DiamondGlow™ is an advanced skin-resurfacing treatment that simultaneously exfoliates, extracts, and infuses skin with condition-specific serums to improve skin health, function and appearance.
This consent form is designed to verify that you have been informed and educated in respect to your treatment that may include dermaplane, waxing, or kenalog.
I acknowledge that I might experience a scratchy, stinging sensation during the treatment. This sensation will subside during the post-treatment protocol.
I understand that if I fail to use sunscreen, I am more susceptible to sunburn and hyperpigmentation.
I acknowledge that I have not been on medication for acne therapy (Accutane/Isotretinoin) during the past six months. I acknowledge that I have not been using retinoids for the past 2 days and I will discontinue the use of retinoids for 2 days after the treatment.
I acknowledge that facial telangiectasia (small blood vessels) is sometimes more apparent immediately after the treatment when the skin is thin and will diminish after re-epithelialization (build up of dead cells).
I understand that my provider uses tools that are disposable.
I acknowledge that my skin may experience temporary tightness, mild erythema (redness), or slight swelling, which should dissipate in a few hours.
I understand if I am pregnant, lactating, have rosacea, salicylate/aspirin sensitivity, or an outbreak of any skin condition, I should consult with my physician prior to receiving the DiamondGlow™ treatment.
I hereby agree to have the DiamondGlow™ treatment performed on my skin by a trained provider and to follow all post treatment protocols.
I understand complications can include whiteheads, cold sores, infection, scarring, numbness, nick/cut from a surgical blade, hypopigmentation, hyperpigmentation, and possible subcutaneous atrophy (indentations of the skin).
I understand that my compliance to my after care instructions will greatly affect my final result. I acknowledge my obligation to follow the guidelines that are provided to me.
I understand and acknowledge that payments for the above procedure(s) are non refundable.
The nature and purpose of this treatment has been explained to me. I have read and understand the agreement. All of my questions have been answered to my satisfaction and I consent to the terms of this agreement. Alternative methods of treatment and their risks and benefits have been explained to me. I understand I have the right to refuse or stop treatment.
My signature below certifies that I have fully read this consent form and understand the information provided to me regarding the treatment.