Buffalo Skincare & Beauty

Treatment Instructions/Consent form for zo 3-Step Peel

Disclaimer: You are not a candidate if you are pregnant, breast feeding or have open sores in the treatment area.

You must start on a pre-treatment program for 4-6 weeks prior to having your first peel. Melamin and Melamix + Tretinoin may be used in patients with a high risk of hyperpigmentation. If you have a history of cold sores, please inform your provider prior to treatment. The doctor will need to write a prescription to pre-treat to eliminate the chances of you developing a cold sore post treatment. Reschedule your appointment at least 48 hours in advance if you have a severe rash, cold sore or blemish in the treatment

Do NOT use the following products 3 days prior and 5-7 days after your treatment (or until pinkness has subsided): Retin-A, retinoids, or similar vitamin A compounds, harsh scrubs or exfoliating products and bleaching creams (unless instructed otherwise by your provider Gentlemen: Shave the treatment area one day before your scheduled treatment (unless instructed otherwise by your provider Avoid laser hair removal, electrolysis, waxing, threading, and use of depilatory creams for 5-7 days prior to peel. Do not apply any creams, lotions, perfume or makeup etc. on the area to be treated, prior to treatment. Avoid tanning or prolonged sun exposure 2 weeks after treatment. Sun may cause adverse reactions, as well as make your pigmentation worse. Avoid Botox at least 2 weeks prior and 2 weeks after treatment. Avoid dermal fillers at least 2 weeks prior and 2 weeks after treatment.

Avoid washing your face for at least 5 hours after the peel. It is recommended to wait until the next morning. Step 1: The morning after your peel, wash your face with Ultra Gentle Cleanser for 30-40 seconds, rinse and pat dry. Step 2: Apply the second half of Retinol Stimulating Crème. Step 3: Apply a thin layer of recovery creme. Recovery Crème may be applied 3 times daily or more often if needed. Avoid direct sun exposure for 7-10 days following the peel. You may apply your Elta MD sunscreen after the skin has completely healed. Besides your Retinol Crème, do NOT use AHA (alpha hydroxyl acids), beta hydroxy acids, benzoyl peroxide, retinoids, or similar vitamin A compounds or any irritating products until the skin is healed. Avoid procedures such as facials, hair removal, microdermabrasion and laser treatment in the treated area until the skin is completely healed 2-3 weeks. After skin is healed, return to your daily Zo skin care regimen. DO NOT rub, scratch, or peel/pick the skin until the skin. DO NOT perform strenuous exercise and sweating including hot showers sauna steam room, until the skin is completely

What To Expect: Redness, stinging, litching, mild swelling, flaking and peeling are all normal signs after a peel and vary based on patient

response. The skin will generally start peeling 2-3 days after you have had the zo peel treatment and you may peel up to5 days, in rare cases longer.

If you have any questions or concerns, please contact our office at (716) 390-7587

I understand that although good results are expected, there cannot be any guarantee or warranty, expressed or implied, that 1 will be completely satisfied by the outcome or that I will not require additional treatment and/or ongoing treatment to achieve the result I seek. I understand that treatments will not cure any medical conditions nor provide immunity against re-occurrence of such conditions. The treatments are temporary and vary per patient with some patients experiencing shorter or longer effects. The number of treatments needed varies per patient and may be affected by the following factors including but not limited to: degree of skin irregularity; severity of volume loss: patient age; personal medical profile; basic metabolic rate; previous cosmetic procedures; history of trauma to the treated area; individual lifestyle choices; and individual patient preference. I understand that all product and service sales are final. No refunds on services or products. I have read and understand all information presented to me before signing this consent form. I have been given an opportunity to have all of my questions answered to my satisfaction. I understand the procedure and accept the risks. I agree to the terms of this agreement. I understand and voluntarily accept the risks associated with all the services provided at Esra'a Abu-taha, including but not limited to: Waxing, Facials, Tanning, Injections, Laser Services and skincare products, ECT. or the use of any of the location's facilities. Except where prohibited by law; I acknowledge and voluntarily assume the risk of injury, accident or death which may arise from the use of any skin care products or services performed by Esra'a Abu-taha. I agree Esra'a Abu-taha will not be liable for death or any injury, including, without limitation, personal, bodily, or mental injury, economic loss or damage to me resulting from negligence, other acts Buffalo Skincare and beauty and Esra't Abu-taha. This agreement together with Buffalo Skincare and beauty and Esra'a Abu-taha's post- care plan rules and regulations, constitute the entire agreement between you and us and cannot be amended, except in writing by both parties. Myself and/or any of my heirs, executors, representatives, or assignees hereby release Buffalo Skincare and beauty and Esra'a Abu-taha from all claims or liabilities for death, personal injury or property loss or damages of any kind sustained while on the premises. I agree that this form and waiver is in effect for all services offered by Buffalo Skincare and beauty and Esra'a Abu-taha and will not expire unless specifically requested by either party. I understand that Buffalo Skincare and beauty and Esra'a Abu-taha is a tranquil and professional environment, and that any inappropriate behavior may result in termination of my services and full payment is expected. I also understand that any medical device used by the patient outside of Buffalo Skincare and beauty and Esra'a Abu-taha care or failing to list or mention such medical devices could result in unexpected or unwanted results. By signing this form. I agree to the above terms and release Buffalo Skincare and beauty and Esra'a Abu-taha and its employees from any liability.

If you have any questions or concerns, please contact our office at (716)390-7587