The Perfect Derma Peel™

Client Informed Consent Form

The Perfect Derma Peel is a medium depth, medical grade chemical peel suitable for all skin types. The peel contains Trichlorocacetic Acid (TCA), Retinoic Acid, Kojic Acid, Salicylic Acid, Phenol, Glutathione and Vitamin C.

Contraindications:

  • Patients who are pregnant or breast feeding

  • Patients with an allergy to any peel ingredient listed above, or to aspirin

  • Patients who have used Accutane within the past 4 months

  • Patients who have open wounds, sunburn, infected skin, cold sores or lesions. Patients with a history of cold sores (herpes simplex) may be given an antiviral 3 days prior to the peel

  • Patients who have recently had treatments such as waxing, electrolysis or chemical exfoliants

  • Patients who are undergoing chemotherapy and/or radiation therapy

  • Patients with a history of an autoimmune disease or any condition that may weaken the immune system

Please read the following:

  • Prior to receiving treatment, I have informed my medical professional about any medications or health conditions that may contraindicate this treatment.

  • I understand that there might be some discomfort such as stinging, redness, burning, itchiness or tightness during and a week after the treatment. I understand that it is important not to pull, pick at or remove peeling skin forcibly.

  • I understand that there is no specific guarantee as to the final results of the peel, and that I may require more than one treatment for optimal results.

  • I understand that while complications are extremely rare, they may occur. In the event of a reaction or complication, I agree to immediately contact my medical professional for follow up care.

  • Occasionally hyper pigmentation or hypo pigmentation may develop which can persist for weeks or months after the treatment.