According to the American Society of Dermatologic Society (ASDS), its members collectively have performed over 100 million laser and light source cosmetic procedures.1 This number should continue to expand as life expectancy increases, causing a seemingly everlasting population desiring to achieve a more youthful appearance. Combining these numerous laser procedures with unrealized patient expectations may be a recipe for a legal disaster.

Since the vast majority of laser procedures in dermatology are elective, the importance of patient informed consent and documentation cannot be overemphasized. Educating the patient in layman terms, further explaining the risks, benefits and alternatives are wise actions even before test spot and/or treatment is attempted. Moreover, the nature, course and aim of treatment should be clearly stated to define the objectives for the patient and physician. This allows the patient to make a rational decision based on the pertinent information that has been presented to them. Informed consent in laser treatment not only protects the physician, but the patient as well.

Informed consent is not merely a piece of paper to be signed by the patient. A nonverbal protocol functioning as an informed consent does not fully protect a physician and does not serve the best interest of a patient. Informed consent involves a meeting of the minds as a result of a discussion between the provider and the patient. Written consent is merely a confirmation of what has been discussed. A patient’s signature on a preprinted consent form, which has not been preceded by a discussion, does not grant free rein, and in the event of a legal dispute, such forms may be declared invalid.2 Unique patient and physician concerns regarding the laser procedure should be documented as part of the informed consent. This can help identify and personalize the treatment plan for each specific patient. Identical informed consents without additional notes may sometimes appear like a reflex, rather than a communication between patient and physician.

The authors prefer to write a risk, benefit and alternatives (RBA) note together with a written informed consent. The note emphasizes the RBA that is especially pertinent to the patient. In this way, it is a reminder to the provider to discuss these issues with the patient, and supplies additional documentation to the medical record. Such a note does not have to be lengthy or extensive. It can consist of a sentence. An example of this would be: “The RBA discussed with the patient emphasizing the potential risk of post-treatment, permanent dyschromia due to the patient’s Fitzpatrick skin type.”

Informed consent retention has been shown to be less than 50% in other fields of medicine.3 In addition, in patients undergoing dermatologic surgery, one study showed an overall retention rate of 26.5% just 20 min after being informed of ten possible complications.3 It is apparent from this study that informed consent might benefit from supplementary modes of communication to improve retention rates. When treatment is usually reserved for a future day, the overall retention rate for patients can be expected to drop even more. Patient pamphlets for education can complement written and verbal informed consent. Handouts can be noted in the medical record indicating an exchange took place on the day of the consultation. It is helpful when numerous modes of communication are involved in order for the patient to solidify his/her decision on a non-medical procedure. Some physicians like Dr. David Duffy, M.D. advocate using a questionnaire that the patient must answer to demonstrate comprehension of the consent.