dermabrasion Treatment Consent

 

DESCRIPTION OF TREATMENT

Microdermabrasion uses inert crystals to mechanically exfoliate the outermost layer of dead skin cells, leaving your skin feeling softer and looking younger and more vibrant. Microdermabrasion can be used to address a number of concerns, including: unwanted lines and wrinkles; mild acne scars; uneven skin tone and texture; and, early sun damage

SIDE EFFECTS

After a treatment, the skin may temporarily be red and feel tight and warm as if exposed to the sun or wind. Slight redness and swelling may appear with deeper treatment levels, in addition to slight blood spotting. Healing may take several days or longer.

Aftercare

Your fresh newly exposed skin will be delicate. It is important to use a mild cleanser and keep the skin well moisturized. Use a full spectrum sun block (30+ SPF) daily. Avoid the use of Retin-A, Tazorac, Renova, Differin or other topical acne treatment for 24 to 48 hours after. Avoid alpha or beta hydroxyl type products and all scrubs for at least 5 to 7 days after, or until initial sensitivity subsides. Avoid swimming and tanning beds for at least one week after. Any time the skin barrier is broken there is a small risk of bacterial or viral infection.

acknowledgements

  1. I acknowledge that I have not used Isotretinoin (Accutane) during the last 6 months.

  2. I acknowledge that if I am prone to Herpes (cold sores, fever blisters) I have consulted my physician and I am taking an antiviral to reduce the chance of a breakout. I should avoid treatments during a breakout.

  3. I acknowledge I must reveal any condition that may have a bearing on the procedure, such as pregnancy, allergies, facial waxing, medication use, diabetes or immune deficiencies, prior to receiving treatment.

  4. I acknowledge that I should avoid use of glycolic or Retin-A type products for 7-10 days following the treatment.

  5. I acknowledge that no guarantee has been given to me regarding the condition of my skin or the improvement expected following treatment. I understand that no specific results are guaranteed.

  6. I understand that I must wear a sun block with an SPF of at least 30 at all times while outdoors to avoid hyperpigmentation that may occur.

PATIENT CONSENT

I have read and understand the foregoing consent form and agree to the treatment. I hereby give consent to my esthetician to perform a microdermabrasion treatment. I hold harmless my esthetician and affiliates of any and all circumstances that may occur during my treatment. By submitting this form I acknowledge the information provided is true and correct to the best of my knowledge.