Dermaplane Informed Consent

Dermaplaning Informed Consent

Dermaplaning is a form of manual exfoliation where an esthetician grade, sterile blade is stroked along the skin at an angle to gently “shave off” dead skin cells from the epidermis. Dermaplaning also temporarily removes the fine vellus hair of the face, leaving a very smooth surface. As with any type of exfoliation, the removal of dead skin cells allows home care products to be more effective, reduces the appearance of fine lines, evens skin tone and assists in reducing milia, closed and open comedones, and minor breakouts associated with congested pores. Dermaplaning can be an effective exfoliation method for clients that have couperose (tiny blood vessels near the surface of the skin), sensitive skin or allergies that prevent the use of microdermabrasion or chemical peels. Due to the contours of the face, certain areas of the face (such as the eyelids and nose) are not treatable using this method.
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First NameLast Name
I understand that Dermaplaning involves the use of a sterilized surgical blade to remove fine vellus hair from the face, and provide light exfoliation
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.
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 surgical blade. The hair that grows back will not be darker or thicker, however I do understand that any hormone imbalance present within my anatomical system can alter the normal hair growth pattern.
If a chemical peel is included with this treatment, I understand that the sensation and penetration of the peel will be enhanced. This may cause skin irritation, mild discomfort, tenderness, lightening or darkening of the skin, infection, scarring, peeling, and activation of cold sores when the virus is already present in the body. I certify that I have read this entire consent form and I understand and agree to the information provided in this form. I certify that I am at least 18 years of age, or I have parental consent co-signed below. I will call to inform my aesthetician of any complications or concerns as soon as they occur. I certify that I have read the above consent and I fully understand it and give my consent to the Dermaplaning treatment.
Contraindications:

Although it is impossible to list every potential risk and complication, the following conditions are recognized as contraindications for dermaplaning treatment and must be disclosed prior to treatment.
- Active acne
- Active infection of any type, such as herpes simplex or flat warts.
- Any raised lesions
- Any recent chemical peel procedure
- Chemotherapy or radiation
- Eczema or dermatitis
- Family history of hypertrophic scarring or keloid formation
- Hemophilia
- Hormonal therapy that produces thick pigmentation
- Moles
- Oral blood thinner medications
- Pregnancy
- Recent use of topical agents such as glycolic acids, alpha-hydroxy acids and Retin-A
- Rosacea
- Scleroderma
- Skin Cancer
- Sunburn
- Tattoos
- Telangiectasia/erythema may be worsened or brought out by exfoliation
- Thick, dark facial hair
- Uncontrolled diabetes
- Use of Accutane within the last year
- Vascular lesions
Post-Treatment/Aftercare

Exercise or vigorous physical activity should be avoided until all redness has subsided. Direct sunlight exposure is to be completely avoided immediately following the treatment (including any strong UV light exposure or tanning beds). Although SPF 30+ should already be a part of your daily skin care, after dermaplaning, SPF 30+ must be applied daily to the treated area for a minimum of two weeks. Twice daily cleanse the treated area with a post- treatment cleanser, followed by a serum or treatment cream and follow with SPF 30+ sunscreen.

Consent:

I understand that if I have any concerns, I will address these with my technician/esthetician. I give permission to my technician/esthetician to perform the above treatment/procedure we have discussed and will hold Em Beauty & Skin and their staff harmless and nameless from any liability that may result from this treatment/procedure. I understand my technician/esthetician will take every precaution to minimize or eliminate negative reactions as much as possible. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read and fully understand the above information and that I have been provided sufficient opportunity for discussion and to have any questions answered. I understand the procedure and accept the risks. I do not hold the technician/esthetician responsible for any of my conditions that were present but not disclosed at the time of this procedure that may be affected by the treatment performed today.

I am over 18 years of age and consent to the agreement and to treatment or have a parent with me that consents to this service.

This agreement will remain in effect for this procedure and all future procedures conducted by my technician.
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Dermaplaning Informed Consent