MICRODERMABRASION CONSENT FORM
Microdermabrasion gently exfoliates the upper layers of the skin while a vacuum system removes debris and stimulates lymph nodes and blood flow. Microdermabrasion can be used to:
- Diminish the appearance of fine lines, rough and dull skin, hyperpigmentation, acne scars, etc.
- Enhance the penetration of products and improve the skin’s ability to retain water.
Due to your unique skin composition, you acknowledge that there are no guarantees, warranties or assurances that you will be satisfied with your results. In our experience, multiple treatments are required in order to obtain optimal results. Microdermabrasion on may be combined with other cosmetic facial procedures such as photo rejuvenation and chemical peels.
NOT recommended under the following conditions:
-Cold sore outbreak: wait until lesions have healed. Consider an antiviral prescription.
-Undiagnosed lesions, grade 3 & 4 acne, warts (especially flat warts), skin cancer of area to be treated, dermatitis, sunburn, and active shingles.
-Pregnancy and nursing mothers.
-Those diagnosed with cancer, HIV/AIDS or any type of autoimmune disorder such as lupus.
-Active rosacea (microdermabrasion may be too stimulating).
-Brittle diabetes, blood thinners, and vitiligo.
-Accutane within the past year
-Topical retinoid products (Retin A, Differin, Tazorac) in the past month.
-History of keloid scarring or pigmentation disorders.
-Waxing of area within the past 3-7 days & use of a tanning bed 3 days before or after your microdermabrasion treatment.
-Surgery over the area to be treated in the past six months
-Phenol or other deep peels with n the past year
The following treatments should not be performed for a minimum of 7 days before or after your microdermabrasion treatment:
-Electrolysis, -Injections (Botox, collagen, fat, etc.)
-Facial steaming -Electric facials (high frequency, galvanic currents)
-Unprotected sun exposure with n the past 72 hours
I am aware of the following:
- Swelling and redness may occur for 2 hours and up to 7 days post-treatment.
- Bruising, itching, irritation, or acne flare-up may occur.
- Microdermabrasion is very dehydrating, therefore regular moisturizing is recommended.
- Daily SPF of a minimum of 30 is needed to protect the skin from harmful UV rays.
- There is a slight possibility that during healing the treated area may become darker or lighter than the rest of the skin. This is temporary, and only in rare cases may become permanent.
- Scarring is a rare possibility that is to be avoided by properly following the post-care instruction.
By signing below you acknowledge you understand and accept all the risks and complications that may result as a consequence of the procedure and the post-procedure care. You also authorize MedSpa at Villagio to take a pre and post photo and perform the procedure on you. This consent is valid for all future microdermabrasion sessions with MedSpa at Villagio.