Micro Needling Consent Form
Date of Birth:
Micro-Needling Informed Consent
AQ Skin Solution or SKinrolla 0.5-1.5 mm device improves the health and quality of the skin by stimulating essential cells to increase collagen, elastin and hyaluronic acid. It is an effective treatment for acne scarring, stretch marks, fine lines and wrinkles, open pores, and generally improves skin tone, texture and brightness. Results are gained gradually over a period of months.
Common Side Effects
Redness which ranges from a pale rose blush to a beetroot red. This redness usually settles within a few hours but can persist for up to 3 days settling daily.
Mild discomfort/ heat, tingling, not unlike sunburn
The skin may feel dry over the first 7 days and will require the application of aftercare cream for comfort
Light peeling/flaking may occur, particularly after the first treatment.
Sensitivity to your usual skin care regime.
Red marks/ ‘track marks’
Rare Side Effects
Bruising, small dark purple bruises
Herpes/ cold sore outbreak
Pigmentation changes – hyper-pigmentation (darkening of the skin treated) or loss of pigment
Severe itching, selling and redness (temporary)
Whilst I have been advised of the probable result, this cannot be interpreted as a guarantee. Results Vary from one individual to another.
I consent to photographs being published for;
I have taken the time to read;
and accept the terms of payment as per the clinic policy (terms and conditions).
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Signed by Nina Bal
Signed On: 8th January 2020
If you have questions about the contents of this document, you can email the document owner.
Document Name: Micro Needling Consent Form
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