PLASMA SKIN TIGHTENING/FIBROBLAST CONSENT FORM

The Plasma Skin Tightening procedure is a non-invasive treatment that will be performed using the best practices, safety, & hygiene techniques to shrink, tighten, lift and rejuvenate the skin using a sterile disposable probe. I have been trained in multiple courses, including advanced techniques, and have been double certified and fully insured to perform these procedures.

Before receiving any treatment, YOU, as a client are required to complete and sign all relevant areas of this consultation record to give your absolute consent to the treatment. You will need to disclose your full medical history to determine whether you are a suitable candidate for Plasma Skin Tightening. If I, as your technician, do not think your skin is able to take this procedure, then the treatment cannot be performed.

I will discuss your Plasma Skin Tightening treatment with you, in full, including what healing, recovery and downtime will be involved, plus the anticipated benefits. Realistic expectations will be addressed, and any rirks will be discussed. I will also discuss any further treatments needed to achieve the desired outcome. You will receive a separate aftercare form for you to read, sign and keep for your short and medium term healing process. It is absolutely essential you follow these instructions fully.

Additional treatments will not be performed until 12 weeks after the date of your initial treatment in order to allow for proper healing.

Every client is different and the healing process will vary. In RARE cases, there may be discoloration to the skin.

There may be minor discomfort depending on the area being treated.

The treatment includes delivering a highly controlled, precise and predictable micro-trauma to the surface of the skin. Plasma gas is completely safe. We work above the skin. We do not cause or leave any wound open. We do not damage the surrounding tissue and there is no risk of infection though you may experience a mild smell of charring and ozone during the treatment. This is normal.

Swelling and redness will occur and this is the desired result. In some instances, moderate to heaving swelling will occur especially the upper and lower eyelids. This is normal.

Carbon crusts will be visible for 3-10 days following the treatment. In some instances, they will flake off and be replaced with pink marks while the skin is regenerating. This could last up to 8 weeks. This is rare.

You must adhere to the aftercare advice. This is very important to reduce the ridk of any post procedure infection. Avoid picking, plucking, knocking or rubbing the carbon crusts. This will hinder the healing process.

Be aware that any skin altering, medi esthetics or cosmetic surgery (implants, injectables,) and weight gain may alter the Plasma Skin Tightening look. It is best to be patient and let it heal properly.

PHOTOGRAPHY CONSENT

Photographs are required BEFORE, DURING and AFTER the treatment. I hereby grant that my photographs will be stored with my file. I consent that my photographs may be used for advertising, marketing and/or social media purposes.

I understand that my Plasma Skin Tightening specialist will be in direct contact with me in relation to my service. This treatment involves the use of disposables. All equipment is sterilized before use, all surfaces involved in the process are protected, gloves will be worn at all times and my Plasma device will look to use medical asepsis conditions and no touch technique throughout. I hereby give written consent to the specialist who is fully trained and insured to carry out the treatment of choice as requested by me. I have read and fully understand the nature of this consult form.

I have the option for a patch test.