Please read carefully before you sign the waiver and consent to receive Microneedling treatment at Ease Medspa & Wellness Group.
I hereby authorize Ease Medspa & Wellness Group to perform Microneedling Therapy (Collagen Induction Therapy) on me. I understand this technique involves the introduction of fine needles through the skin.
The purpose is to create micro-channels in the skin allowing the infusion of active ingredients to penetrate deeply and effectively into the dermis, nourishing the skin and stimulating the regrowth of collagen, and a series of 4 to 6 treatments are recommended in order to achieve the best result.
I understand that I may expect:
• Depending on the area of your face or body being treated, the procedure is well-tolerated and in some cases virtually painless, feeling only a mild prickling sensation.
• I understand that the administration of numbing creams may be used if deemed needed.
• The skin will be pink or red in appearance, much like a sunburn, for a couple of hours following treatment.
• Minor bleeding and bruising is possible depending on the length of the needle used and the number of times it is pressed across the treatment area.
• The skin may feel warm, tight, and itchy for a short while. This should subside in 12-48 hours.
I understand that there are some possible side-effects:
Temporary bruising, skin discomfort during injections, redness or swelling, lightening or darkening of the skin, itching and burning. Skin infection is a possibility any time an injection or surgical procedure is done. If you have a history of cold sores, this procedure may cause flare ups. Side effects are most of the time temporary and typically resolve within 3-4 days. Total healing time depends on the depth of the treatment, skin type, and skin condition, and some clients may heal completely in 24 hours.
I understand the contraindications listed below, and I will notify my provider if any of the following apply to me:
- Have used Accutane (isotretinoin) within the last year.
- Active skin infections, conditions - viral, fungal, bacterial, rashes, warts, skin cancer , herpes simplex in the area to be treated.
- Active acne
- Immune-suppressed patients
- Skin-related autoimmune disorders
- Pregnant or breast-feeding
- On anticoagulants (NSAIDS, ASA, Coumadin/Warfarin)
- Recent ablative dermal procedures
- Have any history of keloid, cold sores, hypertrophic scars or poor wound healing
The benefits and risks of the procedure have been explained to me, and I accept these benefits and risks.
By my signature, I certify that I have thoroughly read and understand the contents of this form and the disclosures listed above were made to me. I am also aware of and accept the risk of rare and unforeseen complications which may not have been discussed and which may result from this treatment.
I acknowledge that no promises or guarantees have been made to me as a result of the treatment. I am aware that the results achieved by this treatment may vary from person to person.
I have had the opportunity to ask questions and seek clarification of this procedure and its alternatives including no treatment and my questions have been answered satisfactorily. I hereby give my voluntarily consent to have this treatment performed on my skin by a licensed technician and to follow all post-treatment protocols.
Dated: January 26, 2021