• Pre Procedure Form

    Contraindications for procedure

    • pregnant or nursing
    • chemotherapy and radiation for treatments – prophylactic chemotherapy is certainly safe to proceed
    • Active dermatologic disorders, I.E.rosacea, eczema, psoriasis
    • eyelash extensions must be removed prior to eyeliner
    • Sick with the flu or fever

    Require Waiting Periods

    • Lasik or cataract surgery in one month prior and wait three months postop
    • Latisse – two weeks sauce
    • Botox or disport – one day since they cannot lie flat for at least five hours
    • fillers i.e. Juvéderm, so, Voluma, sculpture, etc. – one week
    • fat transfer in lips – wait one month for swelling to subside
    • Accutane folders in one year half dose or prophylactic does not need medical clearance
    • suntan skin- one month
    • Retinol, glycolic acid, vitamin C peels – four weeks
    • laser -8 weeks
    • IPL – 1 week
    • shingle shot- 1 month
    • laser that removed old permanent make up – 8 weeks 

    Require Medical Clearance/Pre-Medication

    • heart valves, stents, pacemakers, rheumatic fever – medical clearance and pre-medication
    • organ transplants – medical clearance and pre-medication
    • Joint replacements – medical clearance and pre-medication
    • Insulin-dependent diabetic/medical clearance and pre-medication
    • Fever blister history – pre-medication
    • Seizures - medical clearance
    • lead thinners, steroids – medical clearance
    •  Eye disease (I.e. glaucoma or aggrieves disease) - medical clearance
    • lupus- Medical clearance and pre-medication
    • Blepharitis - Medical clearance
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  • General Medical

    Check all that apply
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  • Photo Release

    We would like your permission to use these photos for advertising. For example: Portfolios, online and print ads, etc. Your consent is necessary regarding this. Please circle and indicate with your signature if you would like your photos used or not used in advertising.
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  • Possible Risks, Hazards, or Complications

    Pain: There can be pain even after the topical anesthetic has been used. Anesthetics work better on some people than on others. Infection: Infection is very unusual. The areas treated must be kept clean, and only freshly cleaned hands should touch the areas. See the "After Care" sheet for instruction

    Uneven Pigmentation: This can result from poor healing, infection, bleeding, or many other causes. Your follow-up appointment will likely correct any uneven

    Asymmetry: Every effort will be made to avoid asymmetry, but out faces our are not symmetrical so adjustments may be needed during the follow-up session to correct

    Excessive Swelling or Bruising: Some people bruise or swell more than others. Ice packs may help reduce the swelling. The swelling or bruising typically disappears in 1-5 days. Some people don't bruise or swell at all. Anesthetics: Topical anesthetics are used to numb the area to be tattooed. Lidocaine, Prilocaine, Benzocaine, Tetracaine, and/or Epinephrine cream and/or liquid are 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 machine. You must inform your MRI Technician of any tattoos or permanent makeup. 

    The alternative to these possibilities is to use traditional cosmetics and NOT undergo the Semi-Permanent Eyebrow procedure. 

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  • Patch Test Consent Form

    Patch testing involves placing small amounts of substance against the skin and fixing them in place for 48 to 72 hours. The testing site is then monitored for local reaction. Potential adverse events include rush at this site, infection, or delayed skin reactions. There is a possibility of an allergic reaction to pigments. Pigments continents are:Iron oxide, titanium dioxide, isopropyl alcohol, glycerin, ethanol, and distilled water.A patch test is advisable however it does not ensure a client will not have an allergic reaction.
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  • Consent to Permanent Makeup Procedure

  • I certify that I have read or have had read to me the contents of this form. I understand the risks and alternatives involved in this procedure(s) I have had the opportunity to ask questions, and all of my questions have been answered. I acknowledge that I have reviewed and approved the material , and given to me, and I authorize as my Eyebrow Microblading technician(s) to perform on my body the 3D Eyebrow Microstroking procedure desired today.

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  • Microblading Aftercare Instructions

    It is essential that you follow these instructions after your Microblading session.

  • Day One (Day of treatment): Wait 1-2 hours and let the wounds weep lymph. After 2 hours you must wipe off the lymph with a moistened cotton pad, Pat dry, then apply a thin layer of  Aquaphor or The after care provided by your practitioner with a cotton swab. Do this every 2 hours until bed.

    At night wash the treated area with warm water and mild soap like Cetaphil. Wash your hands with a disinfectant soap before washing your eyebrows and/or applying the post- procedure ointment 

    NOTE: Too much Aquaphor will cause the pigment to scab. Aquaphor is available in the skin care section of any drug store.

    Day Two - Nine: Repeat the wiping of the brows at least 2 times a day. At night wash the treated area with warm water and mild soap like Cetaphil. Wash your hands with a disinfectant soap before washing your eyebrows and/or applying the post-care cream. 


    Day 3 - wake up rinse with cold temp at water, pat dry, apply ointment. Be sure to apply a very thin coating of ointment as needed throughout the day through the next four weeks of your healing process. Continue to wash at night with a mild soap such as Cetaphil And refrain from using any existing skin care products that you may Typically use at home.

    The following must be avoided during all nine days post-microblading procedure:

    Sweating. It is recommended not to sweat for the first 10 days after the procedure. Sweat is salt and can prematurely fade the treated area. Practicing sports Swimming Hot sauna, hot bath, or Jacuzzi Sun tanning or salon tanning. Absolutely No Sun, sweating, or tanning prior to the procedure or after the procedure for 2 weeks. Do not have a tan/sunburn on your face prior to your procedure. The tan will exfoliate taking color with it as it fades. Any laser or chemical treatments or peelings, and/or any creams containing Retin-A or Glycolic Acid on the face or neck Picking, peeling, or scratching of the micro pigmented area in order to avoid scarring of the area or removal of the pigment Performing tasks related to heavy household cleaning such as garage or basement cleaning where there is a lot of airborne debris Spicy foods Smoking Drinking alcohol in excess, as it may lead to slow healing of wounds Driving in open air vehicles such as convertibles, boats, bicycles, or motorcycles Touching of the eyebrow area except for when rinsing and applying the post-care

    Eyeliner

    Expect light to moderate swelling and redness. Teabags or ice packs maybe used to minimize swelling the day of and the day after the procedure. Use Aquaphor ointment or Vaseline around the treated area for 2 to 3 days following the procedure. You must use a new mascara to avoid contamination.

    Lip liner/lip color

    expect moderate swelling, usually one to two days following the procedure. Applying ice for the first two hours is most important, continue throughout the day. Keep moist with Aquaphor, Vaseline or the ointment provided by your practitioner for the next 5 to 7 days. Then switch to Chapstick we're lipstick with an SPF of 15 or greater, as the sun tends to feed lip color quickly. After the procedure the lips may appear to have too much color. You may add make up to soften the color after 3 to 4 days the color will become lighter as the epidermidis sloughs off it will appear that you have Lost all of the color. However when your lips are healed completely the dermal layer will gradually become darker. Two or three applications may be required to achieve the desired results it is not uncommon to lose up to 70% of the color on the first application.

     

  • Extra Tips:

    Before showering apply a layer of post-care cream to protect your eyebrows from moisture. During the shower keep your face away from the showerhead.

    Itching and flaking may appear during the first seven days post-microblading procedure. However, experience has shown that by following these after-care instructions, these symptoms may quickly disappear.

    The healing of deeper wounds might last between 14-21 days. Touch-ups and/or correction of the shape-design is recommended only after this period.

    If you have any unexpected problems with the healing of the skin, please contact immediately, to discuss further instructions. can be reached on his/her cell phone:

    At the first sign of infection, allergic or adverse reaction, consult with a health care practitioner and report to the Texas Department of State Health Services, Drugs, & Medical Devices Group at 1-888-839-6676

    What to expect during and after your microblading session

    Your new temporary eyebrow will go through several phases during the healing cycle.

    The pigment will appear very sharp and dark immediately after the procedure. This is because the pigment is still sitting on top of your skin, and has not yet settled in completely. The color of the pigment will soften gradually. Do not be alarmed if you see some pigment on the cotton swab, as this is excess pigment and/or body fluid that is naturally exiting your skin.

    Once the healing of the skin starts taking place, it will look like dandruff flakes or dry skin. This might give you the impression that the color pigment is fading too quickly, however, this is just superficial color and dry skin being naturally removed from your eyebrows.

    Once completely healed, after 2 weeks, always apply a layer of sunscreen SPF 30 up to SPF 50 on your eyebrows when exposed to the sun. Sun exposure might cause the color pigment to fade away more quickly.

    You can now enjoy your beautiful new temporary eyebrows. You will simply love your new gorgeous fresh look!

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