Microdermabrasion Consent Form

Microdermabrasion/Dermaplaning Treatment

I authorize Skin Coach aesthetician to perform Microdermabrasion/Dermaplaning treatment on me.

I understand that serious complications are rare but possible. Common side effects include temporary redness and mild “sunburn”-like effects that may last a few hours to 3–4 days or longer, sensitivity, photosensitivity, and flaking. I understand that this treatment is exfoliation in its nature and correction of hyperkeratosis, enlarged pores, and scars cannot be accomplished without multiple treatments.

Other potential risks include crusting, itching, pain, bruising, rash, infection, scabbing, scarring, swelling, and failure to achieve the desired result.

I understand that sun exposure, tanning lamps, self-tanning creams, and not following the post-care instructions may increase the chance of complications.

I consent to photographs being taken for evaluating treatment effectiveness, medical education, training, publications, or sales purposes. No photographs revealing my identity will be used without written consent. If my identity is not revealed, these photos may be used publicly without my permission.

The risk of injuries during these procedures results from the nature of the activity and can occur without fault of anyone associated with Skin Coach or Innovation Health Clinic. By taking part in this activity, I accept the risk that I may be injured.

Post care: I understand that the appropriate post care must be approved by the Skin Coach aesthetician and includes: washing with an appropriate cleanser, applying post-care gel/cream, SPF, or other sun protection. For 7 days after the procedure: no sun exposure, keep skin clean, avoid toxic substances, hot tubs, swimming pools, sweating, or exfoliating. Contact the aesthetician before travel or daily routine changes, medications, or skincare changes discussed during the procedure.

Guarantees: It is impossible to predict an exact response to treatment. Statistical success has been shared, but individual factors like genetics, hormones, and medications cause varied outcomes. While success is expected, it is possible to have a less optimal or no response. When this occurs, it is disappointing for all.

Before and after treatment instructions have been discussed with me. I have read and understand the exclusionary criteria. The procedure, benefits, and risks have been explained to my satisfaction. I have had all my questions answered. I understand that by participating in the training treatment today, I assume all risks.