Medical Aesthetic Clinic
Micro Needling Consent
Client’s Name: _____________________________________ Date: ________________
I consent to have the Micro Needling procedure performed at Beauty Redefined to improve my facial expression lines and or skin surface. The practice of medicine is not an exact science and no guarantees can be or have been made concerning expected results. I understand that several appointments may be necessary to complete the treatment.
Prior to Treatment:
· No Retin-A product applications 12 hours prior to your treatment.
· No auto-immune therapies or products 12 hours prior to your treatment.
· No prolonged sun exposure to the face 24 hours prior to your treatment. A Micro Needling treatment will not be administered on sunburned skin.
· On the day of the treatment, please keep your face clean and do not apply makeup.
· If an active or extreme breakout occurs before treatment, please consult your practitioner.
What can be expected after your treatment:
· Immediately following your Micro Needling treatment, you will look as though you have a moderate to severe sunburn and your skin may feel warm and tighter than usual. This is normal and will subside after 1-2 hours and will normally recover within the same day or 24 hours. You may see slight redness after 24 hours but only in minimal areas or spots.
· Your practitioner will prescribe post-treatment skincare after the treatment to help soothe, calm, and protect the skin. Continue to use for 3 days. Active skincare can be resumed again after Day 3.
· Clean- use a soothing cleanser or face wash with tepid water to cleanse the face for the following 48 hours and gently dry the treated skin. Always make sure that your hands are clean when touching the treated area.
· Heal- Copper-based skincare is recommended post-treatment as the mineral properties are ideal to help heal the skin, but will also create a sterile skin, too.
· Hydrate- Following your Micro Needling treatment, your skin may feel drier than normal. Hyaluronic Acid is an ideal ingredient to hydrate and restore the skin back to perfect balance.
· Stimulate- In the days following your Micro Needling treatment, and as the skin starts to regenerate, collagen stimulating peptides are ideal to continue the stimulation.
· Makeup- it is recommended that makeup should not be applied for 12 hours after the procedure. However, your practitioner may be able to supply you with specialized mineral makeup product that they feel would be suitable for using during this period. Do not apply any makeup with a makeup brush, especially if it is not clean.
· Protect- Immediately following the procedure, apply a broad spectrum UVA/UVB sunscreen with a SPF30. A chemical-free sunscreen is highly recommended.
What to avoid:
· For at least 2 hours post treatment, do NOT use any Alpha Hydroxy Acids, Beta Hydroxy Acids, Retinol (Vitamin A), Vitamin C, or anything perceived as ‘active’ skincare.
· Avoid intentional and direct sunlight for 24 hours. No tanning bed.
· Do not go swimming for at least 24 hours post-treatment.
· No exercising or strenuous activity for the first 24 hours post-treatment. Sweating and gym environments are harmful, rife with bacteria, and may cause adverse reactions.
Risks and Side Effects:
Side effects and complications are usually minimal. Occasionally you may experience erythema, bleeding, temporary scarring, dryness and or discomfort. I have been advised of the risk involved in such treatment, the expected benefits of such treatment, and alternative treatments, including no treatment at all.
I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and that I have had sufficient opportunity for discussion and to ask questions. I consent to this procedure today and for all subsequent treatments.
Signature: ______________________________________ Date: _________________________
Witness Signature: ________________________________ Date: _________________________
With this form, I give my full consent for all photographs/footage captured, during and after my treatment by Beauty Redefined to remain the property of the clinic.
Signature: __________________________________________ Date: ___________________