Treatment Description

HydraFacial® is a hydradermabrasion treatment that combines cleansing, exfoliation, extraction, hydration, and antioxidant protection simultaneously, resulting in clearer, more beautiful skin with little to no downtime. The treatment is soothing, moisturizing, non-invasive, and generally non-irritating.

I understand that individual results from HydraFacial® treatments may vary from person to person.

What to Expect

I understand that the following responses may occur after treatment and are considered normal:

• Temporary irritation, tightness, or redness, which typically resolves within 72 hours depending on skin sensitivity
• Tingling or stinging sensations in the treatment area, generally subsiding within a few hours
• In some cases, a delayed onset of these symptoms

I understand that I may see visible results immediately following treatment and that my skin may feel smoother and more hydrated for one to four weeks with appropriate home care to maintain results.

Risks and Side Effects

Although uncommon, possible side effects may include:

• Redness, flushing, or mild swelling
• Dryness or sensitivity
• Breakouts or purging
• Rare allergic reactions to products used

I acknowledge that my skin may be more susceptible to sunburn or sun damage following treatment.

Sun Exposure and Post-Treatment Care

I agree to:

• Avoid excessive sun exposure
• Use a broad-spectrum sunscreen with a minimum SPF of 40
• Follow all post-treatment instructions provided by my provider

Failure to follow post-care instructions may affect results.

Pre- and Post-Treatment Restrictions

I acknowledge and agree that I will avoid the use of aggressive exfoliation, waxing, and products containing glycolic acids or retinols that are not part of the recommended take-home regimen in the treated areas for a minimum of two (2) weeks before and after treatment, unless otherwise directed by my provider.

Financial Agreement:

I agree that I am financially responsible for the full payment of service provided. Payment is expected at the time of service. I understand these services are non-refundable and that insurance never covers cosmetic procedures.

Consent:

Your consent and authorization for this elective procedure is strictly voluntary. By signing this informed consent form, you hereby grant authorization to our medical staff to perform and/or to administer any related treatment as may be deemed necessary or advisable in the diagnosis and treatment of your condition.

The nature and purpose of this elective procedure and the complications and side effects have been fully explained to me. Alternative treatments and their risks and benefits have been explained to me and I understand that I have a right to refuse treatment. I agree to adhere to all safety precautions and instructions after the treatment. I have been instructed in and understand post treatment instructions and have been offered a written copy of them. I understand that no refunds will be given for treatments received. No guarantee has been given by anyone as to the results that may be obtained by this treatment.

I have read this informed consent and certify that I understand its contents in full. All of my questions have been answered to my satisfaction and I consent to the terms of this agreement. I have had enough time to consider the information given me and feel that I am sufficiently advised to consent to this procedure. I accept the risks and complications of the procedure. I certify if any changes occur in my medical history I will notify the office.

I hereby give my voluntary consent to this elective procedure and release the facility, medical staff, and specific technicians from liability associated with the procedure. I certify that I am a competent adult of at least 18 years of age and am not under the influence of alcohol or drugs. This consent form is freely and voluntarily executed and shall be binding upon my spouse, relatives, legal representatives, heirs, administrators, successors and assigns.

I agree, if I should have any questions or concerns regarding my treatment / results I will notify this office at immediately so that timely follow-up and intervention can be provided.