State-of-the-art, personalized skin care
from experienced professionals
“A regular skin checkup can literally save your life.” Jennifer Krasnoff, MD
  1. All humans heal by permanent scar formation, thus all surgeries will result in a scar.
  2. Scar tissue is pink for 3-6 months, and then usually fades to white. Sun exposure may cause a scar to darken.
  3. The appearance of a surgical scar usually continues to improve for 6-12 months, as the scar “matures”. The surgery scar is usually strong by 4 weeks.
  4. Scars overlying active muscle areas tend to stretch or widen with time. This cannot always be prevented.
  5. Scars can heal thick (keloid or hypertrophic) or heal thin (atrophic). How they heal depends partly on their location on the body and the healing process of the patient. The final appearance of a scar depends upon many factors. While we strive in every case to achieve the best cosmetic result possible, this cannot be guaranteed.
  6. If a surgical site is injured before healing is complete, the scar may remain open, the wound may bleed, and the scar may become more obvious.
  7. A change of feeling (sensation) often occurs around a scar. It may be numb or sensitive. In some areas of the body there is a risk of motor nerve damage.
  8. Infection or bleeding can occur after surgery.
  9. Serious or life threatening reactions may occur to any ointment, dressing, or medication, including local anesthetics used during surgical procedures.
  10. Sometimes more than one surgical procedure is necessary to remove a large lesion, to remove a lesion in a difficult area, or to obtain the best possible cosmetic result.
  11. The lesion removed may be sent to an outside lab for further analysis.
  12. The lesion may recur or regrow.

I agree that pre- & post-operative clinical photographs and videos may be taken to monitor my treatment progress and for patient educational purposes. I understand that my identity will be protected.

I certify that I have read and understand the contents of this consent form. I have been given the opportunity to ask the doctor/staff any questions that I have about the procedure, and all of my questions have been answered. The doctor/staff has explained the procedure and its alternatives to me, and I both understand and accept the risks involved in this procedure. I hereby authorize my doctor and his/her assistant to remove the above lesion.

Please download this PDF form to sign.

 


 

 

 

Petaluma Office
165 Lynch Creek Way
Petaluma, CA 94954
 M-F, 8:00am-5:00pm
(707) 762-5531
Fax: (707) 762-5976

 

 

Hercules Office
500 Alfred Nobel Dr., Ste. 245
Hercules, CA 94547
M-F, 8:00am-5:00pm
Open Saturday for aesthetic services
 (510) 741-7418
Fax: (510) 741-7456

 

Billing office
510-741-7299
Fax: 510- 741-7493

 


At Dermatology Associates of the Bay Area, our board-certified dermatologists serve patients at our Petaluma and Hercules offices. We are committed to the highest standards, and we offer a full range of cosmetic, medical, and surgical dermatology procedures, as well as quality skin care products.

Dermatology Associates of the Bay Area
165 Lynch Creek Way | Petaluma, California 94954 | Phone: (707) 762-5531 | Fax: (707) 762-5976
500 Alfred Nobel Drive, Suite 245 | Hercules, California 94547 | Phone: (510) 741-7418 | Fax: (510) 741-7456