Luminate Skin Health Facial Consent Form
Treatment/Product Information
The Luminate Facial treatment combines ZO Skin Health products and superficial chemical peel agents with 1064nm laser technologies to create a bespoke treatment that will exfoliate the skin, draw out impurities, stimulate collagen, and reduce inflammation associated with acne and rosacea. The DYNAMICS® mode of the 1064nm laser employs short pulse durations (up to 1ms) to generate heat, which ensures the treatment is both safe and effective.
Benefits:
Collagen Stimulation: Promotes collagen formation through a controlled mild wound-healing response, which helps improve pore appearance and softens fine lines.
Skin Improvement: Effective for reducing inflammation associated with rosacea and acne.
Radiant Glow: Enhanced with LED phototherapy, leaving the skin glowing and soothed.
Comfort and Downtime:
Experience: The treatment is generally comfortable, with a slight tingling and warm sensation. Your practitioner will monitor your comfort levels throughout the procedure and adjust the treatment parameters. Always communicate with your practitioner if you experience any discomfort during the treatment.
Recovery: There is minimal downtime. Mild erythema (pinkness) may occur but usually fades within a few hours. 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 Plan:
Initial Series: Typically involves three treatments spaced two weeks apart.
Maintenance: A monthly session is recommended for ongoing benefits.
Standalone Option: Can also be used as a periodic treatment for skin rejuvenation.
Overall, the Luminate Facial is a versatile and effective treatment for various skin concerns, offering noticeable improvements with minimal disruption to your daily routine.
Before Your Luminate Facial Treatment:
Consultation: You should have had your consultation with one of our Nurses or Aestheticians before your Luminate Facial. We will assess your skin type, condition, expectations, and goals during this consultation.
Cost: Your Practitioner will inform you of the cost for each session or series of sessions.
Patch Testing: If deemed a suitable candidate, you must undergo a patch test in the treatment area. This helps determine your skin’s responsiveness and ensures a safe treatment.
Skin Products: For three days before the treatment, refrain from using acid-based skin products, retinol, and retinoids in the treatment area.
Cold Sores Prevention: If you are prone to cold sores, consult with your GP or pharmacist about prophylactic Aciclovir medication. The laser treatment may trigger an outbreak in individuals who carry the cold sore virus.
Allergic Reactions: Any cosmetic products applied during the treatment can cause an allergic reaction. If you notice any signs of an allergic reaction, inform your practitioner immediately.
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 slightly 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.
Your skin will be treated with the 1064nm laser. You will experience gentle tingling as the laser passes across your skin and heat slowly builds. Please be aware that protective eye covers are required during the treatment to safeguard your eyes. Failure to wear these or not following safety instructions from your practitioner could result in physical harm or eye damage.
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 with SPF30-50 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. Other treatment options are available, including clinical skin care, medium-depth chemical peels, injectable treatments, and prescription medications. Please discuss these options with your practitioner if you wish to explore alternative options.
Contraindications:
You cannot have a Luminate Facial treatment if:
An allergy to Allergy to Lactic acid, Citric, Glycolic, Tea tree, Mandelic, Kojic, Sodium bicarbonate, vitamin C, green tea and mint leaf extract or any other ingredients within the ZO Obagi skin health range.
You have or have a history of malignant (cancerous) skin lesions.
You have had roaccutane/Isotretinoin medication in the last six months.
You have photosensitive epilepsy.
You have an active infection or inflammation nearby the intended treatment area, including active acne lesions.
You have open wounds in the intended treatment area.
You have an active outbreak of herpes simplex infection (Cold sores) in the treatment area.
You have a history of keloid or raised scarring.
You have uncontrolled diabetes or poor wound healing.
You have blood clotting problems or are taking blood thinning medications.
You are immunosuppressed.
You have uncontrolled hormonal disorders.
You have a pacemaker.
You have had facial fillers or botox in the intended treatment area under two weeks before treatment.
You think you could be pregnant, are pregnant, or lactating/ breastfeeding.
You need to tell your aesthetic practitioner if:
You suffer from recurrent herpes simplex infections (cold sores). A Luminate Facial Treatment may encourage an outbreak.
You use topical retinol or retinoid prescription medications in the treatment area. You MUST stop using these on the treatment area three days before a Luminate Facial treatment.
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. Treatments are generally well tolerated with minimal discomfort; however, we encourage you to discuss this with your practitioner if you experience discomfort you cannot tolerate.
Skin erythema (skin redness) and heat. This is the most common and likely side effect of your treatment. This is related to the rise of internal skin temperature, which is normal. This can be managed by keeping the skin cool following your treatment. This should subside within a few hours but can last longer.
Swelling, tingling, or tenderness. For a few days after treatment, you may experience slight discomfort (like a mild sunburn) and mild swelling within the skin.
Allergy. Throughout the procedure, we use various topical skin products to loosen dead skin material, absorb light energy 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 that 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.
Skin wounds. Rarely, the treatment may result in blisters or skin wounds. If a blister or skin wound develops, it may take 5 to 10 days to heal and, in extremely rare instances, may lead to a noticeable whitening or darkening of the skin or, even more rarely, a scar. Blisters or skin wounds are much more common if you do not follow the recommended avoidance of sunlight, artificial tanning products, UV light exposure, and fluorescent light exposure pre and post-treatment.
Scarring. Very rarely, if you have developed a wound and a scar, the scar may become flat and white (hypotrophic) or large and red (hypertrophic), or it may extend beyond the margins of the injury (keloid). Subsequent treatment or surgery may be required to improve the appearance of the scar. In some cases, the scar may be permanent. Failure to follow pre- and post-treatment care instructions may increase the likelihood of a skin wound or scar.
Infection. Infection is exceedingly rare. However, a blister or wound may become infected. To avoid infection, it is essential to contact your practitioner if you ever experience a blister or wound following your treatment.
Herpes (cold sores) reactivation. Treatments that create a skin injury, such as laser treatment, carry the risk of an outbreak of herpes (fever blisters/cold sores/shingles) in individuals who already carry the herpes virus. You should manage this as you would typically, such as using over-the-counter cold sore medication. If you experience these regularly, you may need a prescription for aciclorvir medication from your GP to suppress the virus before and after treatments. Please contact your practitioner if you experience a severe outbreak following treatment, as you may require a prescription from one of our Nurse Practitioners.
Dissatisfaction. Not all skin conditions and types are the same and may not respond as expected. Your skin’s response may be subject to variation. Although the overwhelming majority of patients who receive the Luminate Facial Treatment are happy with their results, there is always a possibility that you may not see an appreciable difference in your skin appearance. We will always try our best to help you achieve your expectations; however, you must be aware that, even in these circumstances, we will not refund the treatment.
Risk of Dermaplaning For Vellous Hair Reduction:
Skin tightness and stinging, mild to moderate redness, mild flaking,
Possible nicks/cuts/wounds to the skin
Skin infection
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.
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 Luminate 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 Luminate 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 Luminate 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 Luminate 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.
