Chemical Peel Consent

TOA Clinic Lomdon

Chemical Peels have been used for years to create softer and smoother skin. A chemical peel involves the application of highly specialized acids and/or enzymes that remove the outermost layers of dead skin cells causing superficial peeling and exfoliation. After the dead skin cells are removed, the skin begins to rejuvenate to reveal more glowing youthful skin. Chemical peels can be extremely beneficial if you have hyper-pigmentation, acne, sun damage, photo-aging or rosacea. The benefits of a chemical peel include: Reduction of wrinkles and fine lines Minimization of pore size Decrease or elimination of hyper-pigmentation Reduction of acne flare ups Skin cell renewal Improvement in overall texture and tone of the skin Typically, a series of peels or facial treatments are needed to see results. As with any facial treatment, there are always possible problems that can arise. Everyone’s skin is unique and may or may not be sensitive to an ingredient or product. Allergic reactions are not common, but can occur. Redness, swelling, peeling, increased pigmentation, prolonged skin sensitivity to wind and sun, breakouts and skin burning can occur. These side effects are temporary, but can be uncomfortable.  Contraindications to all peels If you have any of the following, a peel should not be done at this time and you must notify your Practitioner. Use of Accutane in the last 6 months Active herpes simplex (cold sores) Facial Warts If you are now pregnant, think you might be pregnant, or are trying to become pregnant If you form keloid or hypertrophic scars If you have a history of sun allergies Prior bad reaction to a peel Recent radiation treatment for cancer Sun burn or significant sun exposure in the last two days Surgery or cryosurgery within the last month to the area that you plan to have peeled Allergic to Resorcinol Allergies to salicylic acids Blood vessel disease Diabetes Inflammation, irritation or infection of the skin Influenza Varicella (chicken pox) Kidney or Liver disease After the treatment Limit your time outdoors to reduce sun exposure Protect the skin from sunlight damage using a sun block at least 50 SPF Calm the skin using soothing products such as Toskani Regenerating Gel Moisturise regularly with an antioxidant moisturizer Do not pick at the skin to avoid scarring Do not exfoliate Do not over moisturise Do let the process run its course I confirm I have read the Information and acknowledge the contents having asked the practitioner to explain any aspects of Chemical Peels that I did not understand. I understand the results vary from person to person. I acknowledge that it is impossible to list every potential risk and complication, but I have been informed of the benefits, risk and likely improvement that I will see in my skin. I have discussed my medical history with the practitioner, specifically in relation to the contraindications presented in the Information. I have disclosed all medications that I am taking or have taken within the past 60 days and have disclosed all of the topical products I am using. I understand and am willing to comply with all pre- and post-care instructions.  ​ This procedure has been explained to me and my questions regarding such treatment, its alternative, its complications and risks have been answered. I hereby give my unrestricted informed consent for the procedure. 

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