Cellrenew Skin Health Facial Consent Form
Treatment/Product Information
The Cellrenew Skin Health Facial is an advanced multifaceted facial treatment devised by Aesthetic Nurse Specialist Adrian Baker. It includes physical and chemo-exfoliating agents, transdermal delivery of nutritional skin products, and cryo-lymphatic drainage and LED light therapy.
The branded products that may be used within this treatment are ZO Skin Health and Calecim Professional.
The aim of the treatment is to maintain regular skin cell renewal every month (replicating a youthful skin cell turnover timeframe) and provide the skin with the nutrition it requires to function correctly; the result is a noticeably fresher skin appearance that is reflective and bright. We also tailor this treatment specifically for the treatment of enlarged pores, skin blemishes, acne and acne scarring, puffiness, and hyperpigmentation.
Please be aware that this treatment involves massage and touch to the face, neck, and decolletage, but it may also include the body extremities as part of the relaxation techniques used. Please alert your practitioner if you do not wish to be touched or massaged as part of the relaxation process.
You are not expected to have any “downtime” following this procedure. However, reactive skin conditions may remain pink and feel dry as dead skin cells are sloughing away for a few days.
Treatment Process:
At the beginning of the treatment, your practitioner will want to assess the condition of your skin to determine your personalised treatment plan.
Your skin will be cleansed and polished with the appropriate cleanser and biodegradable microbeads, removing makeup and skin debris.
A chemo-exfoliating preparatory solution will be applied to your skin. This can sting a little as your skin's pH adjusts and the acid mantle is prepared.
ZO Restorative or Stimulator peel solution will then be applied to your skin. These skin acids draw water to the surface and fracture the cellular bonds holding the dead skin cells to the surface. While this remains on your skin, you may experience heat, stinging, and tingling sensations, and your skin may temporarily turn pink. We may provide a gentle massage of the neck and shoulders to help distract your attention. Please inform your practitioner if you do not want this.
The peel solution will be neutralised after a short period of time on the skin. This may cause a temporary spike in heat within the skin, but it usually settles within seconds.
The Sono Silk extraction device will gently extract any remaining pore debris. It emits ultrasound vibration and cool mist from the spatula, which assists in drawing out any congested pore debris. Gentle extraction will be performed where required.
Following chemo-exfoliation and Sono Silk, you may wish to receive dermaplaning (shaving of the fine villous hair) or Ultrafine treatment (Ultrasound skin tightening) for an additional cost. This must be requested at the point of booking.
A series of nutritional topical skin supplements and products will be applied to your skin, followed by an application of a medicated treatment masque.
Ice globe tools will be used to massage the face and neck with lymphatic drainage techniques.
Following lymphatic drainage, an LED light canopy will be placed over your face; protective eye goggles will be placed over your eyes. They will emit the desired LED light wavelength required for your presenting skin condition (Blue-Anti-acne, Red - collagen and biostimulation, near-infrared anti-inflammatory). Your practitioner will leave the room whilst you relax under the light.
Following the LED light therapy, any excess masque remaining on the skin will be removed and finishing skin products will be applied to your skin, including sunscreen (during the daytime).
After Treatment:
Do not wash your face for 8 hours to allow transdermal products to infuse into the skin.
You will be advised to drink lots of water for 24 hours, stay out of the sun and protect your skin for two weeks following the treatment.
It is expected to have a slightly pink appearance straight after treatment and should settle after a few hours.
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. Alternatively, other treatment options are available and include clinical skin care, medium-depth chemical peels, and prescription medications. Please discuss these options with your practitioner if you wish to explore alternative options.
Contraindications:
You cannot have a Cellrenew Facial if:
You have an Allergy to Aspirin, Salicylic Acid, Glycolic Acid, Lactic acid, Citric Acid, Malic Acid, NUTS or other ingredients used within the procedure. It is essential to divulge any allergies you know of.
You have had roaccutane/Isotretinoin medication in the last 12 months.
You have an active infection or inflammation near the intended treatment area, excluding acne lesions.
You have an active outbreak of herpes simplex infection (Cold sores).
You have a history of keloid or raised scarring.
You have actinic (solar) keratosis in the intended treatment area.
You have uncontrolled diabetes or poor wound healing.
You have suspicious moles that have changed recently, warts or raised lesions in the intended treatment area.
You have scleroderma, collagen vascular diseases or cardiac abnormalities.
You have active Eczema, Psoriasis or Dermatitis in the intended treatment area.
You have scars less than six months old in the intended treatment area.
You have had facial fillers in the intended treatment area within the last two weeks.
You could be pregnant, are pregnant, lactating or breastfeeding.
Cautions:
You need to tell your aesthetic practitioner if:
You have a history of Rosacea, Eczema, Psoriasis or Dermatitis.
You have a history of Post-inflammatory Hyperpigmentation.
You have a history of Melasma.
You suffer from recurrent herpes simplex infections (Cold sores).
You are immunosuppressed or are taking immunosuppressant medications.
You have blood clotting problems or are taking blood thinning medications.
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:
Skin redness. Skin erythema (skin redness) is your treatment's most common side effect and is likely to settle down within a few hours after treatment.
Dry, flaking skin may occur two to three days after the treatment and is usually very mild. It results from your upper epidermal skin cells shedding, with the generation of new healthy skin cells in their place. However, if you do not have this, it is not a sign that the treatment has not worked.
Skin Spots or Pore Purging. Patients with underlying pore blockages may experience temporary purging as the blockage is removed from the skin naturally. This may mean a temporary flare-up in acne spots. Generally, this stops once skincare and treatments are received regularly, but it may occur after every treatment. Those who develop inflamed spots may scar or produce post-inflammatory hyperpigmentation.
Herpes (cold sores) re-activation. Treatments that stimulate a skin response, such as the CellRenew Skin Health Facial, 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, such as by using over-the-counter cold sore medication. Please contact your practitioner if you experience a severe outbreak following treatment, as you may need to be prescribed an antiviral medication from our nurse prescriber.
Hyperpigmentation. Although only superficial acid solutions are used as part of the chemo-exfoliation stage of this treatment, in certain individuals, post-inflammatory hyperpigmentation (over-production of skin colour) or hypopigmentation (under-production of skin colour) can occur. This could be temporary or permanent.
Allergy. Throughout the procedure, we use various topical skin products to loosen dead skin material, condition the skin and have positive skin-brightening effects. You may have an allergic reaction, including anaphylaxis, to any topical product applied. This could range from red, itchy skin to swelling and blockage of the airways. This is very rare; however, it is important that you declare all known allergies to your practitioner. Please be aware you may have an allergy you do not currently know of and may still have an allergic reaction. It is important that you contact the clinic as soon as possible if you feel you are experiencing an allergic reaction following your treatment.
Scarring. There is a very small risk that the areas treated may cause scarring or marking of the skin, which could be temporary or permanent. This is usually secondary to an allergic reaction, acne purging, or herpes outbreak.
Disappointment/No effect. Although this treatment is known for its skin-refining benefits, we cannot guarantee that it will meet your expectations or achieve what we have advised it should. This is because the treatment relies upon a biological skin response that cannot be predicted. Per our clinic's terms and conditions, you will not be refunded in these circumstances.
Optional Paid Extras
Risk of Dermaplaning For Vellous Hair Reduction:
Skin tightness and stinging, mild to moderate redness, mild flaking, possible nicks/cuts to the skin
Vellous hair will grow back blunt-ended. Hair will not grow back thick, dark, or coarse unless there is a hormonal imbalance that would cause this.
Risks of Ultrafine HIFU 2mm for wrinkle and pore reduction:
Heat, pain and uncomfortable sensation
Bruising of the skin that could take several weeks to settle
Redness of the skin that will settle within 24 hours
Hyperpigmentation dark spots (Over-production of skin colour) that could be temporary or permanent.
Hypopigmentation: white spots (Under-production of skin colour) that could be temporary or permanent.
Temporary nerve inflammation leads to tingling, burning or lack of sensation in the skin.
You MUST inform the clinic immediately if you have any concerns that you may be experiencing a side effect. You may require medical attention from our Nurses.
Informed Consent:
This consent form is not meant to include all possible risks associated with a CellRenew Facial, 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, the reasons why you may not be able to receive treatment, and the known risks of a CellRenew Facial 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.
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 Facial with your practitioner, and your questions have been answered satisfactorily.
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 your 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. We 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 and 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 the CellRenew Skin Health Facial 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.
