The Ulthera® System delivers a low amount of focused ultrasound energy to the skin. The heat from the ultrasound stimulates new collagen to form. I understand that there can be discomfort during the treatment when the ultrasound is being delivered. I’ve discussed with my practitioner the options available to me to optimize my comfort during the procedure.

 Immediately following Ultherapy®, the skin may appear red for a few hours. It is not uncommon to experience slight swelling for a few days following the procedure or tingling/tenderness to the touch for days to weeks following the procedure, but these are mild and temporary in nature.

Occasional temporary effects may include bruising or welts, which resolve in hours to days, or numbness in a select area, which resolves in days to weeks.

As with any medical procedure, there are possible risks associated with the treatment. There is a remote risk of a burn that may or may not lead to scarring (either of which will respond to medical care), or temporary nerve inflammation, which will resolve in a matter of days to weeks. Temporary local muscle weakness may result after treatment due to inflammation of a motor nerve. Temporary numbness may result after treatment due to inflammation of a sensory nerve.

It has been explained to me that the results vary from patient to patient, and, occasionally, the collagen building on the inside that helps counter the effects of gravity does not have a visible effect on the outside. I understand that results will unfold over the course of 2 to 3 months and that some patients may benefit from more than one treatment. I also understand that a noninvasive Ultherapy treatment is not intended to produce the same results as an invasive surgical procedure.

I certify that the preceding medical, personal and skin history statements are true and correct to my knowledge.  I am aware that it is my responsibility to inform the technician, esthetician, therapist, doctor or nurse of my current medical or health conditions and to update this history as needed.  A current medical history is essential for the caregiver to execute appropriate treatment procedures.

  Date:

Cancellation Policy:

Your allocated appointment time is reserved exclusively for you and is very important to us. Because Ultherapy appointments require a significant amount of provider time and limit our ability to schedule other clients, we require at least 48 hours' notice for any cancellation or appointment change.

Please understand that when an Ultherapy appointment is canceled with less than 48 hours' notice or a client does not arrive for their scheduled appointment, we are often unable to fill that reserved time. This impacts both our providers and clients who are waiting for treatment appointments.

I understand that as a new or current client of Skinlogic Med Spa, I provide a credit card to securely keep on file. All card information is stored using a secure, encrypted payment system.

Due to the significant amount of time reserved specifically for Ultherapy treatments, appointments canceled with less than 48 hours' notice or missed without notice will be subject to a $200 cancellation/no-show fee, with no exceptions. I authorize Skinlogic Med Spa to charge the card on file for this fee if the required notice is not provided.

I have read and understand the above Cancellation Policy and agree to its terms and conditions. I authorize Skinlogic Med Spa to securely store my credit card on file and to charge the applicable cancellation fee in accordance with this policy.

I have read the above Cancellation Policy and agree to its terms and conditions.  I hereby give my consent for  Skinlogic Med Spa to securely store my credit card on file and authorize Skinlogic Med Spa to charge my card if I cancel less than 48 hours before any future scheduled appointments.

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