I authorize the chemical peel listed above, to my face and / or neck, chest and hands.
Depending on the chemical peel site, there may be redness and/or irritation and discoloration (dark tan and pink marks) that can persist for several days or weeks.
Occasionally hyperpigmentation or hypopigmentation might develop after the peel that might persist for weeks or months.
With each chemical peel results are achieved. Nevertheless, no guarantees can be made as to the final results. Any number of chemical peels may be required to achieve desired results, depending on the present skin condition, skin care maintenance program, age and lifestyle of the patient.
Once the desired results are achieved, I understand that maintenance peels are necessary to sustain the rejuvenated results. The frequency depends on the individual’s own genetics, age and lifestyle.
Once peeling process is complete it is essential to follow instructions to maintain results and avoid any future complications especially hyperpigmentation.
I understand that this peel is made of the strongest acids such as Phenol and Trichloroacetic acid, also referred to as TCA, salicylic acid, among others. The exact composition is proprietary information of the V.I. Peel system, and I waive any rights, present or future, I may have as to request to divulge the exact composition or concentrations.
Services are cosmetic in nature, and are non-refundable. I understand that payment is my sole responsibility.
I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read and fully understand the above paragraphs and that I have had sufficient opportunity for discussion and to ask questions.
BY SIGNING BELOW, I ACKNOWLEDGE AND CERTIFY THAT I HAVE READ AND UNDERSTAND THE “CONSENT, RELEASE AND INDEMNITY AGREEMENT” FOR THIS PROCEDURE, AND THAT I AM SIGNING IT VOLUNTARILY.
We offer several different medium-depth VI Peels that are suitable for all skin types and tones. Each peel is formulated to treat an umbrella of skin conditions such as acne, acne scarring, lines, wrinkles, uneven texture, and uneven tone. Chemical exfoliation involves the removal of damaged tissue so the construction of new tissue can begin. Peeling will be prevalent for up to 7 days resulting in a fresh layer of skin. Skin is noticeably smoother and more radiant after just one treatment. For patients targeting a specific problem area a series of treatments is recommended for optimal results. Perfect for people struggling with acne, it reduces active breakouts while improving scaring.
Pre-Care Treatment
● Avoid excessive sun exposure, tanning beds, or spray tans 2 weeks before treatment.
● SPF is always required
● Discontinue the use of retinol, all BHA and AHA’s (salicylic acid, glycolic acid, benzoyl peroxide, etc.) and Vitamin C 7 days before treatment.
● No waxing, threading, or any form of hair removal 7 days before treatment.
● Avoid exfoliating facial treatments at least 14 days prior to facial.
Post-Care Instructions
● The most important step to having healthy skin is a good skin-care routine. Complimentary at-home procedure guides will be customized to client needs and products will be available for purchase.
● Avoid excessive sun exposure, tanning beds, or spray tans 2 weeks after treatment.
● Discontinue the use of retinol, all BHA and AHA’s (salicylic acid, glycolic acid, benzoyl peroxide, etc.) and Vitamin C 7 days after treatment.
● No waxing, threading, or any form of hair removal 7 days after treatment.
● Avoid exfoliating facial treatments at least 14 days after treatment.
● SPF is always required
Contradictions
● Retin-A users
● Accutane users
● Pregnancy
● Herpes Simplex
● Sunburn
● Open sores
● Recent antibiotics or antihistamines
● Tetracycline
Diabetes