• Microdermabrasion

    Consultation and Consent Form
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  • Referred by

  • What is Microdermabrasion?

    Microdermabraion uses an adjustable application head that removes dead surface skin cells and initiates cellular turnover at the dermis and epidermis levels in a safe controlled manner. This approach respects the integrity of the skin and promotes even healing. Maintaining even cellular growth on the surface aids in the youthfulness of the skin's appearance. 

    Microdermabrion has been used to treat aging and sun-damaged skin, some types of acne and acne scarring, altered pigmentation, fine lines and wrinkles, and stretch marks. Results may include improved skin tone, fewer breakouts, diminished appearance of scars, even skin color, refined pores, renewed elasticity and a healthy glow. 

  • What should you expect during your treatment?

    Prior to your first microdermabrasion, as your esthetician, I will perform a thorough skin analysis. If microdermabrasion is not appropriate, you are informed during this session and an alternative treatment may be recommended instead.  If microdermabraion is for you, maximum results are obtained by participating in a series of treatments plus following a home care regiment. 

    To further enhance your outcome, I require that you use products specifiacally directed toward obtaining correction. Your current daily regimen and skincare products used will be reviewed and yo will be instructed which products you should continue to use, and will be advised on any recommended additions to your regimen. I recommend keeping regular appointments and carefully following your home care regiment to support your results. 

     

    As your esthetician, I take every precaution to ensure that your skin is well hydrated and calm prior to leaving each session. However, you may experience excessive dryness or even some peeling between sessions, which may or may not be normal. Always check with me if you have any concerns after the treatment. More sensitive skin may experience some redness after the first couple of sessions. This normally goes away after 2-3 hours.

    After your treatment, sunblock must be worn at all times and tanning beds should never be used. You are making an investment in your face; therefore, it is your benefit to continue to protect it long after your series is completed. 

  • Is satisfaction guaranteed?

    The majority of my clients receive satisfactory to above average results with a series of treatments. Maximum results are highly depended on your age, cumulative sun exposure, health, menopause, lifestyle, genetic traits, general skin condition, and your willingness to follow recommended protocols. 

    Be aware that many changes may occur deeper within the skin over time. I find that when participating in a series of treatments, along with a commitment to your daily skin care regiment, noticeable differences may indeed by the outcome. You may see a reduction of fine lines and a softening of deeper wrinkles, reduction of discoloration, softening and possible reduction in scars, adn an overall improvement to the skin's tone and appearance. To continue the maintenance of your skin after you complete your treamtent(s), i my inform you of long-term age management programs. 

  • Do you have concerns with any of the following?*
  • I have been off of Retin-A/Retinol for at least 1 week.*
  • I have not had any chemical peels or exfoliating treatments in the last week.*
  • I am not on any oral or topical steroids.*

  • Contraindications

    Although it is impossible to list every potential risk and complication, the following conditions are recognized as contraindications for microdermabraion treatment and must be disclosed prior to treatment. 

    • Active infection of any type, such as Herpes simplex virus or flat warts
    • Active acne
    • Sunburn
    • Recent use of topical agents such a glycolic acids, AHAs and Retin-A
    • Any recent chemical peel procedure
    • Uncontrolled diabetes
    • Eczena, dermatitis
    • Skin canser
    • Vascular lesinos
    • Oral blood thinner medications
    • Roscea
    • Tattoos (not effective)
    • Pregnancy
    • Use of Accutane within the last year
    • Family history of hypertrophic scarring or keloid formation
    • Telangiectasia/erythema may be worsened or brought out by skin exfoliation 

  • Post-Treatment/Home Care

    Aerobic 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 and tanning beds). If some sun exposure cannot be avoided, first apply sunscreen with an SPF of 30 of greater. Although sunscreen should be a part of your daily skin care, for a minimum of two weeks, a sunscreen with at least a SPF 20 must be applied. 

    Cleanse your face with water and a gentle cleanser twice daily followed my sunscreen (minimum 30). If a site other than the face is treated, you only need to cleanse once daily, followed by sunscreen. 

    In the event that you have additional questions or concerns regarding your treatment of suggested home product / post-treatment care, you must consult your therapist immediately. 

     

  • Microdermabrasion Consent

  • I,*, have read the above information and initialed each section to indicate that I fully understands what to expect. If I have any questions or concerns, I will address these with my skin therapist. I give permission to my therapist, Adrienne Leach, to perform the microdermabrasion procedure we have discussed and will hold her and her staff harmless from any liability that may result from this treatment. I understand she will take every precaution to minimize or eliminate negative reactions such as blisters, sores, or other reactions, as much as possible. I ave given an accurate account of any over-the-counter or prescription medications that I use regularly and I am not presently using Isotretinoin (Accutane). I have not had any facial surgical procedures or other chemical peels or skin treatments that I have not disclosed to my therapist. I am not ingesting or using topically or any over-the-counter product or prescription medication/agent that has not been disclosed to my therapist. I am not presently pregnant or lactating and I am over the age of eighteen (18).I have not had any recent radioactive or chemotherapy treatments, sunburns, windburn or broken skin. I have not recently waxed or used a depilatory (such as Nair) on the area to be treated. I do not have a history of keloid all scarring, excessive telangiectasia, rosacea, bacterial skin infections, fungal infections, viral infections, open lesions or rashes, active acne, any auto immune disease, or any other existing condition that may interfere with the positive outcome of the treatment. I consent to the taking of photographs to monitor treatment effects, as desired or recommended by my therapist. My expectations are realistic and I understand that the results are not guaranteed. I agree that I am willing to follow recommendations by my esthetician for home care. I will be responsible for following home regimens that can minimize or eliminate possible negative reactions, including recognizing the importance of adhering to a sunscreen and avoiding the sun/tanning booths and extreme weather conditions. I agree to use a moisturizer specifically recommended by my esthetician and I acknowledge that I have been informed of the possible negative reactions and the expected sequence of the healing process (dryness, irritation, redness, and peeling of the skin). In the event that I may have additional questions or concerns regarding my treatment or suggested home product/post-treatment care, I will consult my therapist immediately.I understand the potential risks and complications and have chosen to proceed with the treatment after careful consideration fo the possibility of both known and unknown risks, complications, and limitations. I agree that this constitutes full disclosure, and that is supersedes any previous verbal or written disclosures. I certify that I have read, and ugly understand the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered.

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