Microdermabrasion/Peel Informed Consent

  • I understand that there may be a burning sensation or stinging may occur during treatment.
  • I understand that possible side effects include, but are not limited to peeling, tightness, mild to extreme redness, suction marks, wind-burn sensation, dry skin, flaking skin, and lightening or darkening of the skin.
  • I understand that the result of the treatment may vary due to conditions such as age, condition of the skin, sun damage, damage due to smoking, climate, etc.
  • I understand the number of treatments advised is dependent on skin type and condition and the best results are achieved when the advised program is followed.
  • I understand that this treatment is a cosmetic treatment and that no medical claims are expressed or implied.
  • I understand that I cannot exercise or do anything that will cause me to perspire for 4 hours after the treatment.
  • I understand that blemishes and / or cold sores may appear after this treatment.
  • I understand that waxing of the exfoliated area should be avoided for 10-14 days before and after this treatment.
  • I understand that collagen and Botox injections should be avoided for 10-14 days after this treatment.
  • I understand that direct sun exposure, include tanning booths, is prohibited while I am undergoing treatment and that the use of daily sun block protection (minimum SPF 30) to the treated area is mandatory.
  • I have not had a chemical peel or microdermabrasion treatment of any kind within on week of his treatment, whether the treatment was performed at this location or any other location.
  • I understand that I am to discontinue all AHAs, Glycolics, Retin-A, Renova, or any exfoliating products for 72 hours pre and post treatment.
  • I understand that I should not take Accutane for 6 months prior to this treatment.
Fields marked with an * are required.
  • I hereby agree to all of the above and agree to have this treatment performed on me. I further agree to follow all post-care instructions. Prior to receiving this treatment, I have been candid in revealing any condition that may have bearing on this procedure.
  • This field is for validation purposes and should be left unchanged.

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