IPL/BBL Photofacial Procedure Note

Date/Time: [Date and time of procedure] • Location: [Facility and room] • Operator(s): [Name(s) and role(s)] • Session: [Session X of planned Y / Series 1] • Prior IPL/BBL History: [First-time / none / dates of prior sessions with brief response]

Procedure Summary

[Single-sentence summary: modality (IPL/BBL), treatment area(s), and primary indication(s)]

Indications

Treatment intent: [Cosmetic / Medically indicated: brief symptoms/findings]

• [Indication/target 1]
• [Indication/target 2]
• [Indication/target 3]

(Include only targets explicitly addressed in this session.)

Pre-Procedure Assessment

• Fitzpatrick Skin Type: [I / II / III / IV / V / VI]
• Current Tanning Status: [Untanned / recent sun exposure / self-tanner use / not assessed]
• Photosensitizing Medications: [None / list specific agents / not assessed]
• HSV History: [Negative / positive with prophylaxis plan] (Include if treating perioral area.)
• Pregnancy Status: [Status per facility policy / not assessed]
• Relevant Allergies: [None / topical anesthetics / gel / latex / other]
• Scarring/PIH History: [No history / keloid tendency / prior PIH / not assessed]
• Response to Prior Treatment: [Improved / unchanged / adverse reaction: description / N/A]
• Exam Findings: [Baseline pigment/vascular distribution; areas to avoid]

(If any critical safety item was not assessed, document "not assessed" rather than omitting.)

Informed Consent

[Informed consent obtained / prior consent reaffirmed]. Risks discussed included pain, erythema, edema, purpura, crusting, blistering/burns, hyperpigmentation, hypopigmentation, scarring (rare), infection, HSV reactivation, and ocular injury. Alternatives reviewed (topicals, peels, laser options, no treatment), expected number of sessions discussed, and questions answered. Patient agreed to proceed.

Safety Verification

Pre-procedure verification/time-out performed confirming correct patient, procedure, and treatment site(s). Eye protection in place: patient [goggles / metal ocular shields]; staff protective eyewear worn.

Preparation

• Skin Prep: [Cleansed / makeup removed / shaving performed]
• Coupling Gel: [Applied / type / not used]
• Anesthesia: [None / topical agent, concentration, application duration]
• Cooling Method: [Contact cooling / chilled gel / forced air / ice packs / none]

Device and Treatment Parameters

Device: [Manufacturer and model] • Handpiece/Applicator: [Name/model] • Filter/Cutoff (nm): [Value(s)]

Area	Concern	Filter (nm)	Fluence (J/cm²)	Pulse Structure (ms)	Spot Size	Cooling	Passes	Pulses
[Area]	[Pigment / Vascular / Mixed]	[Filter]	[Fluence]	[Pulse width(s), interpulse delay]	[Size]	[Setting]	[Number]	[Count]

(Add rows for each area/concern treated. Do not estimate settings; if values cannot be retrieved, document reason and reconciliation plan.)

Total Pulses: [Total pulse count for session]

Test Spot

(Include only if test spot was performed.)

• Location: [Anatomic site]
• Settings: [Filter, fluence, pulse structure, cooling]
• Pulses: [Number]
• Immediate Tissue Response: [Observed endpoint(s)]
• Tolerance: [Well-tolerated / moderate discomfort / significant discomfort]
• Decision: [Proceed / adjust settings: specify changes / defer treatment]
• Delayed Evaluation Plan: [Timing and reassessment criteria] (If applicable.)

Procedure

[Brief narrative: sequence of areas treated, gel reapplication, intra-procedure adjustments with initial and adjusted settings plus rationale, areas intentionally avoided] (Keep concise; detailed parameters belong in table above.)

Immediate Endpoints and Tolerance

• Pigment target endpoints: [Darkening/peppering of lesions, erythema, etc.]
• Vascular target endpoints: [Vessel darkening, transient blanching, erythema, purpura]
• Overall response: [Degree of erythema and edema]
• Patient tolerance: [Well-tolerated / moderate discomfort / required breaks] [Pain score: X/10]

(Specify actual endpoints observed; avoid generic phrases.)

Complications

[None / Event type, location/extent, immediate management, medications administered/prescribed, whether treatment stopped early, follow-up plan]

Post-Procedure Status

[Skin appearance at completion]. Patient [stable / ambulatory], [discharged from clinic / other disposition].

Aftercare Instructions

• Sun/UV avoidance: [Daily broad-spectrum sunscreen; avoid intentional tanning and UV exposure]
• Skincare holds: [Products to avoid and duration]
• Activity restrictions: [Heat exposures to avoid and duration]
• Expected course: [Erythema/edema duration; pigment darkening and flaking timeline]
• Skin care: Do not pick or scrub treated areas; gentle cleanser and moisturizer as directed
• When to call: Blistering, increasing pain, signs of infection, severe swelling, eye symptoms
• Patient-specific modifications: [HSV prophylaxis regimen, extended restrictions, other] (If applicable.)

Verbal and written instructions provided; patient verbalized understanding.

Follow-Up

Next session in [timing, typically 3–6 weeks]. Patient instructed to contact clinic for delayed blistering, unexpected pigment changes, or other concerns.