This document has been prepared to inform you about the Scarlet S, RF Microneedling procedure, its risks, precautions, as well as contra indications to the treatment. It is important that you read this information carefully and completely. Please enter your full name in each area, indicating that you have read and understand each segment, as proposed by your medical professional, and are mutually consenting to the program outlined for you.

 

Acknowledgement

,have received information about the proposed treatment. I have discussed my procedure with undersigned medical personnel and have been given an opportunity to ask questions and have them fully answered. I understand the nature and purpose of the recommended procedure, alternative treatment options, possible potential complications/risks and subsequent healing period involved with the proposed procedure. As well, I acknowledge the possibility that additional treatments may be necessary for the desired outcome, and that the procedure may not be successful due to other factors such as health or others that have been explained.

 

Pre-treatment Precautions

, have received information about the pre treatment precautions:

. NO NSAIDS, blood thinners 1 week prior to treatment

. NO Chemical peels in 1-6 weeks before the treatment

. No LED or non-invasive lasers 2-3 weeks before the treatment

. No invasive lasers 6-12 weeks before treatment

. No Retin A or Retinols 1 month before treatment

. No hair perm or dye 1 week before treatment

 

Possible Risks

As with any medical procedure, there are possible risks associated with the treatment

, am aware of the following conditions that I am at risk.

Discomfort: warming sensation during treatment. Areas around the jawline, mouth and eye area can be slightly more uncomfortable.

Redness/Swelling: some redness and swelling is common and usually subsides within 24 hours

Skin color changes: hyper or hypo pigmentation is very rare but can occur if you are exposed to sunlight after treatment, extreme precaution after treatment is recommended. Some hyperpigmentation can occur right after treatment and most of the time it subsides after a few days

Skin dryness: it is common up to 7 days. It is important to follow the post care instructions to balance the skin quickly.

 

Contraindications

 am aware of the following contraindications

. Pacemakers, cardioverter defibrillator, or other implanted electrical devices

. Pregnant or breast-feeding mothers

. A history of skin pre cancer or cancer undergoing treatment

. Critically ill patients with heart problems

. Compromised or immune suppressed due to HIV, drug induced

. Heat sensitivity diseases such as Herpes Simplex

. Endocrine disorders that are poorly controlled like diabetes

. Keloid formation or poor wound healing

. Poor blood clotting natural or due to medication

I hereby authorized Dr Nancy Chen,MD and her staff to proceed with Scarlet S treatment