STATEMENT OF CONSENT AND MEDICAL HISTORY:  PLEASE ANSWER EACH QUESTION BELOW

THE MICROBLADING PROCESS


This form is designed to give information needed to make an informed decision on whether to undergo the Micorblading Semi-Permanent makeup application. Upon reviewing the information below, if you have questions, please do not hesitate to ask your technician.


In most cases, no guarantee can be made that a specific client will benefit from the procedure.


This is the process of inserting pigment into the dermal layer of the skin and is a form of tattooing.


All instruments that enter the skin or come in contact with body fluids are disposable and are disposed of after use. Cross contamination guidelines are strictly adhered to.


Generally, the results are excellent.  However, a perfect result is not realistic. A "touch-up" appointment is required after the healing process.


Initially the color will appear much more vibrant and darker compared to the end result.  Usually within 5-7 days, the color will fade 40-50%, soften, and look natural. The pigment is semi-permanent and will fade over time. You will likely need another "touch-up" appointment within 6 months to 2 years. The results can last up to 18 months.


POSSIBLE RISKS, HAZARDS, OR COMPLICATIONS


  • Pain: There can be discomfort and pain even after the topical anesthetic has been administered. Anesthetics work better on some clients than others.
  • Infections: With any procedure that involves a puncturing of the skin, there is a risk of infection. However, that risk is remote. The areas treated must be kept clean and only freshly cleaned hands should touch these areas. See "After Care" sheet for instructions.
  • Uneven Pigmentation: Pigment migration can occur. This can result from poor healing, infection, bleeding or other complications. Your follow up appointment will likely correct any uneven appearance.
  • Asymmetry: Every effort will be made to avoid asymmetry but our faces are not symmetrical. So adjustments may be needed during the follow-up session to correct unevenness.
  • Excessive Swelling or Bruising: Some people bruise and swell more than others. Ice packs may help and the bruising and swelling typically disappears within 1-5 days. Some people don't bruise or swell at all.
  • Anesthesia: Topical anesthetics are used to numb the area to be treated. Lidocaine, Prilocaine, Benzocaine, Tetracaine, and Ephinephrine, in a cream or gel form are typically used. If you are allergic to any of these, please inform your technician prior to the appointment.
  • MRI: Because pigments used in permanent cosmetic procedures contain insert oxides, a low level magnet may be required if you need to be scanned by an MRI machine.  you must inform your technician of any tattoos or permanent cosmetics.
  • Allergic Reaction: There is a remote possibility of an allergic reaction to pigments or other materials used. You may take a 5-7 day "patch" test to determine this determine if you are allergic to any of the pigments or materials. Please ask the technician for details.

**To perform this procedure, the Texas Department of Public Health requires that all clients be 18 years of age or older.  In the event that our records are examined, we have to have this information on file.