Chemical Peel Consent Form

PRECAUTIONS (Please read carefully) The treatment you will receive is a clinical treatment designed to exfoliate or remove the outer layers of the skin. Your participation in your skincare treatments will determine the outcome. It is important that you strictly adhere to your home care products that your esthetician has recommended. No guarantee is expressed or implied as to the precise results, peeling times or discomfort. During the treatment, you may experience some temporary stinging or warm flushing. This will fade within a few minutes. During the next few hours, you may experience some tightening of the skin, which may last for several days. For most patients, flaking begins within 48 hours. It is impossible to pre-determine how much peeling will occur. The shedding process usually subsides within 5-7 days. Depending on the clinical peel performed and your skin quality, the following reactions may occur in some patients: 1) Prolonged redness, irritation and flakiness 2) Dryness and sensitivity 3) Severe allergic reactions in rare instances 

PLEASE INITAL

 

I hereby give my consent and authorization voluntarily and release from any claims, implied or stated that, I have or may have in the future with this treatment, regardless of result. I am stating that the treatment and precautions above have been explained to me in detail and that I fully understand.

1) Discontinue any topical prescriptions or any products containing Retinol or Vitamin A

2) Avoid waxing, electrolysis, depilatory creams, and laser hair removal treatments

3) Avoid sun exposure (indoor and outdoor)

4) Do not receive Botox or dermal fillers

5) Do not have another treatment unless recommended

6) Discontinue all use of alpha hydroxy acid (AHA), beta hydroxy acid (BHA) and benzoyl peroxide 

7) Stop any exfoliating products that may be drying or irritating 

8) Men - do not shave the day of your peel

After receiving your peel do not use any skincare products that have not been approved by your licensed esthetician or physician. Your treatment was finished with IMAGE products that are safe to be left on your skin for the evening

 

IT IS CRUCIAL TO THE HEALTH OF YOUR SKIN AND THE SUCCESS OF YOUR PEEL THAT THESE GUIDELINES BE FOLLOWED FOR THE NEXT 5-7 DAYS:

1) Do not do anything that will cause your body to become heated or to perspire. This may lead to inflammation and/or breakout (Exercise, sauna, hot tubs, etc

2) Always use warm water on your face and do not scrub. Avoid chlorine.

3) You may or may not experience some visual flaking or shedding of the skin approximately 2-4 days post peel. The amount of visual flaking is not indicative of your end results. If heavier shedding is present, do not under any circum- stances, pick or manually peel the skin.

4) You must take precautions to avoid sun exposure in order to protect your skin as well as to get the full benefit of the peel. Peels increase your skin's sensitivity to the sun and particularly the possibility of sunburn. Exposure to UV rays can cause hyper-pigmentation, freckling and sun damage. We recommend that you stay indoors as much as possible and use PREVENTION + SPF.

5) Do not use any glycolic, retinol, or Retinol-A for 5-7 days or until your skin is back to normal. You can resume your regular at home regimen after the 5-7 days. This time may vary depending on the peel performed and each individual's healing

7) For men, do not shave for at least 48 hours after peel.

peel, pick, scrape or abrade the skin have an electrolysis or laser treatment

use tanning beds or sunbathe, facial wax, thread or use depilatory products

have another treatment until your esthetician advises you to do so

SLIGHT REDNESS OR SWELLING MIGHT OCCUR IMMEDIATELY AFTER THE PEEL. THIS USUALLY GOES AWAY WITHIN 24 HOURS. SOME CLIENTS EXPERIENCE TEMPORARY SKIN DISCOLORATION. YOU MAY HAVE AN AREA OF SCABBING OR CRUSTING IN CASES OF SEVERE SENSITIVITY, THIS IS VERY RARE. IF IT IS BOTHERSOME YOU MAY APPLY AQUAFOR (FOUND AT YOUR LOCAL DRUGSTORE) TO THE AFFECTED AREA. CALL YOUR ESTHETICIAN IMMEDIATELY IF ANY OF THESE CONDITIONS DO NOT RESOLVE WITHIN 24 HOURS.

For best results, a series of 6-8 peels at 2-4 week intervals is suggested. Using the correct at home care regimen to keep the results and corrections on going is also suggested. Your esthetician will help you decide which program works best for you, as they vary based on skin conditions.