420903-
Essential Peel Instructions Manual-rev000
l
20
09.
Essential Peel Consent Form
Microdermabrasion is a widely used procedure performed by licensed estheticians, involving the exfoliation of the
outer layers of the skin. This is accomplished by the projection of a natural mineral known as corundum crystals in a
fine layer over the skin. The procedure is gentle and respects the integrity of the skin, with literally no recovery time for
most people, though there are a few areas of the face where the procedure may feel slightly uncomfortable.
Microdermabrasion has been successful in
temporarily improving
the appearance of small scars, large pores,
pigmented spots, fine lines, wrinkles and comedones
.
This
may take
several sessions (average six) the number of
which varies with each individual. ___________________________________________________________
Because of the use of very small crystals, the ears and
eyes must be covered during the procedure. It is
recommended that contact lenses be removed prior to microdermabrasion. ____________________________
The skin is cleansed before and after the procedure. Due to the unavoidable spread of crystals in the hair and possibly
on the clothes, it is strongly recommended that the client shower before retiring that evening.
____________________________________________________________________________________
While these natural mineral crystals are not known allergen, the possibility of an irritation always exists due to the
individuality of each client.________________
During cold sore, herpes simplex, inflammatory or acne eruptions, it is necessary to discontinue
sessions to
avoid
spreading the condition. The procedure should be deferred until the skin is perfectly
healed. _____________________________________________________________________________
Because the skin, after microderm
abrasion,
has no natural protection, it is necessary to use neutral pH moisturizers
and to wear a protective sunscreen no less than SPF 15 but no more than SPF 35. Failure to wear sunscreen can
result in sunburn on your face, and skin damage could occur._________________________________________
I do not present any of Contraindications:
(Yes)_______ (No) _______(Check one)
If yes, Microdermabrasion procedures cannot be performed____________________
While many satisfying results are achieved after six (6)
session
series, there is no guarantee that the desired effects will
be achieved within that delay. Your own body response is a major factor in the result process.__________
I have read the preceding explanations and understand the potential risks and benefits of
microdermabrasion
.
I
received a copy of the “Client Instructions” sheet and agree to follow them and to protect my skin against the
sun at all time.
Client Name :________________________________ Signature :_____________________________
Telephone Number :____________________________ Date :_________________________________
Witness Name:_______________________________ Signature:_____________________________
Summary of Contents for ESSENTIAL Peel
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