Client Consent for Chemical Peel

I acknowledge that I have not been on Accutane within the past six months.*

I acknowledge that I have not used Retin-A or any other form of Retinoic Acid for the past four weeks.*

Although chemical peeling can lighten hyperpigmented skin, I acknowledge that there is NO GUARANTEE that dark discoloration of the skin will be reduced or faded. My face may temporarily develop uneven color, especially if I have uneven color before the peel.*

I acknowledge that during the application my skin may tingle, sting, or feel warm.*

I acknowledge that immediately after peel, my face may appear frosted or sunburned, and by day two, the skin may darken in color, feel tighter and be more sensitive. Day two through approximately seven my skin may slough. I acknowledge that pulling or picking skin may lead to infection or scarring.*

I may experience some breakouts after the peel (for a period up to seven days) that normally disappear. Chemical peels make extractions of the comedones easier and the acne ultimately improve if I continue treatment as directed by my skin care specialist.*

I am aware and acknowledge that there is a possibility of an allergic reaction. I have discussed thoroughly with my skin care specialist any such reactions and understand the care that would be necessary in the event of a reaction.*

I am aware that if I fail to use sun block after the peel, hyperpigmentation can result, and my skin is more susceptible to sunburn.*

I acknowledge that if I am prone to cold sores around the mouth, I will inform my skin care specialist and may need to use an anti-viral medication before the peeling treatment. (Peels may exacerbate the herpes virus.)*