Microneedling

Microneedling Consent Form

Client Name: ______________________

Date of Birth: ______________________

Phone Number: _____________________

Email: _____________________________

I, the undersigned, hereby consent to undergo microneedling treatment for aesthetic purposes. I understandthat microneedling, also known as collagen induction therapy, involves the use of fine needles to create microinjuriesin the skin to stimulate collagen and elastin production, improving skin texture and appearance.Treatment Explanation:Microneedling involves using a device equipped with tiny needles to create controlled micro-injuries in the skin.This process stimulates the skin’s natural healing response, encouraging the production of collagen andelastin, which helps improve skin texture, reduce the appearance of scars, fine lines, and wrinkles, andenhance overall skin appearance. The procedure may be performed with or without the application of topical numbing cream.

Potential Risks and Complications:While microneedling is generally safe, there are some potential risks and complications, which may include but are not limited to:

● Redness, swelling, or irritation at the treated area (usually temporary)

● Minor bruising or pinpoint bleeding

● Infection at the injection site

● Skin irritation or allergic reactions

● Hyperpigmentation (darkening) or hypopigmentation (lightening) of the skin

● Scarring (rare)

● Skin sensitivity to sunlight (temporary)

Pre-Treatment and Post-Treatment Care:I agree to follow all pre-treatment and post-treatment care instructions provided by my practitioner. Pretreatmentinstructions may include avoiding sun exposure, using sunscreen, and discontinuing certain topicaltreatments (e.g., retinoids or exfoliating agents) for a period before treatment. Post-treatment care may includeavoiding sun exposure, using gentle skincare products, and applying moisturizers or healing ointments as directed.

Medical History and Disclosure:I have disclosed all relevant medical conditions, including any history of keloid scarring, active skin infections, eczema, or any other skin conditions, as well as any allergies or medications I am taking. I understand thatfailure to provide full information may increase the risk of complications.

Photographs and Media:I consent to the use of before and after photographs of the treated area for medical records, educational purposes, or marketing, with my identity kept confidential unless otherwise specified.

Acknowledgment and Consent:By signing below, I acknowledge that I have read and understood the information provided above. I consent tothe microneedling treatment and agree to follow all pre- and post-treatment care instructions. I understand thatresults may vary from patient to patient. This consent form will apply to any future Microneedling treatments with Lilo's Spa Orthotherapy & Aesthetic.

Patient Signature: ____________________________Date: ______________________Practitioner Signature: _______________________Date: ______________________Lilo’s Spa-

 

Pre-Treatment Instructions for Microneedling

 

Dear Client,Thank you for choosing our Spa for your Microneedling treatment. To ensure the best possible results and minimize potential risks, please carefully follow these pre-treatment instructions:

1. Consultation Ensure you have had a detailed consultation with our specialist to discuss your treatmentgoals and medical history. Inform us of any skin conditions or concerns.

2. Avoid Blood Thinners Avoid taking aspirin, ibuprofen, or other blood-thinning medications for at least 1week before your treatment unless prescribed by your doctor. This reduces the risk of bruising and swelling.

3. No Alcohol Avoid consuming alcohol for at least 24-48 hours before your procedure, as it can increase swelling and bruising.

4. Avoid Smoking Smoking can impair your skin’s ability to heal. Avoid smoking for at least 48 hours before and after the treatment for optimal results.

5. Avoid Sun Exposure Avoid direct sun exposure, tanning beds, or sunburns for at least 1 week before your treatment. Sunburned skin can lead to complications and poor results.

6. Discontinue Certain Skincare Products Avoid harsh skincare products, such as retinoids, glycolic acid, orexfoliants, for at least 3 days prior to your procedure. These products can make your skin more sensitive.

7. Hydrate Drink plenty of water to ensure your skin is well-hydrated. Hydration improves the procedure's effectiveness and aids in faster healing.

8. Avoid Facial Treatments Refrain from facials, chemical peels, or other treatments for at least 1 week before microneedling to avoid skin irritation.

9. Shave the Area (if necessary) If the treatment area involves facial hair, please shave the area 24 hours before your appointment to ensure a smooth surface for microneedling.

10. Avoid Makeup Arrive with a clean face, free from makeup, sunscreen, or moisturizers, to allow the microneedling treatment to be effective.

11. If You Are Pregnant or Breastfeeding Microneedling is not recommended during pregnancy orbreastfeeding. Please inform us if this applies to you.

12. If You Have Active Skin Conditions If you have any active infections, cold sores, or open wounds in the treatment area, notify us.

 

These conditions may require rescheduling the treatment.By following these instructions, you can achieve the best possible outcome for your Microneedling treatment.

 

Post-Treatment Care for Microneedling

 

Thank you for trusting us with your aesthetic treatment. To ensure the best results and minimize the risk ofcomplications, please follow these post-treatment care instructions. If you have any questions or concerns, please contact us.

1. Avoid Touching the Treated Area Do not touch, rub, or scratch the treated area for at least 24 hours toavoid irritation and the risk of infection.

2. Stay Out of Direct Sunlight Avoid sun exposure for at least 1 week post-treatment, as UV rays can irritatethe skin and interfere with healing. Always apply sunscreen (SPF 30 or higher) when outdoors.

3. Keep the Skin Clean Cleanse your face with a mild, non-irritating cleanser. Avoid scrubbing, exfoliating, or using harsh products for at least 7 days.

4. Avoid Makeup for 24-48 Hours Do not wear makeup for the first 24-48 hours after microneedling to allow your skin to heal fully.

5. Avoid Heat and Hot Showers Do not expose your skin to hot water, steam rooms, or saunas for 48 hours, as heat can increase redness and sensitivity.

6. Moisturize and Hydrate Use a gentle, non-comedogenic moisturizer to soothe the skin. Drink plenty of water to keep your skin hydrated and support healing.

7. Avoid Strenuous Exercise Refrain from strenuous activities or exercise for 24-48 hours to prevent sweating, which can irritate the treated skin.

8. Do Not Pick at Flaking or Peeling Skin As your skin heals, it may peel or flake. Let it shed naturally toavoid scarring or infection.

9. Cold Compress for Swelling or Redness Apply a cold compress for 10-15 minutes if you experienceswelling or redness to soothe discomfort.

10. Monitor for Side Effects Mild redness, swelling, or tingling is common and should subside within a fewdays. If you experience excessive swelling, pain, or signs of infection, contact us immediately.

11. Follow-Up Appointment Your provider may schedule a follow-up session to assess your skin’s healingand discuss further treatments. Please attend all scheduled appointments.

Thank you for adhering to these post-treatment care guidelines. If you have any concerns, feel free to reachout to us.