The Perfect Peel Consent Form

Product/Treatment Information:

The Perfect Peel is a medium-depth chemical skin peel that uses a blend of Retinol, Glutathione, TCA, Phenol, Salicyclic, and Kojic Acid. The very nature of a skin peel means that your skin will peel away older, dysfunctional epidermal skin cells to reveal new, fresh skin cells.  

The Perfect Peel is used to reduce Melasma, sun-damage pigmentation, acne scars, overall skin rejuvenation, and fine line reduction.

The Perfect Peel is a medium-depth skin peel and, therefore, has a longer recovery than light skin peels you may receive within a beauty facial.

The Treatment

  • Preparation: Your skin will undergo a cleansing process followed by the removal of natural oils using an alcohol or acetone solution. This may cause a slight stinging sensation and have a strong odour. A fan can be used to disperse the scent while providing comfort to your skin.

  • Booster Option: Depending on your skin condition and type, we may recommend adding a booster to enhance the effects of The Perfect Peel, potentially increasing the peeling effect.

  • Application of The Perfect Peel Solution: The Perfect Peel solution will be applied in a cross-hatched method across the treatment area, with up to 3 or 4 applications based on your skin type. The initial layer may feel hot and sting, but subsequent layers tend to be less intense due to the solution's anaesthetic effect.

  • Duration: The peel solution remains on your skin for 6-8 hours. Your practitioner will provide post-care instructions and give you an essential aftercare pack.

After Treatment

  • Aftercare Email: You will receive an aftercare email detailing how to care for your skin after The Perfect Peel. Adherence to these instructions is crucial to prevent treatment failure or complications.

  • Expected Effects: Significant skin peeling, irritation, and redness may occur for up to 10 days after treatment. Individual recovery periods may vary.

  • Topical Medications: If prescribed topical medications, such as Perfect A and Perfect B, start using them as directed 7-10 days after the peel application, once the peeling phase has concluded.

  • Possible Pigmentation Changes: Hyperpigmentation or hypopigmentation may occur after the peel, persisting for weeks, months, or, rarely, permanently.

  • Results and Guarantees: Each chemical peel achieves results, but no guarantees can be made regarding the outcome. The number of peels needed depends on factors such as skin condition, maintenance, age, and lifestyle.

  • Maintenance: Once desired results are achieved, maintenance peels may be necessary. The frequency depends on individual factors like genetics, age, and lifestyle.

  • Follow-Up: A review will be scheduled one month after The Perfect Peel to assess your progress and guide you on future skin care.

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 skincare, light chemical peels, and prescription medications. Please discuss these options with your practitioner if you wish to explore alternative options.

Contraindications:

You cannot have a Perfect Peel if:

  • Patients who are pregnant or breastfeeding.

  • Patients with an allergy to any peel ingredient listed above or aspirin.

  • Patients who have used Roaccutane within the past six months.

  • Patients who have open wounds, sunburn, infected skin, cold sores, or lesions. 

  • Patients who have recently had treatments such as waxing, electrolysis, or chemical exfoliants.

  • Patients who are undergoing chemotherapy and/or radiation therapy.

  • Patients with a history of an autoimmune disease or any condition that may weaken the immune system.

Cautions:

You need to tell your aesthetic practitioner if:

  • You have an upcoming important event. You can expect significant peeling for 7-10 days, so you should plan your treatment and social/work diary around this.

  • You suffer from recurrent bouts of herpes simplex (cold sores) infections near the intended treatment area. The Perfect Peel may encourage an outbreak. Patients with a history of cold sores may be given an antiviral three days before The Perfect Peel.

  • You use topical retinol or prescription retinoid medications, such as Perfect A, in the treatment area. If you use this on the intended treatment area, you MUST stop using it five days before The Perfect Peel.

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:

  • Redness and Irritation. It is very common following The Perfect Peel for the skin to appear red and have a tingling sunburn sensation. This may continue throughout the peeling phase too. Some patients also report intense itching when applying the first-night post-peel wipe. Please refer to your aftercare email for further details on how to manage this.

  • Skin peeling and dryness. This may seem obvious, however, you shoud be aware that skin peeling will be substantial and you may not wish to be seen in public. You MUST NOT pull at peeling skin; allow this to detach naturally or use nail scissors to snip it shorter.

  • Discomfort. Once peeling begins, you will likely experience some skin stinging, especially upon application of the aftercare cream. This can be quite unpleasant, but you must apply the post-peel moisturiser during the peeling stages. It contains ingredients to calm the skin and reduce the risk of pigmentation complications.

  • Skin wounds, infection, and scarring. This is very rare and is usually a result of pulling off peeling skin. You MUST NOT pull at peeling skin; allow this to detach naturally or use nail scissors to snip it shorter. If you develop a wound, this could become infected, therefore it is important to let your practitioner know as soon as possible. Furthermore, wounds and skin infections could lead to temporary or permanent scarring of the skin.

  • Post-inflammatory hyperpigmentation (darker pigment) or hypopigmentation (lighter pigment). You may develop pigment changes in the skin that could be temporary or permanent. If you think this is happening to you, please contact your practitioner. 

  • Herpes (cold sores) reactivation. You should manage this as you would normally, such as using over-the-counter cold sore medication. Please contact your practitioner if you experience a severe outbreak following 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:

This consent form is not meant to include all possible risks associated with a Perfect Peel 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, the reasons why you may not be able to receive treatment, and the known risks of a Perfect Peel treatment.

By signing this consent form, you acknowledge and confirm the following:

Risks and complications

You have discussed The Perfect Peel's potential risks and benefits with your practitioner, and all of 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 following a Perfect Peel treatment 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 Perfect Peel 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.