• LEVEL IV CUSTOM PEEL

    Please read through all pages of this form thoroughly at least 7 days prior to your custom peel off treatment at FAIRY GLOW MOTHER.
  • PEEL INFORMATION

  • ABOUT THIS PEEL

    The peel corrects skin problems at the cellular level rather than just the surface skin. The combined acids erase fine lines, wrinkles, actinic keratosis (a rough, scaly patch on the skin caused by sun exposure), refines enlarged pores, builds collagen and elastin to tighten the skin, repairs and reduces breakouts, controls oil, improves the appearance of post acne scarring, softens lines and provides an even smooth skin texture. The function of this peel is to create an even, controlled shedding of several layers of damaged cells exposing a new fresh layer of skin with a more even color and smoother texture. This allows deeper layers of new skin to be revealed. In addition, the peel stimulates new cells to grow, thereby tightening the skin which decreases wrinkling.
     
    HOW LONG DO THE RESULTS OF THE PEEL LAST?

    The effects of the treatment are long lasting. After the peel, the skin continues to improve for 8 to 12 months becoming firmer and tighter, more supple and elastic and developing a smooth texture with a stable moisture balance. This is the reason the treatment is known as a SKIN RENEWAL SYSTEM.

    It produces a genuine rejuvenation of the skin. More important than the physical peeling, is the formation of Collagen which takes place in the dermis and takes approximately 2-3 months to form. This is why we cannot see immediate results until at least 2 months post peel and this is why we wait 6 -8 weeks between our peels. It can take a number of months once your peel series is complete to see all the benefits as the skin continues to improve up to 12 months.

  • PEEL INSTRUCTIONS

    Please read thoroughly. Feel free to print this page out if you need to.
  • CLIENT PRE PEEL CARE INSTRUCTIONS

    • Discontinue use of Retin-A, Renova, Adapalene, Hydroxyl Acid, Differin Gel, Glycolic Acid, Salicylic Acid, or Retinol/Vitamin A derivative product for at least one week prior to your peeling.

    • If you are being treated for pigmentation, your skincare provider will provide a pigment inhibitor to be used twice a day 2 weeks prior to treatment.

    • Avoid tanning and extreme sun exposure for at least 2 weeks prior to your peel.

    • You will not be treated if you have an infection or severe cold/flu OR are taking an antibiotic.

    • You cannot have the peel treatment if you have used Accutane or its derivatives within the last 6 to 12 months.

    • You cannot have the peel if you are pregnant, breastfeeding, have active cancer or are currently undergoing chemotherapy or radiation.

    • You cannot have the peel treatment if you have active herpes. If an antiviral medication has been prescribed for you, you must begin taking the first dose Two (2) days prior to your appointment.

    • You will be at the skincare studio for approximately two to two and a half hours on the first day of your treatment and for approximately two hours on the second day.

    • If you are taking any medications that make you drowsy, you must arrange to have a responsible adult drive you home.

    • Please ensure that you have adequate sun protection in the form of a hat and scarf to be utilized directly after treatment.

    • Do not wear contact lenses to your appointment. Hearing aids will have to be removed during the treatment.

    WHAT TO EXPECT DURING PEEL - INSTRUCTIONS

    The Skin Renewal Peeling Treatment will help the skin become softer, moister and will permit the easy removal of blackheads and grease from clogged pores and will enable the skin to function better.

    The First Day

    Immediately after the first application of the Skin Renewal cream or paste, the skin will be normal aside from redness which is like strong sunburn. This cream/paste is harmless to the hair and therefore will not affect the eyebrows. If the cream/paste accidentally gets into the eyes, there is no danger. The eyes can be washed out with plain water. Of course the cream/paste as with any foreign body in the eye will be unpleasant. 

    You cannot wash, cleanse or wet your face, neck or any area to which the peeling has been applied for the duration of the peeling process 6 days - 7 days. During this period, refrain from using such products as hair dye, hair spray or make up. No other product may be used on the treated areas except the special lubricating “Soothing Cream” or substituted ointment which will be provided to you. The Soothing Cream, or ointment, is to be used on and around the areas on which you have had the Skin Renewal treatment.

    The Second Day

    There is a second application of the Skin Renewal peeling cream. The skin will start to darken and will gradually take on a deep sun tanned appearance.

     

    The Third to the Sixth Day

    By noon on the third day, the skin will become very dark, swell and wrinkle on the surface. You will experience a tight pulling sensation over the entire treated area. This will be the most unpleasant day of the treatment. Your face will not hurt, but because of the tightness, you will find difficulty eating, talking, laughing and moving the face. Drinking using a straw is sometimes helpful. Avoid sunglasses pressing down on the sides of the nose if at all possible. Do not be afraid to move your facial muscles gently. At the end of the third and fourth days, the skin will start to peel and will continue for a maximum of three days. The process will begin around the mouth and eyes. The last area to clear will be the cheeks and forehead. The neck will take a little longer. DO NOT PULL OFF THE SKIN.

    Keep applying the Cream or ointment by patting gently so as not to rub the skin off prematurely. If you feel the slightest unpleasant sensation on your face or neck as you do this, it means that the piece of skin is not ready to come off and should be left in place. Pulling the skin off before it is completely ready will lead to skin irritation, post inflammatory pigmentation, blotches and the clearing of impurities will not be as successful.

    At Home Care

    The Cream or Ointment should be applied at home continually until the treatment is completed which is approximately six days after the first application. The application of the Cream or Ointment should start straight after the first application of the peel. Keep the skin continually covered with this cream/ointment, reapplying whenever it has penetrated the skin. This will keep the skin soft and moist and ensure the easy removal of the top dead cell layers.

    Be Advised

    During the treatment you may go out, but you MUST protect yourself from exposure to the sun. Wear a large hat out of doors, sunglasses and a silk or light cotton scarf to protect your neck. Take particular caution whilst driving in a car. The sun is intensified through glass, so protect the sides of your face as well as your neck, with a scarf. Limit time spend outside to the cooler part of the day. During the winter, protect your face from the cold and wind with a light woolen scarf across your cheeks.

    The Skin Renewal treatment is completely harmless, however the unpleasant aspects of the treatment are:

    1. For about 20 to 30 minutes after the application of the Skin Renewal treatment cream, you will feel a stinging sensation which disappears slowly giving way to a new numb-likesensation. The use of a fan will ease the stinging.

    2. The ugly skin appearance with dark and light patches of uneven coloring during the process will disappear as the top dead cell layers are removed.

    3. Allergy. An allergic reaction to the Skin renewal treatment can occur with redness and swelling of the face and eyelids along with itching. Should this happen, call Sabrina immediately. There is absolutely no need to panic. The allergy is localized and temporary and is easily dealt with by the use of anti histamines.

    4. If pimples are already present on the skin, an increased breakout maybe expected. This is because the Skin Renewal treatment will help to bring to the surface the hidden infection and impurities in order to facilitate their removal.

    5. The delicate skin around the eyes will take a little longer to peel away so for about two weeks, the skin around the eyes appears very dry.

    6. In the darker skin, the color normalization will take a little longer than in fair skin.

    Important Notes

    • Drink lots of fluids, especially the first two days. Try to drink 8 to 10 glasses a day. (preferably water and fruit juice)

    • Avoid alcohol during this period.

    • Sleep on extra pillows as upright as possible to preclude excess facial swelling.

    • Post treatment discomfort may be relieved by over the counter pain medication such as Tylenol.

    • Oral antihistamine such as Benadryl may help with itching, but is sedating so do not drive whilst taking antihistamines.

    • Try to rest as much as you can.

    • From the moment your face begins to peel, DO NOT expose your new skin to the sun, wind and cold.

    • If it is absolutely necessary to expose your skin to these elements, be sure to protect the new skin with a sun screen cream obtainable from us.

    • Do not exercise profusely. Perspiration could irritate the skin. Avoid excess heat, steam or extreme cold.

     

    YOU MUST PROTECT YOUR SKIN FROM EXPOSURE TO ULTRA VIOLET LIGHT AND THE SUN FOR AT LEAST THREE MONTHS POST THE SKIN RENEWAL PEELING TREATMENT.

  • Acknowledgement

    By signing below, you acknowledge that you have read and agree to the information provided.
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  • POST-PEEL INSTRUCTIONS

    Please read for how to handle your skin in the days immediately following your peel-off.
  • POST-PEEL INSTRUCTIONS

    Once the skin has been removed at the clinic on day 7 or 8, you will discontinue the use of the provided aftercare cream/ointment. Your post peel regimen will be explained to you in detail by your esthetician. You may now wash your hair in the shower/bath and very gently cleanse your skin.

    • You should use a very mild, non irritating cleanser recommended to you by your esthetician. Cleanse your skin using only your finger tips in gentle circular motions. The use of a facial brush, sponge or cloth should be avoided. Rinse skin using lukewarm water. Hot or very cold water should be avoided. Do not rub, pick or scratch at your skin. Gently blot skin dry using a soft clean piece of paper towel or microfiber soft towel and apply your appropriate salon recommended creams.

    • Avoid the use of toners containing scrubs and antiseptic soaps for 2 weeks post peel off. Products containing skin irritants such as Retinol, Benzoyl Peroxide, Glycolic/Salicylic acids, Astringents or Vitamin C should be avoided for a period of two (2) weeks post peel off or until all sensitivity has resolved.

    • When showering, avoid getting the shampoo and conditioner directly on your face and neck for the first few days. You may consider taking a shower with the back of your head towards the water to avoid directly hitting your face with the full force stream.

    • Moisturize your skin adequately. Your clinic will recommend gentle, fragrant free, mild soothing post peel skin care products until all skin sensitivity has resolved.

    • Avoid sun exposure for at least three (3) months post peeling. The skin is vulnerable and sun damage can easily occur.

    • Ensure that you use adequate sun protection at all times including on cloudy days. Sunscreen must be used vigilantly to help prevent pigmentation issues that may be caused by direct and indirect sunlight. The sun is intensified through glass, so precaution whilst driving in your car should be taken by protecting your skin with a scarf. Sunscreen along with a hat, sunglasses, scarf and even an umbrella should be used whenever outdoors. Darker skinned individuals should be extra diligent about sun protection.

    • Makeup may be used.

    • Do not wax, tweeze or use a depilatory product on your face or neck for at least 2 weeks post peel.

    • Do not use a self tanner.

    • Avoid exercise that causes excessive perspiration as well as saunas and steam rooms for two (2) weeks post peeling as this could irritate the skin.

    • Once skin sensitivity has resolved, your clinic will suggest an appropriate skin care regimen including the use of a Pigment fading cream, a gentle retinol or Vitamin A cream and a Vitamin C cream or serum. Continue using gentler products should you experience any sensitivity.

     

    PLEASE NOTE: We cannot be held responsible if after care instructions are not carefully adhered to.

  • Acknowledgement

    By signing below, you acknowledge that you have read and agree to the information provided.
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  • MODEL RELEASE

    This custom peel does require photographs and your consent to use said photographs.
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  • I hereby consent to having clinical photographs taken before, during and after my peeling procedure. I understand that these photographs are an important part of my medical record.

    I consent to and authorize the use and reproduction by FAIRY GLOW MOTHER® of any and all photographs which you have taken of me, for any purpose whatsoever, without further compensation to me. All negatives and positives, together with the prints, shall constitute your property, solely and completely. 

    By signing, I certify that I am 18 or more years of age.  

    I, the undersigned Model, assign to you the right to copyright photography.

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  • ANTIVIRAL MEDICATION RELEASE

    Please choose whichever statement below applies to you and sign and date before submitting.
  • Instructions for Anti-herpes medication if you are undergoing the Skin Renewal Peeling
    treatment. If you have ever had a fever blister or cold sore at any time in the past, you will be required to take an Antiviral Medication to prevent an outbreak from occurring.

    Please request one (1) of these four medications from your doctor’s office:
    ZOVIRAX
    FAMCICLOVIR A
    CYCLOVIR
    VALTREX

    You will need 5000mg for each peeling treatment. Please request 10000mg in total for
    your two peels.

    You will take 1000mg of the medication for five (5) consecutive days. You begin by taking the pills two (2) days before your peeling treatment. You will continue to take your medication on the two (2) days of the peeling application and then on the day following your second application. This will constitute taking the Anti-Viral for 5 consecutive days.


    Do not miss a dose.

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  • CONFIDENTIAL SKIN & MEDICAL HISTORY

    Please read through each question thoroughly and answer truthfully to the best of your knowledge.
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  • ACKNOWLEDGEMENT

    I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure. I understand that withholding information or providing misinformation may result in contraindications from the treatment. I am aware that it is my responsibility to inform the skin care therapist of my current medical or health conditions and to update this history.
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