INFORMED CONSENT FORM FOR SKIN CARE PROCEDURE

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The purpose of the explanations in this form is not to worry you, but to enlighten you in a scientific framework about the before - during - after and possible risks of the procedure to be performed. Please read carefully. If you have questions or points you do not understand, ask for help.

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1. Personal Information

 

Please fill out this section completely.

 

Name:

Surname:

Date of birth:

Gender:

Mobile number:

Signature:

 

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2. Skin Care What is its application and for what purpose is it used?

 

Skin care is a special process that peels the skin by applying various devices, cosmetic products and/or chemical peeling agents to the skin, and then renews the skin with the wound healing process that begins. In the skin care process, skin cleansing with cosmetics, steam application with or without ozone, comedone press device, peeling with diamond head, peeling with scrubber, hydrodermaabrasion (Innofacial), superficial effect and low-intensity chemical peeling, low-intensity cold LED laser application, cosmetic-containing soothing and Treatments such as neutralizing products are applied together or alone. Which type of procedure will be applied is determined according to the existing skin problem, skin type and social-work life. Our skin care practices are safe and effective methods that have been used for many years to treat skin wrinkles, acne scars, skin spots, sun damage and facial rejuvenation. Despite this, side effects and undesirable situations may occur in these procedures.  As the peeling depth increases in skin care procedures, the possibility of undesirable situations increases proportionally. The expected side effects of skin care procedures are the results of new skin formation and this situation is not dangerous. All these problems can usually regress on their own. Your skin care applications are superficial peeling procedures, and wound care treatment is required after medium and deep peeling procedures, in addition to superficial peeling. There is a possibility that the treatment may turn out badly. The procedure is done in the office environment.  Skin care application does not prevent skin problems and wrinkles completely or in the future. These methods cannot change the ongoing signs of aging of the skin. Multiple sessions are often needed for the effectiveness of our skin care treatments. In some cases, the use of other additional applications or treatments under doctor supervision (surgery, laser, filler, botox, etc.) may provide better results for the desired cosmetic improvement.  However, it should not be forgotten that the desired cosmetic result may not always be achieved. Sometimes skin lesions may recur after application.  As a result of the skin care process, you may need to continue your skin care programs with the products we recommend at home.

 

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3. Skin Care What are the points to be taken into consideration beforehand?

 

Please answer the following questions completely.

 

1. Do you have any infection in the application area or in your body?          YES         NO

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2. Do you have a chronic disease such as diabetes?          YES         NO

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3. Do you have an allergy, immune system or rheumatic disease?          YES         NO

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4. Have you had any surgery?          YES         NO

 

5. Do you have an active skin disease or do you have herpes attacks?          YES         NO

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6. Are you prone to bleeding?          YES         NO

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7. Are you positive for hepatitis (HBsAG, HCV) or AIDS (HIV)?          YES         NO

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8. Are you at risk of pregnancy, pregnancy or breastfeeding?           YES         NO

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9. QHave you used any medication in the past 1 week?          YES         NO

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10. Have you used blood thinners (aspirin, coumadin, etc.) in the last 3 days?          YES         NO

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11th. Have you had any dermatological or aesthetic procedures in the last month?          YES         NO

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12. Have you tanned with the sun or a tanning bed in the last few weeks?          YES         NO

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13. If you have had this procedure done before, have there been any problems?           YES         NO

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WRITE BELOW THE SITUATIONS WHEN YOU ANSWERED YES TO THE QUESTIONS OR WOULD YOU WANT TO EXPLAIN OTHER THAN THE QUESTIONS.

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4. How is skin care applied and what is the course of its effect?

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• skin care sa slight burning sensationYou may experience the feeling of  , it may be more especially in some sensitive areas. If it becomes too disturbing, you need to report it.

• During the application, your skin will be cleaned of cosmetics and dirt with cosmetic products.

• For a more successful application, steam with or without ozone can be applied to your clean skin.

• Black spots and pores will be cleaned with comedone press and vacuum hydrodermabrasion devices. There is a possibility of minor bleeding and wounds occurring during this cleaning. These wounds will heal during the normal wound healing process.

• When necessary, superficial skin peeling can be performed with devices such as scrubber, diamond dermabrasion, hydrodermabrasion and/or AHA, BHA and various peelings.

• Cosmetic creams, tonics and serums can be applied to your skin.

• Energy-based cosmetic applications can be performed with devices such as radiofrequency, galvanic current, ultrasound, cold application, hot application, vibration massage and low intensity LED therapy.

• If skin care sessions are continued regularly and care is taken at home with appropriate skin care products, your skin will have a glowing and lively appearance. There will be tightening of the pores. There will be reductions in problems such as blemishes, tone differences, oiliness, acne, and redness, although these may vary from person to person.

• Skin care is not a treatment and does not offer the expected effects of medical interventions.

• Session intervals should be at least 2 weeks apart. After each session, you can be told when to come and we can also arrange your sessions according to you.

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​5. Skin Care What are the points to be taken into consideration after?

 

• If it starts to peel after the application, the skin should never be plucked by hand, rubbed or scrubbed, and should be waited for it to shed on its own.

• You should not take a shower on the first day of the application.

• After the procedure, no cosmetic cream/solution or procedure should be applied other than the care recommended by your esthetician.

• There will be sun sensitivity on the skin after the application, so sun protection and SPF 50+ sunscreen should be applied for the period determined by your doctor after the procedure.

• If an unexpected effect develops, please inform your practicing esthetician.

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6. Skin Care What are the Risks and Side Effects of its Application?

 

• KThere may be mild skin pain, burning and tenderness, and redness for a short time.

• Discoloration: Skin care discoloration is a normal phenomenon in applications. However, light or dark color changes may occur with applications at any depth. Color darkening may be temporary or permanent. It may develop immediately after application or months later, and is often caused by early sun exposure after application. Sun protection and daily use of sunscreen are very important to prevent discoloration.  There may be a color difference between skin that has been skin treated and skin that has not. More rarely, permanent discoloration may occur after application.

• Infection

• Persistent erythema (redness) and delayed healing

• Scar: It is a rare complication. Although normal healing of the skin is expected after the application, abnormal scarring and even keloidal scars that may appear as raised skin may occur.

• Pimple-like rash

• Allergic reactions: Although allergic reactions to the agents used in the application are very rare, it is possible that they may occur.

• Eye complications: During the application or subsequent removal of the chemicals used in the application, chemicals may get into the eyes, resulting in chemical damage. Rarely, lower eyelid retraction may occur with medium or deep application to the eye contour area.

• It should be noted that, like many procedures in skin care practice, there is the possibility of additional or unknown risk factors.

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APPROVAL OF THE PERSON TO BE TRADED

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This procedure is not of vital importance like other cosmetic applications.is. Cosmetic procedures are non-medical  performed to reduce the negative effects on your skin such as wrinkles, lines, spots, scars, tattoos, capillaries, hair loss, sagging, stretch marks, unwanted hair, lack of moisture or unpleasant facial and body appearances.interventionare ales. For reasons that are not fully understood, the success and permanence of the procedure may be shorter than expected. Additionally, no guarantee can be given regarding the results of the application. Any side effects that may occur will be evaluated by our center and the improvement (prescription adjustment, medical intervention, emergency intervention) procedures will be carried out by our center's contracted doctor in the doctor's office. You can reach us at any time through the communication channels provided to you by our center.

 

• I was explained and understood that no cosmetic intervention, medical intervention or treatment could be performed on me without my permission.

• I have read the text above, which contains the information that should be given before applying SKIN CARE. I understand the expected impact and risks of the method to be applied.

• In addition, other application options, possible consequences and risks were explained to me, written and verbal explanations were made to me about this procedure, necessary warnings were given and I understood it.

• I was in a position to ask questions about the trading options to be applied and their risks. My questions and concerns were discussed and answered to my satisfaction.

• It was stated to me that visual material samples (such as photographs) could be taken before, during and after the procedure in order to evaluate the effectiveness of the procedure to be performed, and I agreed.

• I understand that no guarantee is given as a result of the procedure to be performed on me.

• I did not encounter any coercive behavior in purchasing this application.

• I voluntarily agree to have SKIN CARE under these conditions and to pay the necessary costs for this application.

 

THE PERSON TO whom the APPLICATION IS MADE

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Name and surname:

History:

Signature:

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THE PERSON WHO MAKES THE APPLICATION

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Name and surname:

History:

Signature:

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THE PERSON WHO WITNESSED THE APPLICATION

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Name and surname:

History:

Signature:

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