Consent Form for PRP Microneedling Treatment

Aluna Cosmetic Dr. Ramtin Massoudi, MD

You have elected to undergo PRP (Platelet-Rich Plasma) Microneedling treatment. This procedure involves the use of microneedling combined with PRP derived from your own blood to promote skin rejuvenation and healing.

Purpose: The purpose of PRP Microneedling is to improve skin texture, tone, and overall appearance by stimulating collagen production and enhancing the skin's natural healing processes. It can help address issues such as fine lines, wrinkles, acne scars, and hyperpigmentation.

1. A small sample of your blood will be drawn. 2. The blood will be processed to separate the platelet-rich plasma (PRP) from other blood components. 3. Microneedling will be performed on the treatment area using a device with fine needles to create micro-injuries in the skin. 4. The PRP will be applied to the skin, allowing it to penetrate through the microchannels created by the microneedling process. 5. Post-treatment care instructions will be provided to aid in the healing process.

Potential Risks and Complications:

While PRP Microneedling is generally safe, there are potential risks and complications, including but not limited to:

Redness and swelling Bruising and bleeding at the treatment site Infection Scarring Allergic reactions Discomfort or pain

Alternative treatments to PRP Microneedling include, but are not limited to, chemical peels, laser treatments, traditional microneedling without PRP, and topical skincare treatments. These options can be discussed with Dr. Ramtin Massoudi to determine the most suitable treatment for your condition.

Follow all post-treatment care instructions provided by Dr. Ramtin Massoudi and the Aluna Cosmetic team. Avoid direct sun exposure and use sunscreen as recommended. Keep the treated area clean and moisturized. Avoid using makeup or other skincare products not approved by our office for the specified period. Report any unusual symptoms or concerns to our office immediately.

By signing this form, I acknowledge that I have read and understood the information provided about PRP Microneedling treatment. I have had the opportunity to ask questions and discuss any concerns with Dr. Ramtin Massoudi. I understand the potential risks and benefits associated with the procedure, as well as alternative treatment options. I consent to proceed with the PRP Microneedling treatment under the care of Dr. Ramtin Massoudi and the Aluna Cosmetic team.

Contact Information: Please ensure all information is filled out accurately and consult with our team if you have any questions or need further clarification.