Microneedling Consent Form

1. MICRONEEDLING TREATMENT OVERVIEW

Microneedling involves creating controlled micro-injuries in the skin using a sterile device to stimulate natural collagen and elastin production. It can help improve:

Fine lines and wrinkles
Acne scars and other superficial scars
Uneven skin tone and texture
Pore size
Skin laxity and overall rejuvenation

Treatment may be combined with serums such as hyaluronic acid, peptides, polynucleotides, or PRP to enhance results.Patient Agreement By signing below, I acknowledge that I have read and understood the information provided about BOTOX® treatment, including potential side effects and post-treatment care. I consent to the treatment administered by a qualified physician.

2. MICRONEEDLING POTENTIAL BENEFITS

Smoother, firmer, and more radiant skin
Improvement in texture and tone over several weeks
Minimal downtime compared with other resurfacing treatments

I understand that the following may occur temporarily after treatment:

3. MICRONEEDLING POTENTIAL SIDE EFFECTS

Redness, swelling, and pinpoint bleeding (24–48 hrs)
Dryness or mild flaking
Bruising, mild tenderness, or sensitivity
Post-inflammatory hyperpigmentation (rare)
Infection or scarring (very rare if aftercare is followed)

I confirm I have informed my practitioner if I have:

Active acne, cold sores, or skin infections
Recent sunburn or laser treatment
Keloid scarring tendency
Use of isotretinoin (Roaccutane) within the last 6 months
Any medical condition or medication affecting healing

4. PRE-TREATMENT GUIDELINES

Avoid sun exposure, tanning, and active skincare (retinoids, AHA/BHA) for 3–5 days before.
Arrive with clean skin (no makeup or creams).
Inform the practitioner of any recent procedures or changes in medication.

5. AFTERCARE INSTRUCTIONS

Expect mild redness for up to 48 hrs; avoid touching the face unnecessarily.
Do not apply makeup for 24 hrs post-treatment.
Use gentle cleanser and hydrating serum only.
Avoid sun exposure, swimming, saunas, or intense exercise for 48 hrs.
Apply SPF 30+ daily for at least 1 week post-treatment.

6. RESULTS AND FOLLOW-UP

Improvement is gradual and may take several sessions (typically 3–6 treatments spaced 4–6 weeks apart).
Results vary based on skin condition, age, and adherence to aftercare.
Maintenance treatments may be recommended every 4–6 months.