PRP Platelet Rich Plasma Consent Form
What is PRP?
Platelet Rich Plasma, also known as "PRP" is a treatment whereby a person's own blood is used. Blood is drawn up from the individual patient into a specialized tube. The blood is spun in a special centrifuge to separate its components (Red Blood Cells, Platelet Rich Plasma).
Platelets are very small cells in your blood that are involved in the clotting and healing process. When PRP is injected into the damaged area it causes a mild inflammation that triggers the healing cascade, they release a number of enzymes to promote healing and tissue responses including attracting stem cells and growth factors to repair the damaged area. As a result new collagen begins to develop. As the collagen matures it begins to shrink causing the tightening and strengthening of the damaged area. When treating injured or sun and time damaged tissue, they can induce a remodeling of the tissue to a healthier and younger state. The full procedure takes approximately 45 minutes to an hour dependent on area of treatment. Typically 3 treatments on the face initially followed by maintenance treatments and 6 initial treatments of the scalp for hair restoration.
Benefits
PRP has been shown to have overall rejuvenating effects on the skin including: improving skin texture, thickness, fine lines and wrinkles, increasing volume via the increased production of collagen and elastin, and by diminishing and improving the appearance of scars. The most dramatic results to date have been the crepey skin problems in areas such as under the eyes, neck, and décolletage. It is not designed to replace cosmetic surgery as there are some cases where those procedures would be more appropriate.
CONTRAINDICATIONS
PRP used for aesthetic procedures is safe for most individuals. Parental Consent required for patients under 18. There are very few contraindications, however, patients with the following conditions are not candidates:
1) Acute and Chronic Infections
2) Skin diseases
3) Cancer
4) Chemotherapy treatments
5) Severe metabolic and systemic disorders
6) Abnormal platelet function (blood disorders, i.e. Haemodynamic Instability,
Hypofibrinogenemia, Critical Thrombocytopenia)
7) Chronic Liver Pathology
8) Anti-coagulation therapy
9) Underlying Sepsis
10) Systemic use of corticosteroids within two weeks of the procedure.
CONSENT
My consent and authorization for this elective procedure is strictly voluntary. By signing this informed consent form, I hereby grant authority to the practitioner to perform Platelet Rich Plasma " aka" PRP injections to area(s) discussed during our consultation, for the purpose of aesthetic enhancement and skin rejuvenation.
I am 18 years or older. I have read this informed consent and certify I understand its contents in full. All of my questions have been answered to my satisfaction and I consent to the terms of this agreement. I agree to adhere to all safety precautions and instructions after the treatment. I have been instructed in and understand post treatment instructions.