CHEMICAL PEEL CONTRAINDICATIONS - Allergy to any of the chemical peel components, especially salicylic acid (a derivative of aspirin)
- Pregnancy/Lactating
- Herpes Simplex (cold sores or fever blisters). Antiviral medication may be necessary prior to treatment.
- Extensive sun or tanning 3 days prior and 3 days post-treatment.
- Accutane in the past 6 months to 1 year.
- Topical retinol products in the past 2 weeks.
- Waxing of the area to be treated in the past 7 days.
- Any other chemical peel within 14 days of the treatment.
- Skin must be healthy and intact
Multiple treatments are required in order to obtain optimal results spaced 2-6 weeks apart. Due to variables such as age, condition of your skin, sun damage, smoking, skin care products, climate, lifestyle, and general health, you acknowledge that there are no guarantees, warranties, or assurances that you will be satisfied with your results. Pre-Treatment Care ONE WEEK BEFORE YOUR CHEMICAL PEEL Avoid these products and/or procedures for one entire week prior to your chemical peel: Electrolysis, Waxing, Depilatory Creams, Laser Hair Removal, Clients who have had medical cosmetic facial treatments or procedures (e.g. laser therapy, surgical procedures, cosmetic filler, microdermabrasion, etc.) should wait until skin sensitivity completely resolves before having a Chemical Peel. Clients who have had BOTOX injections should wait until the full effect of their treatment is seen before receiving a Chemical Peel. THREE DAYS BEFORE YOUR CHEMICAL PEEL Avoid these products and/or procedures: Sun Exposure, Retin-A, Renova, Differin (Adapalene 0.1%), Tazorac, Any product containing Retinol, AHA or BHA, or benzoyl peroxide. Any exfoliating products that may be drying or irritating. Note: The use of these products/treatments prior to your peel may increase skin sensitivity and cause stronger reactions. Treatment Expectation DESCRIPTION OF PROCEDURE The area(s) to be peeled, usually, the face is cleansed with an alcohol or acetone preparation solution. The peel solution is carefully applied to the face avoiding the eyes and lips. The solution or gel is left on the skin for up to 2-5 minutes and then is removed with gauze sponges in cool water or a neutralizing agent or not removed. WHAT WILL BE EXPERIENCED As the peel solution begins to take effect, a mild burning/tingling sensation starts. This is minimally uncomfortable, but for most patients lasts approximately ten minutes and is soothing. At the end of the procedure, cool water or neutralizing solution may be applied to the face. The face is usually pink for up to several or more hours and may be dry over the next day or two. But, typically, any dryness is very subtle and not visually obtrusive – there is no need to skip work. Use an SPF 30 or higher sunscreen every morning and moisturizer as needed for several days. A skin care program is an important part of any post-peeling regimen and should be started or restarted when your skin is back to normal (i.e. no longer pink or dry); usually after 2-5 days or more. Post-Treatment Expectations and Instructions AFTER YOUR CHEMICAL PEEL It is crucial to the health of your skin and the success of your peel that these guidelines be followed. - It is imperative that you use sunscreen with an SPF of at least 20 and avoid direct sunlight for at least 1 week.
- Clients with hypersensitivity to the sun should take extra precautions to guard against exposure immediately following the procedure as they may be more sensitive following the peel.
- Because of the superficial nature of a chemical peel, clients should expect to see visible peeling. Occasionally, some clients may have very minor flaking 3-4 days after the procedure.
- The skin may appear red for about one hour after treatment. If the neck and décolletage area are treated, the redness might last slightly longer.
- Your skin may be more red than usual for 2-3 days. Please avoid strenuous exercise during this time.
- Approximately 48 hours after the treatment, your skin will start to peel. This peeling will generally last 2 to 5 days. DO NOT PICK OR PULL THE SKIN.
- Do not have any other facial treatments for a least one week after your peel.
- Apply a light moisturizer as often as needed to relieve dryness and tightness.
- When washing your face, do not scrub. Use a gentle cleanser.
- You may resume the regular use of Retin-A, alpha-hydroxy acid (AHA) products, or bleaching creams ONLY after the peeling process is complete or after 4-5 days.
AVOID ANY IMPORTANT WORK OR SOCIAL PLANS ON DAYS 3-6 POST PEEL: It is essential to use plenty of SPF beginning day two, we will offer our recommended product for your first treatment. It is very important to protect your skin from irritation during the exfoliation process, so no harsh products, AHA’s or tretinoin, hot water, scrubbing, or Clarisonic brushes. DO NOT pull at or remove peeling skin as this can cause scarring. Be patient! The dead skin will slough off when you wash your skin. If you’re not sure about something or have any concerns, please call your provider directly for advice. ADVERSE EXPERIENCES THAT MAY OCCUR AFTER YOUR CHEMICAL PEEL: It is common and expected that your skin will be red and possibly itchy and/or irritated. It is also possible that other adverse experiences (side effects) may occur. Although rare, the following adverse experiences have been reported by clients after having a chemical peel: edema, stinging and burning, dryness, and erythema.
Please initial here that you have read, understood, and agreed to the following information: CANCELLATION POLICIES I do understand the 24-hour cancellation notice required and agree to pay the appropriate fees if I do not cancel or reschedule within 24 hours of my appointment date and time. A cancellation fee of $45 will be applied if I fail to cancel or reschedule within the specific time frame. The same rule applies to NO SHOW appointments. As a courtesy, we will send an email/text message reminder to confirm your appointment date. Must confirm on all follow-up appointments. Please understand that it is your responsibility to let us know if you need to cancel or reschedule to avoid the cancellation fee.
Refund Policy I do understand all sales are final and non-refundable. There will be no refund or reimbursement for the unfinished package(s), voucher, or deals if you become ineligible for laser treatment or physically unable to continue the treatment within the stated period. However, exchanges may be made for any remaining credit toward other services we provide. Tipping/Gratuity I do understand that TAXES/GRATUITY are not included in any service I purchase. Tipping is not mandatory but it is customary in most circumstances for service. It is common practice to tip 10%-20% of the original service price. Please feel free to extend a gratuity as a result of your experience. Gratuities are accepted in the form of cash or credit card. By signing below, I certify all information is true and correct to the best of my knowledge, understand and agree to the following: - I certify that I am not Pregnant and I am not planning to get pregnant during the course of the treatment.
- I certify that I have not taken Accutane within the past six months.
- I certify that I have not taken an Antibiotic within the past four weeks.
- I certify that I do not have a Pacemaker or internal defibrillator.
- Have the right to consent to or refuse any proposed procedure at any time prior to its performance.
- I certify that the information contained in this Informed Consent was explained to me using terms I could understand, and all my questions and concerns have been answered. After reviewing all the information provided to me about cosmetic procedures and reviewing my health status, I believe I am a good candidate for the procedure/s.
- I acknowledge and accept the risks inherent in the procedure/s. I voluntarily assume the risk of possible complications and side effects which may arise from the Treatments set forth herein; and any of my heirs, executors, representatives or assigns hereby release Sarah Laser Center Inc. from any and all claims, liabilities for personal injury, and property damages of any kind sustained while on the premises, during the treatments set forth herein by any employees or representatives of Sarah Laser Center Inc.
- I confirm that I have read the post-treatment instructions provided by Sarah Laser Center Inc. and I understand that it's my responsibility to follow these instructions and that my failure to adhere to these recommendations may result in complications and contraindications for which I am fully responsible.
- I certify that I have been advised of the pre-treatment instructions, the post-treatment healing process, and the possible risks relating to treatment, and have been given the opportunity to ask and have answered all questions. I agree to follow all aftercare instructions and to notify Sarah Laser Center Inc. of any concerns or difficulty in healing, along with any updates in my medical information. Further, I will not hold Sarah Laser Center Inc. liable for any omissions or post-treatment reactions.
- I certify that I have read the entire above Informed Consent and believe that Sarah Laser Center Inc. has adequately explained the risks of this treatment, alternative methods of treatment, and possible benefits from this treatment, and I hereby consent to the Chemical Peel treatment to be performed by the technicians of Sarah Laser Center Inc. Considering that I have been informed that certain medical conditions prohibit the patient from the treatment, I have provided a full and truthful medical history and a truthful and accurate account of my medications to this office. Having been apprised of all the above, I have signed this Consent Form and authorized the subject treatment.
Date: May 21, 2024
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