MICRONEEDLING CONSENT FORM

What is BBGlow Treatment?

BB Glow treatment is an anti-aging and skin brightening procedure based on Microneedle Therapy System, which is based on the skin’s natural ability to repair itself when it suffers physical damage. Immediately after an injury to the skin, the body begins a healing process, triggering new collagen synthesis.

How is BB Glow Done?

The procedure is safely done using a Microneedling pen with a single use sterile needle head. The device offers adjustable depth, speed and needle size control. A session usually takes 2 hours, in which the serums and/or pigments will be applied to stimulate the rejuvenation process along with a facial hydrating mask at the end.

What to Expect After a BB Glow Treatment?

Skin will be red with mild swelling and/or brusing, skin might feel tight and sensitive to touch. Although these symptoms may take 1 to 2 days to resolve completely, they will diminish significantly within a few hours after the treatment.

Complications and Risks of Microneedling?

The complications and risks with microneedling are minimal. You might experience scarring, pain, persistent redness, itching and/or swelling, allergic reaction. Although microneedling is a minimally invasive procedure, there is a risk of infection. It is your responsibility to fully and accurately disclose all medical history prior to any treatment. If you have any conditions listed, if you are taking any medications and/or if you are allergic to anything, please bring it to the attention of your specialist prior signing this consent form.

What are the Results of Microneedling?

Microneedling will not completely/ permanently improve the skin texture, tone elasticity, hyperpigmentation, scars, fine lines and wrinkles. It is important that your expectations to be realistic and you understand that the procedure has its limitations. Additional procedures may be necessary to achieve your desired effects.

Unsatisfactory Results

Although rare, there is a possibility microneeding may induce undesirable results, including but not limited to skin sloughing, scarring, permanent pigment change, and/or other undesirable skin changes. Pigment/color change (hyperpigmentation) is very rate, but could happen due to failure to follow post treatment instructions such as avoid sun exposure for 1 to 2 weeks after treatment, apply daily SPF facial moisturizer and avoid picking or peeling skin during healing period.

Post-Treatment Instructions

During the first 24 hours, it is not recommended to wash the face. As your face gets dry after the treatment, it is recommended to apply lotion that contains Hyaluronic acid, This will moisturize the skin. Please make sure you apply sunscreen SPF 30 from the following day. BB Glow treatment is recommended to be done in a series of 3 to 5 sessions. The results are accumulative.

Medical Conditions

_____ Active Acne                                            _____ Collagen Vascular Disease                    

_____ Kelloid/Hypertrophic Disease                     _____Eczema, Psoriasis, Dermatitis

_____Active Infection (viral, bacterial, fungal)        _____Raised Lesions or Moles

_____Blood Thinner Medications                          _____Hemophilia/Blood Disorder

_____Recent Chemical Peel                                 _____Cardiac Irregularities

_____Hormone Replacement                               _____Recent Use of Tropical Rx

_____Chemotherapy or Radiation                        _____Rosacea

_____Scleroderma                                            _____Skin Cancer

_____Sunburn                                                  _____Tattoos

_____Uncontrolled Diabetes                                _____Vascular Lesions

Medications Taken and Known Allergies

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I, the undersigned, consent to the use of my pictures and videos taken at Z Beauty Academy, Z Beauty Spa before and after BB Glow/ Microneedling treatment for training purposes, marketing and social media networking. I understand that I will not be entitle to receive any payment for the use of my pictures or videos pursuant to this declaration of content.

My signature below acknowledges that I have read and understood the content of this consent document. I have been given ample opportunity to ask questions, all of which have been answered in a satisfactory manner. I understand that the results vary from person to person and no guarantee, neither expressed nor implied has been given to me regarding my results. I am aware of the complications, risks and benefits of this cosmetic treatment that is not critical to my health.

Of my free will, I am requesting and providing my written consent to undergo a Microneedling treatment and/or BB Glow Treatment at Z Beauty Academy, Z Beauty Spa, Salon Lofts. I assume all the risks as my own and agree to hold harmless Z Beauty Academy, Z Beauty Spa, Salon Lofts, Tampa Urgent Care, Salons by J.C its providers, staff, affiliates and independent contractors. I hereby release them from any liability, both seen and unforeseen, now and forever.

Print Name: ___________________________________              Date: ___________________ Signature: ___________________________________

Parent/ Legal Guardian (If Under 18) Name: ___________________  Date: ______________