Consent Form

Mesoeclat

I declare:

Sydney Dermal Lounge has explained to me the suitability, benefits and possible side effects of performing a rejuvenation facial treatment with mesoéclat.

The purpose of the technique is to eliminate the superficial layers of the skin to stimulate cell renovation and obtain the facial rejuvenation.

The treatment consists of the elimination of the superficial layers of the skin by applying chemical agents, producing a mild burn, resulting in the epithelisation.

The technique is used on superficial scars, pigmentation, wrinkles and any process representing cutaneous ageing. The professional has explained that in order to obtain the best results, the treatment has to be repeated 5 times, with 10 to 15 days in between each session. The total duration of the treatment is around 2 to 3 months.

I understand that with this treatment I might experience some temporary side effects like stinging, crystallising, superficial desquamation, redness , acne eruption and hyper or hypo pigmentation on treated areas.

The therapist has warned me, not to expose myself directly to the sun after sessions and to use hydrating moisturiser with sun protection and mesoéclat ceam daily after treatment.

I have been informed of the importance to disclose my personal records of possible drugs allergies, actual medication intake, facial herpes episodes, family and personal keloid scaring, pregnancy or breastfeeding, or other conditions.

I will immediately report any unusual symptoms I might experience to my therapist and be especially aware of any slight chills or fever, redness or increased warmth, excessive bruising or swelling.

I completely understand the nature of the procedure and any possible risks mentioned, but not limited to all stated risks, which are related to the procedure.