Dermaplaning Informed Consent
Dermaplaning is a manual form of exfoliation performed by a licensed esthetician that involves the use of a sterilized, single use, scalpel blade to provide exfoliation and removal of dead skin cells and vellus hair revealing a brighter and smoother complexion. This treatment is performed every 4-6 weeks for upkeep and the best results.
What to expect during your appointment :
Before proceeding with this treatment, I will perform a skin analysis to determine if you are a good candidate for Dermaplaning. If you are, I will proceed with treatment protocol and answer additional questions you may have and go over after care.
Client Name
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Date submitted
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I understand that Dermaplaning involves the use of a sterilized scalpel blade to provide light exfoliation and removal of vellus hair.
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Please Select
Yes
No
The nature and purpose of Dermaplaning has been explained to me and any questions I have regarding the treatment have been answered to my satisfaction prior to procedure.
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Please Select
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No
I have been explained all Pre and After care instructions thoroughly and understand I must discontinue use of all actives: Exfoliants such as AHAs/BHAs, retinoids, astringents, and lightening agents for 5-7 days prior and after in order to avoid prolonged sensitivity or adverse reactions. I must also avoid prolonged direct sun exposure for as long as possible, saunas, steam, and hot water for at least 72 hours. Chlorine, vigorous exercise, and makeup for at least 24hrs. I understand I must also use a gentle cleanser and nourishing skincare for 5-6 days, clean makeup brushes before application, and pillow cases. I must apply spf 30+ daily to protect my skin against burning and sensitivity.
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Please Select
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I understand that the treatment may involve the risk of complication or injury and I freely assume those risks. Possible side effects of the treatment area can include mild redness, mild irritation, and dryness. Additionally, nicks to the skin can occur due to the sharp scalpel blade. The vellus hair does not grow back darker or thicker however, I do understand that current hormonal imbalances such as PCOS/hirsutism present within my anatomical system can alter the normal hair growth pattern.
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I understand there are contraindications to this treatment. Including but not limited to; Inflamed acne, allergy to stainless steel/nickel, diabetes (uncontrolled), auto immune diseases, hypersensitive skin, rosacea, eczema, psoriasis (if present on face), facial dermatitis (peri-oral), sunburn, erythema, skin cancer, HIV/Aids, active cold sores, hirsutism(PCOS), open wounds/lesions, telangiectasia, bleeding disorders, hemophilia, inability for blood to coagulate or development of keloids following injury. Certain medications including blood thinners, higher does of aspirin, and Accutane (must be off at least a year) are contraindications for this treatment due to the possibility of delayed clotting from a nick or cut. You may also not receive this service if you’ve recently had any other skin treatments (laser, micro needling, chemical peels, Botox, fillers). Must wait 2-4 weeks to receive service. I certify I am not under the use of any of the listed medications, or had any recent invasive treatments, and experiencing any of the above conditions.
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By signing below, I certify that I have read and fully understood the contents of this consent form and that the information I provided above is complete, accurate, and up-to-date to my knowledge. I hereby consent to the Dermaplaning procedure.This constitutes the full disclosure and supersedes any previous verbal or written disclosures. I release My esthetician Jasmine Magdaleno, owner of Inara Aesthetics in all liability associated with any injuries or current or future conditions resulting from the skincare procedures and products.
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