* Muse Sthetix has explained to me the treatment process and it may include various acids which are called chemical peel. I understand that side effects may include, but are not limited to, increased color, decreased color, infection, pain, bleeding, swelling, scarring or damage to nearby structures, nerves, drug reactions or unforeseen complications.
* I am undergoing this peel in an effort to improve my skin texture and color. I understand I may achieve some improvement in my fine wrinkles as well, but no guarantee has been made to me regarding my level of improvement from this peel. Muse Sthetix has explained to me that I may need several of these peels to achieve optimal results.
* I understand that there is a possibility that this procedure will fail or be unsuccessful or need to be repeated or may require additional treatment of complications
* I have read the instructions provided as to how to care for my skin prior to and following this Procedure and agree to abide by it. I understand that proper sun protection including, but not limited to, the faithful use of broad spectrum UVA-UVB sun block with SPF 30 is vital to proper aftercare and the reduction of risks of undesired side effects.
* I understand my responsibility for properly fulfilling the appropriate aftercare instructions as explained by Muse Sthetix. I hereby release and hold harmless my Skincare Specialist, Muse Sthetix and any of its employees, their suppliers from any consequences resulting from my failure to properly fulfill such aftercare instructions.
* Since multiple treatments may be required, this consent continues for all subsequent treatments by Muse Sthetix regardless of the time between treatments.
* I am aware and acknowledge that there is a possibility of an allergic reaction. I have discussed thoroughly with Muse Sthetix any such reactions and understand the care that would be necessary in the event of a reaction. I have had a chemical peel patch test done.
* I acknowledge that if I am prone to cold sores around the mouth, I will inform Muse Sthetix and may need to use an anti-viral medication before the peeling treatment. (Peels may exacerbate the herpes virus.)
* I acknowledge that immediately after the peel, my face may appear frosted or sunburned and by day two, the skin may darken in color, feel tighter and be more sensitive. Days two through approximately seven, my skin may slough.
* I may experience some breakouts after the peel (for a period up to seven days) that normally disappear. Chemical peels make extractions of the comedones easier and the acne will ultimately improve if I continue treatment as directed by my skin care specialist.
* I acknowledge that pulling or picking skin may lead to infection or scarring.
* I am aware that on rare occasions the peel can penetrate deeper in certain areas, causing a crusted scab to form. I understand that if this area is not treated appropriately it could become infected and possibly lead to the formation of a scar. It is my responsibility to contact Muse Sthetix if any crusted areas form or if my skin does not look and feel completely normal within one week after my peel. I acknowledge this and desire that this product be applied to my skin.
* I understand and am willing to comply with all pre and post care instructions. This procedure has been explained to me and my questions regarding such treatment, its alternative, its complications and risks have been answered. I have been asked at this time whether I have any further questions about this procedure and I do not.
* I understand the procedure and accept the risks, and request that this procedure be performed on me by Muse Sthetix. The information that I have been given has been in terms clear to me and I understand the risks and complications of the treatments. My questions have been fully and completely answered for me and I have read this document and understand its contents. I hereby give my unrestricted informed consent for the procedure.
* By my electronic signature below, I acknowledge that I have read and fully understand this agreement and all information detailed above.