Chemical Peel Consent

I,

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consent to the treatment known as a chemical peel. I understand that this is an elective in-office procedure, for the purpose of improving the smoothness, texture, pigmentation and tone of the skin on my face and body.

  • The procedure may cause swelling of the treated areas. The treated skin may turn red, peel, and flake off much like a bad sunburn before it heals. The peeling usually lasts about a week. Some patients may not experience much peeling due to thickness of their top layer of skin (stratum corneum).
  • I understand there is a risk of developing temporary or permanent pigment (color) changes in the skin. Protecting the treated areas from sun with sun block, hats, gloves, or other appropriate clothing for several months after the procedure can minimize any pigment changes.
  • If you have cold sores or fever blisters (herpes) in the past this procedure may cause a breakout. Prescription medications like Acyclovir, Famvir, or Valtrex should be taken by patients with known HSV histories.
  • Some patients may experience an acne breakout shortly after the chemical peel, if they are prone to breakouts.
  • You must call the office 702-360-6686 if you are having itching, pain, or swelling in the treatment area(s).
  • There is a rare incidence of scarring. Do not have this procedure if you have a history of bad scars or keloids.
  • I consent to photographs for my medical record and/or education purposes. You will not be identified by name in any photos.
  • The actual degree of improvement cannot be predicted or guaranteed.
  • I understand that this is a fairly superficial chemical peel and multiple sessions may be required to achieve my goal.

The treatment has been explained to me, and I have had the opportunity to ask questions. I understand the treatment, treatment goals, aftercare instructions and risks of this procedure.

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Chemical Peel Consent

Chemical Peel Consent

I,

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consent to the treatment known as a chemical peel. I understand that this is an elective in-office procedure, for the purpose of improving the smoothness, texture, pigmentation and tone of the skin on my face and body.

  • The procedure may cause swelling of the treated areas. The treated skin may turn red, peel, and flake off much like a bad sunburn before it heals. The peeling usually lasts about a week. Some patients may not experience much peeling due to thickness of their top layer of skin (stratum corneum).
  • I understand there is a risk of developing temporary or permanent pigment (color) changes in the skin. Protecting the treated areas from sun with sun block, hats, gloves, or other appropriate clothing for several months after the procedure can minimize any pigment changes.
  • If you have cold sores or fever blisters (herpes) in the past this procedure may cause a breakout. Prescription medications like Acyclovir, Famvir, or Valtrex should be taken by patients with known HSV histories.
  • Some patients may experience an acne breakout shortly after the chemical peel, if they are prone to breakouts.
  • You must call the office 702-360-6686 if you are having itching, pain, or swelling in the treatment area(s).
  • There is a rare incidence of scarring. Do not have this procedure if you have a history of bad scars or keloids.
  • I consent to photographs for my medical record and/or education purposes. You will not be identified by name in any photos.
  • The actual degree of improvement cannot be predicted or guaranteed.
  • I understand that this is a fairly superficial chemical peel and multiple sessions may be required to achieve my goal.

The treatment has been explained to me, and I have had the opportunity to ask questions. I understand the treatment, treatment goals, aftercare instructions and risks of this procedure.

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