Chemical peels are designed to provide controlled exfoliation of damaged skin with significant visible results. Chemical peels assist with uneven skin pigmentation, fine lines and wrinkles, acne, acne scaring and to improve texture and appearance of your skin, as well as stimulation of collagen production. This powerful yet non-invasive approach to chemical resurfacing uses a synergistic combination of acids including: alpha hydroxyl acids (mandelic acid, lactic acid), beta hydroxyl acid (salicylic acid), other exfoliating acids (phenol and trichloroacetic acid, also referred to as TCA, and retinoic acid) to achieve a superficial to medium depth peel.

I understand there may be some degree of discomfort, i.e., stinging, pin prickling sensation, hotness or tightness.

I understand that there are no guarantees as to the results of this treatment, due to many variables, such as: age, condition of skin, sun damage, smoking, climate, etc. To achieve maximum results, I may need several treatments.

I have not been exposed to direct sun exposure, tanning booths and have not used self-tanning products in the past 14 days. I do not intend to continue to have sun exposure until completion of the peeling process and have been explained the importance of daily use of sunscreen.

I have not used depilatory creams, any type of hair removal, electrolysis, or Botox in the past 7 days.

I have discontinued any products such as: Retin-A, Renova, Differin, Tazorac or products containing retinol, alpha –hydroxy acid (AHA) or beta-hydroxy acid (BHA) or benzoyl peroxide and/or any exfoliating products that may be drying or irritating for the past 2-3 days.

Services are cosmetic in nature and are nonrefundable. I understand that payment is my sole responsibility.

I agree that I am willing to follow recommendations by my therapist for home care. I will be responsible for following home regimens that can minimize or eliminate possible negative reactions and have been provided with Post-Treatment/Home Care Instructions.

Patient who should NOT have a chemical peel:

Patients with active cold sores or warts, skin with open wounds, sunburn, excessively sensitive skin, dermatitis or inflammatory rosacea in the area to be treated. Inform the esthetician if you have any history of herpes simplex

Patients with a history of allergies (especially allergies to salicylates like aspirin), or other skin reactions, or those who may be sensitive to any of the components in this treatment

Patients who are pregnant or breast feeding (lactating)

Patients who have received chemotherapy or radiation therapy

Patients with vitiligo

Patients with a history of an autoimmune disease (such as rheumatoid arthritis, psoriasis, lupus, multiple sclerosis, etc,) or any condition that may weaken their immune system.

By my signature below, I acknowledge that I have read this Consent form and understand it. I have been given the opportunity to ask questions and my questions have been answered to my satisfaction. I have been adequately informed of the risks and benefits of this treatment and wish to proceed with this Chemical Peel.