This form provides information about microblading, which involves the application of semi-permanent makeup. You are encouraged to carefully review the information provided to make an informed decision as to whether to undergo the microblading procedure. Microblading involves the insertion of pigment into the dermal layer of the skin and is a form of tattooing. Initially the color will appear more vibrant or darker compared to the end result. Usually within 7 days the color will fade 10-20%, soften, and look more natural. The pigment is semi-permanent and will fade over time and will likely need to be touched up within 6-18 months. All instruments that enter the skin or encounter body fluids are disposable & disposed of after each use. Cross contamination guidelines are carefully adhered to.
Skin quality, skin care routine, UV and environmental exposure as well as abidance of aftercare instructions are all major factors in outcome of microblading and permanent makeup. centail skin types are not ideal candidates for microblading; Oily skin, very dry skin, large pores, mature skin, & frequent tanners may possibly experience color migration in which the strokes make widen and blur as well as a color change in the pigment. Our bodies contain natural foreign body fighting components, their job is to surround and break down foreign substances and implants in our body. They cannot easily break down and disperse large particles and tend to spread them out under the skin. This results in hazy & widely healed strokes. It is each individual's immune system response and is beyong LUXX, and the cleints, control. Generally, the results of microblading are excellent. However, a perfect result immediately following initial procedure is not a realistic expectation & it is usual to expect a touch up after the healing is complete.
Please note: With microblading, the results are a very natural fuller looking brow. Initially, the brows appear darker but fade significantly over a two week period. It is imperative to have a touchup. It is very difficult to predict how well your skin will retain pigment or how it will heal. Due to this and many other various factors, we cannot guarantee your individual results but will do our best to please each client. Individual results may vary. Refunds are not offered at any time, for any reason.
Possible risks, hazards, or complications:
PAIN: There is a possibility of pain or discomfort even after the topical anesthetic has been used. Anesthetics work better on some people than others.
INFECTION: Although rare, there is a risk of infection. The areas treated must be kept clean and only freshly cleaned hands should touch the areas. See "After Care" sheet for instructions.
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. Adjustments may be needed during the follow up session to correct unevenness.
EXCESSIVE SWELLING OR BRUISING: Some people bruise and swell more than others. Ice packs may help, and the bruising and swelling typically disappear within 1-5 days. Some people don’t bruise or swell at all.
ANESTHESIA: Topical anesthetics are used to numb the area to be tattooed. Lidocaine, Prilocaine, Benzocaine, Tetracaine and Epinephrine in a cream or gel form are typically used. If you are allergic to any of these please inform me now.
ALLERGIC REACTION: There is a possibility of an allergic reaction to the pigments or other materials used. You may take a 5-7-day patch test to determine this.
The alternative to these possibilities is to use cosmetics and not undergo the microblading procedure.
CONSENT FOR MICROBLADING PROCEDURE:
Please read and initial all lines
I am currently not under the influence of any drugs or alcohol.
I am NOT pregnant.
I do not currently take nor have taken Accutane within the last 12 MONTHS.
I have not had Botox and/or other cosmetic filler procedures within the past two weeks.
I have not had any surgery of any kind in the past 6 weeks.
I have not taken any blood thinning medication within the past 72 hours nor have i taken Aspirin within the past 24 hours.
Aftercare instructions have been explained to me and are attached to this consent form. A written copy will be given to me to retain in my possession, which I will follow to the best of my ability. If i have questions I will contact my technician.
I will contact my physician if I notice any infection beginning to form.
I understand a certain amount of discomfort is associated with this procedure and that swelling, redness, and bruising may occur.
I understand that Retin A, Renova, Alpha Hydroxy and Glycolic Acids must not be used on the treated areas. They will alter the color.
I understand that the sun, tanning beds, pools, some skin care products and medications may affect my permanent makeup.
I accept the responsibility for explaining to my technician my desire for specific colors, shape, and position for any procedure done today.
I understand that implanted pigment may changer or fade over time due to circumstances beyond the salon's control (such as oily skin, dry skin, skin care productsnatural immune system, sleeping side, UV exporure) and I will need to maintain the color with future applications and a touch-up session in 4-6 weeks.
I acknowledge that the microblading procedure involves inherent risks and that there is a possibility of one or more complications during and/or following the procedure such as: infection, misplaced pigment, poor color retention and hyper-pigmentation.
I have been quoted the cost of today's appointment which includes (1) perfecting touch-up within 4-6 weeks following today's appointment. After 8 weeks, a fee will apply for any further touch-ups. There will be no refund for this elective procedure.
I acknowledge that I am at least 18 years of age and i certify that I have read or have had read to me the contents of this form. I understand the risks and alternatives involved in this procedure. I have had the opportunity to ask questions and all of my questions have been answered. I acknowledge that I have reviewed and approved the materials given to me and I authorize Jessie Winn, owner of LUXX Beauty & Brow Bar, to perform the microblading procedure on me. I hereby release Jessie Winn, and LUXX Beauty & Brow Bar and its affiliates from any liability arising from the risks that are known and/or inherent in the microblading procedure.
Today's Date: February 21, 2020