POWDER OMBRE BROW CONSENT FORM

CONSENT AND RELEASE AGREEMENT FOR PERMANENT COSMETICS
This form provides information to assist in making an informed decision of whether or not to undergo a permanent cosmetics application. If you have questions, please don‘t hesitate to ask. 

Although permanent cosmetic tattooing is effective in most cases, there are biological factors specific to any individual client that are beyond our artist’s control. Every effort will be made to ensure optimal results, however no guarantee can be made that a specific look or outcome will result from the procedure.

During the permanent cosmetics procedure pigment is deposited 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 sealed and sterilized before use and disposed of after use. Cross contamination and bloodborne pathogen guidelines are strictly adhered to.

Generally, the results are excellent. However, a perfect result is not a realistic expectation after an initial application.  It is usual to expect a touch-up after the healing is completed. We recommend two sessions to achieve optimal desired results. However, in certain cases subsequent sessions may be needed in which case any corresponding fees will apply.

Initially the color will appear much more vibrant and/or darker compared to the end result.  Usually, within 5-7 days the color will shrink about 25% in size and the color will soften about 40-50%. The pigment will fade naturally over time and will likely need to be touched-up through the years.

POSSIBLE RISKS, HAZARDS, OR COMPLICATIONS
• Pain: There can be pain even after the topical anesthetic has been used. Anesthetics work better on some people than others.

• Infection: Infection is very unusual, but can occur. The areas treated must be kept clean and only freshly cleaned hands should touch the areas.  See “After Care” sheet for instructions on care. 

• Uneven Pigmentation: This can result from poor healing, infection, bleeding or many other causes.  The follow up appointment can help correct any uneven appearance.

• Allergic Reaction:  If there is any concern for an allergic reaction to pigments, a patch test can be done. However, if a allergic reaction to occur, it may not show up for a long period of time, making the patch test inconclusive.

• Asymmetry: Every effort will be made to avoid asymmetry however, anatomical facial features may not be symmetrical. Adjustments may be needed during the follow up session to correct any unevenness.   

• Excessive Swelling: Clients with sensitive skin are more prone to swelling. This should dissipate within 24 hours.

• Acne prone: If acne is present on the forehead area, the brows may not heal correctly. If acne is a consistent issue, please consider having permanent micro pigmentation done is not in your best interest. 

• Anesthesia: Topical anesthetics are used to numb the area to be tattooed.  Lidocaine, Prilocaine, Benzocaine, Tetracaine and Epinephrine in a cream or gel form are typically used. If you are allergic to any of these please inform us now. 

• MRI: Because pigments used in permanent cosmetic procedures contain inert 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.

I understand that necessary photos will be taken before, during and after the course of my treatments for medical purposes and to evaluate treatment effectiveness. I understand that my photos will be kept confidential in my electronic patient recor

I have read and understand all information presented to me before signing this consent form. I have been given an opportunity to have all of my questions answered to my satisfaction. I understand the procedure and accept the risks.I release Edge Systems, the Aesthetician, management, and staff of Pua Manu MedSpa from any and all liability associated with any injuries and/or current or future conditions resulting from the procedure or products used. I agree to the terms of this agreement.