Permanent Makeup Medical History, Consent and Release

Permanent Makeup Pre-Care Instructions

 

Thank you for choosing Bella Lash & Beauty Bar for your permanent makeup treatment. Please make sure you read the following instructions to assure the best results for your procedure. These instructions are also found on our website.

 

• Do not drink coffee, alcohol or energizing drinks 24 hours before treatment.
• Do not take Aspirin, Niacin, Vitamin E or Ibuprofen 24 hours before treatment.
• Do not tan or have intense sun exposure 3 days before treatment.
• No waxing 2-3 days before treatment.
• Do not take omega3 (fish oil) 1 week before treatment.
• No chemical peels, dermabrasion, laser or any other intense treatments 2 weeks before treatment.
• No Botox 4 weeks prior to your treatment.
• Do not work out the day of the procedure

Please read the following statement and sign and date on the line to indicate that you have read the statement and understand it:

Client Medical History Form

 

Do you have or previously had any of the following: (Select Yes or No)

I agree that all the above information is true and accurate to the best of my knowledge.

Statement of Consent and Recitals:

Please read and agree to all lines

Aftercare Instructions

Possible Risks, Hazards, or Complications

Pain: There can be pain even after the topical anesthetic has been used. Anesthetics work better on some people than on others.

Infection: Infection is very unusual. The areas treated must be kept clean, and only freshly cleaned hands should touch the areas. See “After Care” sheet for instruction on care.

Uneven Pigmentation: This can result from poor healing, infection, bleeding, or many other causes. Your follow up appointment will likely correct any uneven appearance.

Asymmetry: Every effort will be made to avoid asymmetry, but our faces are not symmetrical so adjustments may be needed during the follow up session to
correct any unevenness.

Excessive Swelling or Bruising: Some people bruise or swell more than others. Ice packs may help reduce the swelling. The swelling or bruising typically disappears in 1-5 days. Some people don’t bruise or swell at all.

Anesthetics: Topical anesthetics are used to numb the area to be tattooed.
Lidocaine, prilocaine, Benzocaine, Tetracaine, and or Epinephrine cream and or
liquid are used. If you are allergic to any of these, please inform your
Permanent Makeup Artist now.

MRI: Because pigments used in Permanent Cosmetic procedures contain inert
oxides, a low level magnet may be required be required if you need to scanned by an MRI machine. You must inform your MRI Technician of any tatoos or
permanent cosmetics.

 

The alternative to these possibilities is to use the traditional cosmetic and NOT undergo the permanent makeup procedure.

Consent and release for procedures performed:

Consent and Release Agreement

This form is designed to give information needed to make an informed choice of whether or not to undergo a 3D Eyebrow, Microblading, or permanent makeup application. If you have any questions, please don’t hesitate to ask.

Although permanent makeup is effective in most cases, no guarantee can be made that a specific client will benefit from the procedure.

This is the process of inserting pigment into the basal layer of the epidermis. It is a form of tattooing, though semi-permanent.

All instruments that enter the skin or come in contact with body fluids are disposable, and disposed of after use. Cross contamination guidelines are strictly adhered to.

Generally, the results are excellent. However, a perfect result is not a realistic expectation. It is usual and advised to expect a Touch-Up after healing is completed.

Initially the color will appear more vibrant or darker compared to the end result. Usually within 5-7 days the color will fade 40-50%, soften and look more natural. The pigment is semi-permanent and will fade over time. Additional Touch ups are likely needed within 6 months to 2 years.