Microneedling/PRP Facial information:
I have been informed as to what this treatment will do for my skin. I understand there is no guarantee that can be given to me as to the condition of my skin or degree of improvement expected in the following treatment. I understand that multiple treatments and the use of the recommended home skin care maintenance are required to achieve optimal results.
I am not pregnant or lactating and I have told the medical staff about any allergies.
You are eligible for Microneedling if you notice the following: Lack of skin radiance, loss of elasticity and epidermal thickness, rough and uneven skin texture - Fine lines, Wrinkles, Crow’s feet - Hyperpigmentation, Scars, especially indented acne or chicken pox. Post surgical Scars - Skin Dullness, Dry Skin
You are NOT eligible for micro-needling if the following applies to you: - You suffer with active pustular acne, Active bacterial, viral or fungal infections - Eczema, Psoriasis, Rosacea, Actinic (solar) keratosis or Diabetes - Keloid or raised scars or scars less than 6 months old, presently using isotretinoin (Accutane) - Raised moles or warts, had facial surgery in the past 6 months - Patients taking blood pressure, blood thinning or heart medications or Immunosuppression. Also agreeing that you have not recieved laser treatment, waxing or used a depilatory (such as Nair) on the area to be treated at least 2 weeks prior to appointment. You have not recieved botox or filler in the area to be treated in the last 2 weeks prior to your appointment.
Risks and Side effects: Side effects and complications are usually minimal. After the procedure, the skin will be red and flushed in appearance in a similar way to moderate sunburn. You may also experience skin tightness, minimal bleeding, dryness, discomfort and mild sensitivity to touch on the area being treated. This will diminish greatly after a few hours following the treatment and within the next 24 hours the skin will be completely healed. Follow aftercare instructions from your esthetician. You will also want to take extra precaution from sun exposure. Side effects & Results may vary among individuals.
Read below if you are undergoing PRP Facial with your microneedling:
By signing this form you are also consenting to having your blood drawn by Kelly Brown who is a licensed Phlebotomist and Master Esthetician. You understand that you will witness your own blood be separated by means of a centrifuge and it will be your own plasma used in the prodedure.
Pertaining to all Microneedling/PRP facial patients:
I understand that although I may see a change after my first treatment, I will likely require a series of sessions to obtain my desired outcome. I am advised that though good results are expected, the possibility and nature of complications cannot be accurately anticipated. I have had the opportunity to ask any questions about the treatment including risks or alternatives and acknowledge that all my questions about the procedure have been answered in a satisfactory manner. I have read the above information and I fully understand what to expect. I give permission to my Esthetician to perform the micro-needling procedure we have discussed and will hold her, and staff harmless from any liability that may occur.