Consent for Treatment with
AQUAGOLD® fine touch
AquaGold is based on the skin's natural ability to repair itself. AquaGold treatments creat superficial "micro-channels" to the outermost layer of the skin, inducing the healing process including new collagen production. AquaGold has been shown to reduce the visibility of acne scars, fine lines and wrinkles, diminish hyperpigmentation and improve skin tone and texture.
I hereby authorize Beauty Marx and the appointed provider to perform my AquaGold treatments. I consent to AquaGold treatment containing Botox micro units, HA, vitamins, and possible PRP and/or growth factors.
I understand possible side effects include and are n ot limited to: Slight or extreme redness, histamine reaction, swelling, stinging, itchy, tender, dry or flaking skin. In rare instances, hyperpigmention and/or hypopigmentation, scarring, nodule formation, or infection can occur. I understand that I should only apply products recommended by my provider post treatment.
Most side effects will gradulally diminish over time as healing may take several days. Notify your clinician immediately if any side effects cause extreme discomfort or any unexpected problems occur.
I have avoided the following products/procedures THREE DAYS prior to
opical prescriptions including but not limited to Retinol, Tretinoin, Differin, Tazorac
Abrasive scrubs or other exfoliating products
I have not had any cosmetic injections within the last TWO WEEKS.