Microneedling Consent Form

Conset Microneedling

Microneedling Consent Form

I hereby authorize L3 Aesthetics or any delegated associates to perform Microneedling Therapy (Collagen Induction Therapy). I understand that this procedure is purely elective.

What to Expect:

• Depending on the area of your face or body being treated and the type of device used (i.e. needle length), the procedure is well-tolerated and in some cases virtually painless, feeling only a mild prickling sensation. • Your practitioner will apply a topical anesthetic to your skin prior to treatment to reduce any pain and discomfort. • Your 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. • Your skin may feel warm, tight, and itchy for a short while. This should subside in 12-48 hours.

Possible Side-Effects:

• Side effects or risks are minimal with this type of treatment and typically include minor flaking or dryness of the skin with scab formation in rare cases. • Milia (small white bumps) may form; these can be removed by the practitioner. • Hyper-pigmentation (darkening of certain areas of the skin) can occur very rarely and usually resolves after a month. • If you have a history of cold sores, this procedure may cause flare ups. • Temporary redness and mild-sunburn effects may last up to 4 days. • Freckles may temporarily lighten or permanently disappear in treated areas. • Other potential risks include: crusting, itching, discomfort, bruising, infection, swelling, and failure to achieve the desired result. Permanent scarring (less than 1%) is extremely rare. The benefits and risks of the procedure have been explained to me, and I accept these benefits and risks. The nature of my medical or cosmetic condition has been explained to my satisfaction as have been any substantial or significant risks of harm. 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 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 understand the following contraindications listed below and will notify my provider if any of the following apply to me: • Active infections - viral, fungal, or bacterial • Rashes, warts, skin cancer • Active acne • Immune-suppressed patients • Skin-related autoimmune disorders • Pregnant or breast-feeding • Patients on anticoagulants (NSAIDS, ASA, or Coumadin/Warfarin) • Recent ablative dermal procedures • Rosacea • Diabetes • Actinic (solar) keratosis • Keloids
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