11550 Jonesbridge Rd, Suite# 6, Alpharetta GA 30022 Email: info@cosmomedspaatl.com Tel: (678) 829-7722 Microneedling/Vampire Facial PRP Consent Form
Description of the Procedure Microneedling treatment allows for controlled induction of the ksin’s self-repair mechanism by creating micro“Injuries” in the skin, which triggers new collagen synthesis, yet does not pose the risk of permanent scarring. The result is smoother, firmer and younger-looking skin. Microneedling procedures are performed in a safe and precise manner with the use of the sterile needle head. The procedure is normally completed within 30-60 minutes, depending on the required treatment andanatomical site. Topical numbing is usually used prior to make the procedure more comfortable.
Side Effects After the procedure, the skin will be red and flushed in appearance in a similar way to moderate sunburn. Youmay also experience skin tightness and mild sensitivity to touch on the area being treated. This will diminishgreatly after a few hours following treatments, and within the next 24 hours the skin will be completely healed. After three days there's barely any evidence that the procedure has taken place. As with any procedure thatdisrupts the normal integrity of the skin, there is a small chance of bruising and/or infection. Any bruising isusually very minimal and resolves quickly.
Contraindications Microneedling treatment is contraindicated for patients with: keloid scars, scleroderma, collagen vasculardiseases or cardiac abnormalities, a hemorrhagic disorder or clotting dysfunction, active bacterial or fungalinfection, or those with a history of shingles outbreak on neck or head.
Precautions & Warnings Microneedling treatment has not been evaluated in the following patient populations, as such, precautionsshould be taken when determining whether to treat; scars and stretch marks less than one year old, women whoare pregnant or nursing, keloid scars, patients with a history of eczema, psoriasis and other chronic conditions,patients with a history of actinic keratosis, patients with a history of herpes simplex infections, diabetics orpatients with wound-healing deficiencies, patients on immunosuppressive therapies, and skin with presence ofraised moles or warts on targeted areas.
Patient Consent
- I understand that results will vary among individuals.
- I understand that although I may see a change after my first treatment, I may require a series of sessions to obtain my desired outcome.
- I understand that procedure and side effects have been explained to me including alternative methods, as have the advantagesand disadvantages.
- I am advised that though good results are expected, the possibility and nature of complications cannot beaccurately anticipated and that, therefore, there can be guarantees as expressed or implied either as to thesuccess or other result of the treatment.
- I am aware that microneedling treatment is not permanent as naturaldegradation will occur over time.
- I state that I have read (or it has been read to me) and I understand this consent and the information contained init.
- I have had the opportunity to ask any questions about the treatment including ricks or alternatives andacknowledge that all my questions about the procedure have been answered in a satisfactory manner.
Waiver Agreement THE UNDERSIGNED acknowledges that TECHNICIAN has explained the nature of all the above noted treatment of Microneedling procedures including the risks and dangers inherent therein. I HEREBY CONSENT to performing the above-noted treatment procedures on me and in consideration of their so doing; I hereby release and forever discharge Cosmo Med Spa & Salon, from all claims, demands, damages, actions or causes of action arising out of the performance of the said treatment procedures, which I, my heirs, executors, administrators or assigns can, shall, or may have. (NO REFUND ON ANY TREATMENT.)