Aquafirmexs Patient Consent

aquafirme xs

AQUAFIRMEXS Patient Consent

AquaFirmeXS is a multifunctional device which combines 3 technologies in 1 platform, delivering customized cosmetic treatments for every skin type and condition.  EVO: a technology based on proprietary micro-cupping and conical evacuation utilizing bio-based serums, to cleanse & remove debris from the skin and increase hydration simultaneously  EXO2: a technology based on vibration with Surface CO2 to promote oxygen-rich environment for the most effective microdermabrasion. | Soft Waves LED CO2/O2  ULTRA: a technology based on 1MHZ ultrasoundwaves to micro-heat the skin. The ultrasound waves assist in breaking down the texture of the serum to help improve absorption by the skin

What to Expect

 Your skin may experience temporary irritation, tightness, or redness. These are all normal reactions that typically resolve within 24 hours depending on skin sensitivity.  You may experience tingling and stinging in the treatment area. These sensations generally subside within a few hours.  Client experiences may vary. Some clients may experience a delayed onset of these symptoms.  You will likely see results immediately after treatment and your skin may feel smooth and hydrated for one to four weeks with appropriate home care to maintain treatment results.  The skin is more susceptible to sunburn/sun damage. Avoid excessive sun exposure and use a minimum of SPF 25 sunscreen.

Absolute Contraindications (We cannot perform service if the answer is YES to any of the conditions below)

Accutane or other similar medication Autoimmune disease, HIV, lupus, hepatitis, scleroderma Active infection in the treatment area Melanoma or lesions suspected of malignancy Active Sunburn Pregnancy (medical-legal) Breastfeeding (medical-legal, may increase skin sensitivity & likelihood of PIH) Epilepsy contraindicated for LED light on EXO2 (can perform without LED light Therapy) Metal implants, pacemakers, defibrillators, nerve stimulators or any in-vivo electronic devices contraindicated for ULTRA Filler injections less than 4 weeks (recommended to wait at least 4 weeks after injectables)

Relative Contraindications:

: Anticoagulants therapy (use lower settings), Very thin skin, Other Aesthetic Treatments such as mesotherapy, peeling, resurfacing, injections on the area of cosmetic treatment; allow two weeks for the skin to rest

Other Concerns:

Keloids: avoid direct contact, Rosacea, telangiectasia (use lower vacuum)

I acknowledge the following

 I will avoid the use of aggressive exfoliation, waxing, and products containing glycolic acids or retinol that are not part of the recommended take-home regime in the treated areas for minimum 2 weeks post-treatment.  The information provided has been explained to me and all my questions have been answered to my satisfaction.  By signing below, I acknowledge that I have read the above information and give my consent to be treated with AquaFirme.  This consent form is valid for all future AquaFirme treatments. I will alert the staff if there are any future changes to my medical history.
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