CellRenew Microneedling Consent Form
Product/Treatment Information:
Microneedling is a medical aesthetic skin treatment for the face or body that reduces fine lines and wrinkles, acne scarring, scars, and hyperpigmentation (overproduction of skin colour). It is also used to thicken the dermis of the skin and encourage pigment cells to migrate into areas of hypopigmentation (no skin colour), such as in Vitiligo.
Very fine needles create thousands of micro-channels within the skin, stimulating the body's natural healing ability, creating new healthy collagen and elastin fibres in the area, and increasing the penetration of therapeutic serums applied afterwards.
At Lumière MediSpa, we use an automated pen-like device called The SkinPen Precision.
The CellRenew Microneedling Procedure
The Celrenew Microneedling treatment programme is a multi-faceted treatment that involves skin exfoliation with superficial acids, SkinPen Precision microneedling, Calecim Professional Serum skin infusion, and LED light therapy.
You must ensure you arrive 30 minutes before your appointment for a topical anaesthetic cream to be applied.
Following a skin cleanse, a superficial acid is applied to the skin for up to 5 minutes and then removed. This step removes redundant dead skin cells before microneedling.
Your skin will be cleansed with a gentle antibacterial solution called Clinisept before starting the microneedling procedure.
A water-based gel will be applied onto your skin before passing the SkinPen Precision microneedling device multiple times across your skin. Hundreds of micro-channels are created within the skin with each pass.
It is usual for the skin to have a sunburn appearance and pinprick bleeding, and it is a necessary endpoint to stimulate the healing cascade effectively.
Following microneedling, Calecim Professional Serum will be pressed into the skin before applying a hydrogel wound dressing.
Protective eye shields will be placed over your eyes, and a DermaLux Flex LED Light canopy will be placed over the treatment area. Your practitioner will select specific light wavelengths for their antibacterial, anti-inflammatory, and collagen-stimulating effects.
You will be provided with three to five days of specific skin products. To avoid irritating the treatment area, you must follow the post-treatment advice.
Alternative Treatments
Your practitioner will always advise you of the safest and most effective treatment based on your medical history and skin appearance. However, you should also consider the option of no treatment at all. Other treatment options may also be available. Please discuss these options with your practitioner if you wish to explore alternative options.
Contraindications:
You cannot have a CellRenew Microneedling treatment if:
You have an allergy to papain or bromelain enzymes, glycolic acid, DiglycerinAleurites Moluccan (kukui) seed oil, Brassica oleracea italica (broccoli) extract, sunflower seed oil, or any other ingredients used within the procedure. It is essential to inform your practitioner of any allergies before every treatment.
You have had roaccutane/Isotretinoin medication in the last 12 months.
You have an active infection or inflammation near the intended treatment area, including active acne lesions.
You have an active outbreak of herpes simplex infection (Cold sores).
You have a history of keloid or raised scarring.
You have a history of eczema and /or psoriasis.
You have actinic (solar) keratosis in the intended treatment area.
You have uncontrolled diabetes or poor wound healing.
You have raised moles, warts or raised lesions in the intended treatment area.
You have scleroderma, collagen vascular diseases or cardiac abnormalities.
You have active rosacea in the intended treatment area.
You have blood clotting problems or are taking blood thinning medications.
You are immunosuppressed.
You have scars less than six months old in the intended treatment area.
You have had facial fillers in the intended treatment area under two weeks before microneedling.
You could be pregnant, are pregnant, lactating or breastfeeding.
Cautions:
You need to tell your practitioner if:
You suffer from recurrent herpes simplex infections. A microneedling treatment may encourage an outbreak.
You use retinol, retinoid medications, or acid-based skin products.
Material Risk (the level of significance you personally apply to the risks, side effects or complications of this treatment within your own circumstances):
As with any medical procedure, this treatment carries the risk of side effects or complications. Discuss these risks with your practitioner to fully comprehend their implications. Consider the risks in relation to your personal circumstances, including your health, lifestyle and career and decide if they are acceptable. If not, discuss alternatives or take more time to decide.
Associated Risks:
Discomfort and pain. While we will do all we can to make the treatment as comfortable as possible, you should understand that it can be uncomfortable both during and after the procedure. The topical anaesthetic we apply before treatment will help alleviate most of this during the procedure; however, it is common to feel intense vibration, pin-pricks, and stinging. After the treatment, you may experience skin stinging and intense heat in your skin for 24-48 hours.
Skin redness. Skin erythema (skin redness) is the most common and likely side effect of your treatment with microneedling. This is a positive side effect that is a part of your skin healing response. This will usually last for up to three days.
Dry, flaking skin. This usually occurs two to three days post-treatment and lasts up to ten days. This is where your upper epidermal skin cells are shedding, with the generation of new healthy skin cells in their place.
Treatment site bruising. Patients with thin skin or areas of the skin that are naturally thinner (such as around the eyes and mouth) may develop pin-point bruising. Patients using medications that prolong bleeding, such as aspirin, warfarin, or certain vitamins and supplements, may experience increased bruising or bleeding at the injection site. Bruising could take several days or weeks to heal.
Skin swelling. These symptoms are usually mild and last less than a few days but can last longer, particularly following intense eye treatments with microneedling.
Herpes (cold sores) re-activation. Treatments that stimulate a skin response, such as microneedling, carry the risk of an outbreak of herpes (cold sores/shingles) in individuals who already carry the herpes virus. You should manage this as you would normally, using over-the-counter cold sore medication. Please contact your practitioner if you experience a severe outbreak following treatment. You may require an anti-viral medication prescription from our nurse prescriber.
Infection. As with any procedure that involves a break to the skin’s surface, a microneedling treatment carries the risk of infection, although rare. You should inform your practitioner if swelling, heat and/or discomfort occurs in the treated area for longer than a few days. This may require medical intervention, such as antibiotic therapy.
Hyperpigmentation. Although microneedling regulates skin pigmentation, post-inflammatory hyperpigmentation (over-production of skin colour) or hypopigmentation (under-production of skin colour) can occur in certain individuals. This may be temporary or permanent.
Allergy. Allergic reactions or anaphylactic shock may occur with any product applied to the skin, including the facial cleanser, local anaesthetic cream, skin acids, Calecim professional serum and post-procedure skincare products used for this procedure. You must contact your practitioner should you feel unwell or believe you have had an allergic reaction following your treatment. You must seek immediate emergency medical care in cases of a severe allergic reaction (anaphylaxis, mouth swelling).
Scarring. There is a very small risk that the areas treated may develop scarring or skin marking, which could be temporary or permanent.
This consent form is not meant to be inclusive of all possible risks associated with a CellRenew Microneedling treatment, as there are both known and unknown side effects and complications associated with any medical treatment. We have written this consent form to ensure you are fully informed of the procedure, reasons why you may not be able to receive treatment, and the known risks of our CellRenew Microneedling treatment.
Photographs:
We need to take photos of the treatment area to document the original condition before treatment begins and to monitor results and potential changes throughout the treatment process. These photos will become part of your medical aesthetic treatment record at Lumiere Medispa.
You have the right to refuse consent for these photographs. However, please be aware that without this consent, we will not be able to treat you for medico-legal reasons.
If we wish to use your photos for any other purpose, we will always seek separate written consent from you. You have the right to refuse this additional use of your photos, and it is not mandatory to consent to any other photo usage to receive treatment.
Informed Consent:
By signing this consent form, you acknowledge and confirm the following:
Risks and complications
You have discussed the potential risks and benefits of a CellRenew Microneedling treatment with your practitioner, and all of your questions have been answered to your satisfaction.
You understand that medical attention may be required to resolve any complications associated with your treatment. In most cases, except those in an emergency, you should contact you practitioner for advice/treatment.
Medical History
To the best of your knowledge, you have provided the details of your past medical history and will inform your practitioner if this changes before any future treatments.
You understand that withholding aspects of your medical history could lead to serious physical and mental harm.
Contraindications & Cautions
You are not pregnant or possibly pregnant, lactating or nursing, and you will inform your practitioner if this changes before any future treatments.
Fees & Charges
You understand and agree that all services rendered will be charged directly to you, and you are personally responsible for payment.
You further agree, in the event of non-payment, to bear the cost of collection, court costs and reasonable legal fees, should they be required.
Refunds
Fees charged for treatment are for the delivery of a treatment and the accompanying service, which is inclusive of the following;
-Consultation and assessment
-The provision of information and advice
-The provision of the treatment itself, as described above
-Follow-up appointments and aftercare advice and support as appropriate
Whilst we undertake to provide excellent service, factual, honest and ethical advice, safe, expert treatment in experienced hands and only the best products, we cannot guarantee your results and cannot offer refunds if the results achieved fail to meet your expectations. The successful outcome varies by degree, and how long these effects last varies from one individual to another and cannot be guaranteed.
You understand that whilst you have been advised of a probable result, this should not be interpreted as a guarantee.
You will contact your practitioner if you are unsatisfied with your treatment outcomes.
Aftercare
You have verbally discussed the aftercare required following a CellRenew Microneedling treatment, and you have been informed that you will also receive this via email. You understand the importance of following the post-treatment advice and agree to follow it.
You understand that failure to follow this advice could lead to serious physical and mental harm.
Photograph Use Consent:
You understand that receiving treatment at Lumiere Medispa requires photographs to be taken of the treatment area. These photographs may be taken before, during, and after each treatment and will form part of your legal medical record at Lumiere Medispa. By signing below, you freely give your consent for your photos to be used solely for this medico-legal purpose. If we wish to use your photos for any other purpose, we will always seek separate written consent from you, and you have the right to refuse.
Valid Consent
By signing below, you acknowledge that you have read and understood this consent form and have had the opportunity to discuss any questions you have with your practitioner to your satisfaction. You consent to receive a CellRenew Microneedling treatment under the terms of this consent form and understand that you have the right not to consent to this treatment and that your consent is voluntary.
