This form is designed to provide you with the information you need to make an informed decision on whether or not to have the PPP treatments performed. If you have any questions or do not understand any part of this consent, please do not hesitate to ask us. The information provided is confidential and for professional use only.
PPP Skin Treatment is used for correction of wrinkles and fine lines, pigmented lesions, age spots and skin discoloration, resurfacing the skin, correction of melasma, acne scar and surgical scar correction, mole and skin tag removal, and more.
- I understand that a single procedure will not remove all my skin problems completely and that optimal results may require multiple treatments (Minimum of 3 treatments is recommended)
- I understand that each individual’s response will vary according to their skin type, area being treated, and their follow up care.
- I understand that post treatment skincare products to heal my skin are required at an additional cost. ANESTHETIC: The topical anesthetic that will be used contains Benzocaine, Lidocaine and Tetracaine.
- I approve for these creams and lotions to be used before and during the procedure
- I do not have diabetes, autoimmune disorder, uncontrolled heart conditions.
- I am not using Accutane, nor have I been on Accutane in the last year.
- I do not have a history of keloid scar formation or poor wound healing.
- I do not have allergies to Benzocaine, Tetracaine and/or Lidocaine.
- I am not pregnant, and I am not breastfeeding.
- I do not have a pacemaker
- I do not have any metal implants (if you do a determination will be made pending location)
- HERPES SIMPLEX- I understand that if I have ever, in my life, experienced a cold sore in the same area as my current treatment, I must start on an antiviral prophylaxis (i.e. Valtrex) 1 week prior to starting my treatments.
SIDE EFFECTS- The nature of the PPP procedure has been explained to me. Just as there may be benefits to a procedure, I understand that all procedures involve risks to some degree.
Side Effects may include, but are not limited to:
Pain - Most people feel some heat-related discomfort during the treatment. This discomfort is usually temporary during the procedure and localized within the treatment area.
Redness and Swelling - PPP treatments will cause varying degrees of redness and swelling in the treatment area. These common side effects last from several days to a couple of weeks depending upon the aggressiveness of the treatments.
Itching - This can occur as part of the normal wound healing process or may occur as part of infection, poor wound healing or contact dermatitis.
Acne or Milia Formation - A flare-up of acne or formation of milia, tiny white bumps or small cysts on the skin, may occur. These symptoms usually resolve completely. Although not necessary, on occasion a series of prophylaxis antibiotics may be prescribed by your Doctor.
Pigment Changes - During the healing phase, the treated area may appear to be darker. This is called PIH, post inflammatory hyperpigmentation. PIH occurs as a part of the normal skin reaction to injury. This pigmentation usually fades in 3 to 6 months.
Hypo-pigmentation - In some patients who experience pigment changes, the treated area loses pigmentation and becomes a lighter color than the surrounding skin. This type of reaction may also be permanent but usually resolves in 1-3 months.
Bleeding; Oozing; Crusting - Aggressive treatment may cause pin point bleeding and/or oozing. Crusting or scabbing may form after the drying of clear fluid or blood. These reactions need to be reported to the office for additional post care instructions.
Blisters; Burns; Scabbing - Heating in the upper layers of the skin may occasionally cause blisters or burns and subsequent scab formation. The blisters usually disappear within 2-4 days. A scab may be present after a blister forms, but typically will disappear during the natural wound healing process of the skin.
Scarring - Scarring is a possibility due to the disruption to the skin’s surface and/or abnormal healing. Scars, which can be permanent, may be raised or depressed, and scarring could lead to loss of pigment or hypo-pigmentation in the scarred area.
Melasma - Melasma is a condition which is very difficult to treat. Although good results have been obtained, multiple treatments, as well as use of bleaching creams are necessary for optimal results. No guarantees can be offered, as results vary greatly from patient to patient.
NO GUARANTEES/NO REFUNDS - Because all individuals are different, it is not possible to completely predict the benefits from this treatment. By signing this form, I acknowledge that guarantees as to the final result of my treatment have not been made. Some individuals will have a very noticeable improvement after the first treatment, while others may have little improvement. I understand that additional treatments for additional fees may be needed to achieve my desired end result.
This office has a strict no refund policy. This means that no refunds are given for any reasons.
By my signature, I acknowledge that I have read the foregoing informed consent form and have been adequately informed of the nature of my condition, the nature of the procedure, the expected benefits of this treatment, the risks of this treatment, the alternative methods of treatment, and the risks of not treating my condition. I hereby consent to this procedure. I hereby indemnify Asteria Skin Aesthetics and its technician(s), from all liability associated with this procedure.
What to Expect After Your Plasma Pen Pro (PPP) Treatment
Plasma Pen Pro (PPP) produces side-effects. The intensity and duration of your side effects depends on the treatment aggressiveness and your individual healing characteristics. Generally, patients who are treated more aggressively experience more intense side-effects that last longer. Notify your provider if the severity of your side-effects becomes a problem for you.
Swelling: You will notice most of the swelling on the first morning following the treatment, particularly around the eyes. Swelling usually lasts 2-3 days, however, they can last up to 3 weeks, depending on the intensity of the treatment and the healing ability of the client. To minimize swelling do the following:
- Take Anti-Inflammatory medication (such as: Advil, Motrin, Ibuprofen, Aleve) starting 6 hours after treatment if needed.
- Sleep elevated for the first 2 nights. Use as many pillows as tolerated.
Redness: Most redness resolves in 7-10 days after treatment, but a rosy “glow” can remain for several weeks after the treatment, again, depending on your healing ability, age, medications, metabolism, etc.
Dry Skin: Your skin may feel dry, peel or flake. You may notice a “sandpaper” texture a few days after treatment. This is the treated tissue working it way out of you body as new fresh skin is regenerated.
Bronzing, Crusting and Small Dark Dots: A Plasma Pen Pro (PPP) Treatment causes destruction to microscopic cylinders of skin which then exfoliates during the healing process. The PPP treatment can make the skin look bronzed, or small areas appear crusted (DO NOT TRY TO SCRATCH THEM OFF). Scratching off any carbon deposits may result in hypo-pigmentation of the skin that may not be able to be reversed and could cause scarring. Please refrain from scratching any areas that are healing.
Raw Skin: If you develop areas of raw skin post treatment, keep the area moist with Bacitracin or Aquaphor. You DO NOT need to apply band-aids but try to keep the areas moist and do not pick at the skin. They will heal very rapidly on their own without problems.
How to Care for Your Skin After a PPP Treatment
Moisturize: Remember that peeling and /or flaking is normal during the healing process. Therefore, any products should be non-irritation and non-clogging, else you could develop breakouts. During the healing period your moisturizer may be too occlusive, so please consider a light-based product, rather than a heavy cream-based product. Re-apply whenever your skin feels dry.
Scrubs, Toners, Glycolic Acid, Retin-A: Your skin will be sensitive for the 2 weeks after treatment (possibly longer), so do not use products that will cause irritation at this time. Do NOT use abrasive scrubs, toners, or products that contain Glycolic Acids or Retin-A.
Bleaching Creams: Discontinue use of your bleaching cream while your skin is tender. Restart your bleaching cream 4-6 weeks after your skin has fully healed.
Make-up: We recommend that no make-up be applied to the affected area until the scabs are fully healed which can take between 3-5 days.
Resume your normal skin care regimen when your skin has fully healed.
Cold Sores: Contact the office if you are developing any cold sores so that they may be treated properly.
If you have any questions or concerns, please do not hesitate to contact us directly so we can further assist you and advise you to be able to get the best possible results after your treatment.