __________________________________________

Copyright 11/87 Last revised 03/08
Juris Bunkis, M.D., F.A.C.S.