Reemake Skin Medical Spa + Laser Clinic

REEMAKE SKIN

Jessner Medical Grade Peel Consent Form:

Jessner Medical Grade Peel:
This Jessner Peel safely provides controlled exfoliation of damaged skin. Ideal for aging skin, age spots, acne-prone skin, enlarged pores, post-inflammatory hyper-pigmentation and dull, lackluster completion.

What to expect:
Your skin may experience a slight stinging sensation as the treatment activates on the skin. Approximately 48 hours after the treatment the skin may peel. The amount of sloughing experienced will vary depending on the preparation of the skin, the condition of your skin, the home care products used. The amount of peeling observed is not an indication of the effectiveness of the treatment. The skin may take on a sunburned appearance and peeling and redness, if any, may last for three to five days.

Contraindications:
1. Active acne or infection.
2. Open lesions or cold sores.
3. Skin conditions on your face or body such as eczema, dermatitis, rashes, psoriasis, etc.
4. An active infection in the treatment area.
5. Hypertrophic scarring or keloid formation OR a family history of this.
6. Melanoma or lesions suspected of malignancy.
7. Pregnancy or lactation.
8. Extensive sun or tanning 3 days prior and 3 days post treatment or an active sunburn
9. Use of Accutane, Retin A, Renova, Adapalene or any other prescription skin products.
10. Any other chemical peel, microdermabrasion or resurfacing treatments in the past 14 days.
11. Waxing of the area in the past 7 days.
12. Topical retinol products in the last 14 days.
13. Telangiectasia/erythema which could be worsened or brought out by exfoliation.

I am aware of the following risks/complications that may occur:
1. Mild to moderate discomfort/pain
2. Slight redness or swelling
3. Sun and skin sensitivity
4. Pigment changes
5. Scarring
6. Allergic reaction
7. Bacterial infection

I consent and authorize the staff at Reemake Studio to perform the Jessner Peel treatment on me. I hereby release the staff at Reemake Studio from all liabilities associated with this procedure. This consent form is valid for all future Jessner Chemical Peel treatments.

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