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Carbon Facial Consent Formnicolepaton2020-10-07T06:25:46+00:00

Carbon Facial Consent Form

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  • About Carbon Facials:

    Carbon facials, also known as the “China Doll facial” or the “Hollywood peel”, utilises a Q-Switched laser mechanism as well as liquid carbon, which is applied to the face, to deep cleanse, exfoliate, rejuvenate and remove oil and congestion. It is a treatment that is focusing on exfoliating the top layers of the skin to give a smoother, clearer and more even appearance.

    How it works:

    During this treatment, liquid carbon is applied to the skin and allowed to be absorbed into the pores. Once it has been absorbed, the Q-Switch ND-Yag laser is passed over the skin where the energy is absorbed by the carbon and ultimately shatters these particles. The shattered particles are then buffed/blasted off the area, taking the dead skin, excess oil and impurities with it. Up to 3 passes can be done on the skin, depending on the client’s skin and the sensations being felt throughout.

    To achieve the best results, a series of 4-6 treatments is recommended at 2-4 weeks intervals, depending on the client’s skin and severity of condition being treated. Maintenance treatments will be needed.

    Possible side effects/reactions:

    • Heat felt in the skin
    • Some mild inflammation and erythema in the skin
    • Potential histamine reaction of skin purge/breakouts
    • Pigmentation changes (lightening and darkening of the skin
    • Dryness and flakiness post treatment
  • I certify that the above statements are true and correct, and that I have been advised and fully informed of the fat cavitation procedure and the nature of the process proposed, along with all risks, responses and pre and post care instructions. I hereby authorize and direct them to perform such process and perform such services as may be deemed necessary or advisable.

    My signature below constitutes my acknowledgement that:

    1. I have read, understand and fully agree to the foregoing
    2. Understand the caution and contraindications for each process and service proposed
    3. Give consent to the proposed process that has been satisfactorily explained to me and my questions have been addressed
    4. I hereby give my consent and authorization voluntarily and release My Laser Room and its therapists of any claims that I have or may have in the future in connection with the described application or service.

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406 Bell Street, Pascoe Vale South 3044

Tel: 1300-413-699

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