Louisville Beauty & Wellness PMU/ Tattoo Client Information

Do you presently have or previously had any of the following :(yes or no)

I agree that all the above information is true and accurate to the best of my knowledge.

Statement of Consent (initial each)

Consent and Release Agreement for Permanent Cosmetics, Microblading & Tiny Tattoo Procedure

This form is designed to give information needed to make an informed choice of whether or not to undergo a permanent cosmetic and microblading application. If you have questions, please don't hesitate to ask. Although permanent cosmetic tattooing and microblading are effective in most cases, NO guarantee can be made that a specific client will benefit from the procedure. Microblading is not permanent. There are no refunds.

Generally, the results are excellent. However, a perfect result is not a realistic expectation. A perfecting touchup is generally needed 45-60 days after the healing is completed. YOU MAY NEED MORE THAN ONE PERFECTING TOUCH UP

SESSION TO ACHIEVE DESIRED RESULTS. MICROBLADING LASTS 6 MONTHS TO

24 MONTHS ON AVERAGE. RESULTS VARY PER PERSON. You are SIGNING this

KNOWING that color retention is NOT guaranteed.

Photography and Videography Release :

Before and After photos/videos may be taken and kept on file. We would like your permission to use these photos/videos for advertising of ANY kind. We do recommend coming in makeup and we will remove the necessary areas if you would like to look your best for your before/after images.

Results/Outcome Disclosure

 

It has been reviewed multiple times that my color MAY FADE SIGNIFICANTLY and

will also FADE IN AND OUT DURING THE ENTIRE HEALING PROCESS

MICROBLADING AND PERMANENT COSMETICS PROCEDURES ARE NOT FOR

EVERYONE, I MAY BE ONE OF THEM.

RESULTS vary ( EVEN AFTER HEALING) depending on but not limited to :

how your body metabolizes the color, environmental factors, sun exposure (even after healing), tanning (tanning bed or direct sun even after healing), SMOKING ( this is big one), skin care products/makeup herbal supplements, underlying OR undiagnosed medical conditions, use of certain medications, hormones, not following ALL instructions, unknown causes ( which are beyond any person's control), PICKING OR SCRATCHING TREATED AREA, LAKE WATER/ CHLORINATED POOLS AND HOTTUBS ( even after healing), chemical peels, microderm treatment, anti-aging treatments, plucking, waxing, threading on treated area, pregnant OR nursing. Microblading is a superficial, temporary treatment. It is implanted in my lower layer of my epidermis which / am continually exfoliating. Everyone exfoliates at different rates.

Microblading is NOT permanent and may last 6 months to 24 months realistically but could fade sooner or last longer depending on the above points that I have read through and agree to move forward with my procedure. Tiny Tattoos are permanent but can need maintenance based on the area selected. Fingers, hands and feet are specifically hard to retain but depending on the person, skin type, aftercare etc. any tattoo can and will fade. If it does, you can schedule a color boost session (generally about half the price of the original service so long as we can still see and use original work as a guide.

To whom this contract may concern, I have carefully read and understand EVERYTHING I have signed and have had all my questions answered, I am choosing to proceed on my own free will and am in a healthy state of mind to do so. I have viewed the risks and complications, contraindications and followed my pre-care instructions and will follow my post care instructions as well.

Permanent Cosmetics/Tattoo Contraindications

(yes or no)

 *Let me know if you have/had allergic reactions to topical anesthetics.

Flu, Cold, Fever Please stay home, reschedule your appointment if you have a cold or flu or sinus/respiratory infection *we will take no-contact forehead temperature checks before administering services to keep everyone protected and our environment safe for all of our clients and employees.

Eye lift or blepharoplasty :Wait about 3 months

I do not have any of the contraindications listed above or have my doctor's direct approval to proceed with permanent makeup services.

Possible Risks and Complications

Excessive bleeding, which can affect results. Excessive bleeding can be due to many factors beyond technician's control.

Pain : There can be pain even after the topical anesthetic has been used. Anesthetics work better on some people than others.

Infection :Infections are very unusual. The areas treated must be kept clean and only freshly cleaned hands should touch the areas. Should any sign of infection occur, contact your physician immediately (Pus/oozing, extreme redness, swelling, heat to the area are all signs of infection).

Uneven Pigmentation or poor color retention. This can result from poor healing, infection, bleeding. Excessive scabbing, picking scabbing or many other causes. Your follow up appointment will likely correct any uneven appearance.

Asymmetry :very effort will be made to avoid asymmetry but our faces are not symmetrical so adjustments may be needed during the follow up session to correct any unevenness.

Excessive Swelling or Bruising : Some people bruise and swell more than others. Ice packs may help with the bruising and swelling will typically disappear within 1-5 days.

Eye Exposure There is a small risk of eye injury when an eyeliner procedure is performed. To avoid corneal abrasion, Celluvisc, a thick eye drop is used to protect the eye prior to the procedure. Eye drops are used to cleanse and flush the eye after the procedure is complete.

Anesthesia : Topical anesthetics are used to numb the area to be tattooed. Lidocaine, Prilocaine, Benzocaine. Tetracaine and Epinephrine in a cream or gel form are typically used. If you are allergic to any of these please inform me now.

MRI : Because pigments used in permanent cosmetic procedures contain inert oxides, a low-level magnet may be required if you need to be scanned by an MRI

Fever Blisters :If you are prone to cold sores or fever blisters, (herpes simplex), there is a high probability that you will get themlf getting a service on the lips It is advised that you call your doctor for a prescription antiviral in advance to help prevent his form occurring.

Microblading, Permanent Cosmetic and Tattoo Pre-care

It is absolutely crucial that you follow your Pre-Care AND Post-care instructions

to achieve the full and best result.

Do not work out for 24 hours before or after procedure NO alcohol or caffeine 48 hours before procedure. Avoid sun and tanning on week prior to procedure Do not take Aspirin, Niacin, Vitamin E or Advil/Ibuprofen 48 hours before procedure. Avoid Fish Oil for 1 week and Prenatal Vitamins, Nutritional Shakes 48 hours prior to procedure. Discontinue Retin-A, Chemical and Laser Peels, microdermabrasion, and Alpha Hydroxy Acid (AHA) for at least 3 weeks prior (and avoid on eyebrow area after procedure to prevent premature fading) Botox and filler on the forehead, temple and eye area should be avoided 2 weeks prior to AND 2 weeks after procedure in that same area. Avoid ginger, cinnamon, garlic, black and cayenne pepper for 48 hours. No brow waxing, tinting and threading 1-week prior (the more natural hair growth you have, the better!) You will be more sensitive during your menstrual cycle and have a greater chance of bleeding if you smoke. Consider this when booking your appt.

Please plan all procedures 1-6 weeks prior to a special event or vacation. This allows adequate time for healing. Your desired brow cannot be achieved in just one session, it is a 2-step process and is not uncommon to lose 30% to 80% of your color after the first treatment. Some clients need MORE than two sessions to achieve their desired density and shape. If excessive bleeding occurs, extra appointments may be necessary for desired outcome of procedure may not be effective.

Your perfecting sessión (if needed---not all clients will need a perfecting session) should be done at the 6-8 weeks mark after your work from your first sessión has fully healed. This is to correct any initial pigment that didn't take and to add more color or shape if desired after seeing how you heal. If you love them after 6 weeks, there is no need for a perfecting session! If you want to tweak them a bit, be sure to get in before the 60 day mark. The perfecting sessión is $100 and You will get $25 refunded after that sessión for any Google or Facebook positive (5 star) review left (can be combined up to $50 If you need additional touch ups we will evaluate and discuss any necessary charges at that time. It is absolutely crucial that you follow your Pre and Post-Care instructions to achieve the full results of the Microblading procedure. If directions are not followed, there is a risk that your procedure results won't last as intended. Scabbing is normal. The amount of scabbing cannot be predicted as each person is different. Excessive bleeding can cause excessive scabbing.

Brows/Tattoo Typical Healing Schedule

Day 1-4- Areas treated become darker and more filled in looking as they form a scab. This is only temporary, DO NOT PANIC. They will be much darker and fuller looking as scabs form.

Day 5-12- Scab naturally exfoliates, peels and flakes away over the course of several days. The fresh skin underneath is white or pinkish and may have a waxy coating, making it appear that the brows are too light. It may seem like ALL your color has fallen off! Be patient as this is part of the natural skin healing process--

the final outcome will be wonderful.

Day 10-30- After 10 days you may use brow makeup very gently if you need it. The color will slowly come back to life and bloom back to the surface as the new, milky layer of skin settles in and heals. Wait at least 4 weeks to see the true color, it will take on new strength, and it is only after 4 weeks that your touch-up/adjustment can be done. Your second appointment is to tighten up your shape, touch up any light spots, assess how your skin reacts to the process, and decide if you are happy with the chosen color or would like to 90 darker.

NOT EVERYONE FOLLOWS THE EXACT HEALING SCHEDULE. THIS IS ONLY THE AVERAGE HEALING. ALL SKIN IS DIFFERENT AND YOUR BROWS AND PERMANENT

DO NOT FADE. IT MAY TAKE MORE THAN ONE TOUCH UP TO ACHIEVE MY

PROCEDURES MAY NOT WORK FOR ME AND | AM SIGNING THIS SHEET KNOWING THIS AND WILL NOT HOLD TECHNICIAN AT FAULT.

For the first 24 hours, blot any fluid from the treated area with a tissue or gauze pad. Scabbing is normal. Some scab more than others for a variety of reasons such as bleeding, or the body's own immune reactions. DO NOT PICK

1st day, VERY IMPORTANT Rinse the treated area (VERY GENTLY) a few hours after procedure then 2x per day for the next 2 days with warm water and gentle, neutral soap (cetaphil, Baby Shampoo or antibacterial dial) to prevent wound from getting dirty and lessen scab formation. Apply a very thin layer of aftercare each time you rinse. Make sure treated area is COMPLETELY dry before applying ointment (pat dry with paper towel or air dry)

Day 2-8 Maintain Facial Hygiene. Morning and Night dab using a cotton pad and sterile water to keep brows clean. Apply after care very sparingly 3-5 times a day to dry pmu/tattoo. Try to keep the treated area as dry as possible. No Makeup or skin care should be applied to brows or area treated.

Day 1-10 Limit showers to 5 mins and avoid too much water on treated area. Avoid pools, saunas, steam rooms, hot showers and or hot baths for 10 days.

Do not rub, pick or scratch the treated area. Let any scabbing or dry skin naturally exfoliate off. Picking can cause scarring and pigment loss!

Avoid sun exposure and tanning beds for a minimum of 4 weeks after your procedure. Direct sunlight can cause the pigment to change color while healing and can also cause hyperpigmentation and scarring. After 10 days, once the area has healed completely, use sunblock when going out in the sun to stop the color from fading.

Avoid Sweating on treated area for 10 days. Sweating through or on the brows will expel pigment from the dermis producing poor results.

Avoid sleeping on your pmu/tattoo for the first 10 days!

Avoid Retin-A, Chemical Peels, Laser Treatments, Microdermabrasion, and/or anything to treat hyperpigmentation around the brow area to prevent fading.