Skin Pen / Microneedling - Consent Form

 Marketing

We would like to contact you with special offers, related products and relevant services. If you consent for this purpose, tick you preference:

Photographs taken shall be part of the medical record and used for documentation of response to treatment. With explicit permission these photographs may also be used for educational purposes or for client information.

As part of the marketing activity (digital and/or print) we would like to use anonymously before & after photos of your treatment for use to promote this treatment.

Introduction to Skin Pen / Microneedling.

I confirm I have seen therapist for a medical health check prior to today's treatment.

THE TREATMENT

SKIN PEN / MICRONEEDLING  are advanced treatments designed to rejuvenate the skin by stimulating collagen production and improving skin texture. The procedure involves the use of a device with fine needles to create controlled micro-injuries in the skin, which triggers the body’s natural healing process. This results in improved skin tone, reduced appearance of fine lines, wrinkles, acne scars, and overall skin rejuvenation. Microneedling enhances the skin’s elasticity and promotes a smoother, more radiant complexion.

RISKS AND COMPLICATIONS: Understanding the risks is essential. No procedure is completely risk-free. The following risks may occur, but there may be unforeseen risks and risks that are not included on this list. Some of these risks, if they occur, may necessitate hospitalisation, and/or extended outpatient therapy to permit adequate treatment. It has been explained to me that there are certain inherent and potential risks and side effects in any invasive procedure and this specific instance such risks include but are not limited to:

1. Post-treatment discomfort, swelling, redness, bruising, and discolouration;

2. Post-treatment infection associated with any transcutaneous procedure;

3. Allergic reaction to topical agents or numbing creams;

4. Reactivation of herpes (cold sores);

5. Temporary dryness, flaking, or peeling of the skin;

6. Hyperpigmentation or hypopigmentation;

7. Rare risk of scarring or keloid formation.

I hereby indemnify the practitioner from any liability relating to the procedures that I am having. I also understand that any treatment performed is between me and the practitioner who is treating me and I will direct all post-operative questions or concerns to the therapist.

The possible side effects of Skin Pen / Microneedling include but are not limited to:

BLEEDING & BRUISING: IIt is possible, though unusual, to experience bleeding during the procedure. Bruising in soft tissues may occur. If post-treatment bleeding develops, it may require medical attention. The use of aspirin, anti-inflammatory medications, platelet inhibitors, anticoagulants, Vitamin E, ginkgo biloba, and other "herbs/homeopathic remedies" may increase the risk of bleeding. It is recommended to avoid these for seven days before and after the procedure.

SWELLING: Swelling (oedema) is a normal response following the treatment and typically subsides within a few days. If swelling persists, medical intervention may be required.

ERYTHEMA (Skin Redness): Redness in the skin is common after the procedure and usually resolves within a few days.

NEEDLE MARKS: Visible needle marks are a normal occurrence and typically fade within a few days.

ACNE-LIKE SKIN ERUPTIONS: Acneiform skin eruptions may occur following the procedure but generally resolve within a few days.

SKIN LUMPINESS: Lumpiness can occur after the treatment but usually smooths out over time. In some cases, the treated area may feel uneven for an extended period.

VISIBLE TISSUE MATERIAL: In rare cases, areas with thin skin may show visible signs of the treated tissue.

PAIN: Discomfort during and after the procedure is normal and typically short-lived.

SKIN SENSITIVITY: Skin rash, itching, tenderness, and swelling may occur. After treatment, it is advised to minimise exposure to excessive sun, UV lamps, and extreme cold until any redness or swelling subsides. If you are considering additional treatments such as laser therapy, chemical peels, or other skin procedures, or if you have recently undergone such treatments, there is a potential risk of an inflammatory reaction at the treated site.

RESULTS

SKIN PEN / MICRONEEDLING are safe and effective treatments for improving skin texture, reducing fine lines, wrinkles, and acne scars, and promoting overall skin rejuvenation. Results can vary depending on individual skin conditions and treatment goals. The effects typically become noticeable within a few weeks and continue to improve over time as collagen production is stimulated.

The results are not permanent, and maintenance treatments are often recommended to sustain the benefits. Follow-up sessions may be required every 4-6 weeks initially, and periodic treatments may be needed to maintain the desired results.

I understand that the duration and effectiveness of the results depend on various factors, including skin type, lifestyle, and adherence to post-treatment care. I have been instructed in and understand the post-treatment guidelines. Recovery may involve a downtime period of up to 2-4 weeks, during which the skin may appear red, sensitive, or slightly swollen.

MEDICAL HISTORY & CURRENT MEDICAL CONDITIONS 

Please check any health conditions which you have ever had previously or are now experiencing. (If Yes to any of the following please detail in the box below)

Add your text

Current Medical Status

By signing below l acknowledge that I have read the foregoing informed consent and agree to the treatment with its associated risks.

THERAPIST ONLY

I confirm that I have fully informed the client about the risks and benefits of treatment with Skin Pen / Microneedling and believe they understand all the information given.

They have also been informed of alternative treatment for their presenting complaint.