Consultation & Consent Form | Hannah Louise Beauty

Consultation & Consent

Please read these statements carefully

Semi-permanent makeup is a form of tattooing called Micropigmentation / Microblading. This is the process of inserting pigment into the basal layer of the epidermis. It is a form of tattooing and on occasions it may be permanent.
Re-touch procedures may be required following the initial procedure; please note this is a two-stage treatment process. Retention holds much stronger following the retouch.
A minimum healing period of 4-6 weeks is required before a retouch procedure can be performed depending on age and skin type.
A fully healed result can only be seen 4-6 weeks after the full treatment.
Retention of pigment depends on many factors including, skin type, age of client, adhering to aftercare procedure, lifestyle, sun exposure, medication, and vitamin intake. There is no guarantee that a specific client will benefit from this procedure or that pigment will hold in every client's skin.
On rare occasions the pigment may migrate under the skin particularly if skin type is very oily or presents open pores. Therefore, the treatment will give a more 'powdered' look and may have less retention due to pigment migration under the skin.
Old Scaring may act like 'dead skin' and at times may not hold pigment.
Application of semi-permanent cosmetics can be painful.
The pigments will fade over time. This may vary with each client.
Immediately after the procedure the pigment can appear 20% darker than the desired result. You will experience fading between the initial treatment and your retouch.
There may be immediate or delayed allergic reaction to pigments. However, allergic reactions are extremely rare.
A negative allergy test (patch test) result will not guarantee that you will not have an allergic reaction.
Allergic reactions to anaesthetics can occur.
Semi-permanent cosmetics cannot be applied to pregnant women or nursing mothers.
Semi-permanent cosmetics cannot be applied to any person under the age of eighteen.
Infections can occur if aftercare instructions are not followed correctly.
There may be swelling, redness, and minor bleeding following the procedure.
You must follow the aftercare procedure carefully for 7 days following treatments.
If you have an MRI scan within 3 months of your permanent cosmetics procedure we recommend that you discuss this with your GP.

Possible scarring or inconsistency of colour may occur.
It is normal for the top layer to flake off, DO NOT PICK, as you will remove the deeper layers of pigment and will have no retention.

What to expect straight after the procedure:

Day 1: For eyebrow treatments: the brows will appear slightly thicker and the colour will look much stronger and perhaps warmer due to the redness caused in the skin.
Day 2-4: The brows will appear 2 shades darker from when you left the clinic and colour may seem a little red still.
Day 6-10: not all brows go through the flaking process; some clients can't even see the flaking. Brows may look very light and patchy at this stage. The pigment will reappear in nearly all cases.
Day 28-40: Depending on the client, this is the time when you actually start to see the final result. People who heal quickly and younger clients can see their final colour by the 4-5-week mark, while more mature women and slower healers may have to wait 6-7 weeks to see the colour fully bloomed back.
As the months go by the pigment will appear softer and lighter as it settles under the layers of skin. To protect against fading use a sunscreen, avoid sunbeds, and cut down on vitamin C and Glycolic acid intake.
Your skin is a living organ so it is not possible to foresee how pigment will heal or retain in your skin.

This information is not intended to alarm you. However, it is imperative that you are informed of the risks involved and that you follow the aftercare instructions.

A booking fee of £50 is payable upon booking appointment. This is deducted from the final balance. A minimum of 7 days' notice is required to transfer this to a different date. A minimum of 3 days' notice is required to amend a retouch treatment, otherwise it cannot be provided free of charge. A £39 set up fee, plus labour will be required for the new retouch appointment.

By ticking the box below I agree to follow the aftercare procedures given to me during my treatment for both my initial and retouch procedure.

Signed by Client

Medical Health

What is your skin type?

Normal

Dry

Oily

Combination

Please let Hannah know if you are undergoing drug / alcohol rehabilitation and having blood / urine samples taken as the numbing products used may show a positive test result. A letter can be provided confirming this.

Patch Testing:

The pigment will be tested for sensitivity prior to your procedure taking place. You should inform Hannah immediately if you experience any redness, itching, irritation or swelling due to the pigment test and clean the area of product immediately.

If there is no reaction you can go ahead with the procedure as discussed.

By ticking the box below I confirm that the medical information l have given is correct and I have NOT experienced any reaction to the pigment test carried out prior to treatment:

Signed by Client

General Consent & Procedure Permit

I hereby authorise Hannah Louise Foster of Hannah Louise Beauty, practicing at True You Skin Clinics, to perform upon myself the procedure of MICROBLADING.
If any unforeseen condition arises in the course of this procedure, calling in her judgement in addition to, or different from those now contemplated, I further request and authorise her to do whatever she deems advisable and necessary in the circumstances.
l accept responsibility for determining the colour, shape and position of the permanent cosmetic procedure as agreed during the course of my consultation.
I understand that an allergy test does not guarantee that I will not have an allergic reaction to the pigment.
Hannah cannot accept responsibility if the treatment area does not effectively numb. Each individual is different according to skin type. For all procedures a cream or gel topical anaesthetic is used. These products are perfectly safe, and can be purchased over the counter from any chemist.
I fully understand and accept that non-toxic pigments are used during the procedure and that the cosmetic enhancement achieved may fade over a period of 1-3 years. Even though the colour has faded the pigment will stay in the skin indefinitely.
l have been informed that the highest standards of hygiene are met and that sterile disposable needles and pigment containers are used for each individual client, procedure and visit.
I understand and accept that each procedure is a process requiring multiple applications of pigment to achieve desirable results, and that 100% success cannot be guaranteed during the first procedure. I understand that this is why I will need to return for a retouch procedure.
I understand that a retouch procedure will be performed 6 – 12 weeks after the initial procedure and that after a 12 week period I will be charged an additional fee for any further work. I understand that it is my responsibility to book the appointment at a time convenient for both parties.
The result of the procedure is determined by the following: medication, skin characteristics (dry, oily, sun-damaged and thickness), natural skin undertones - (blending with chosen pigment), personal pH balance of skin, which changes from visit to visit, alcohol intake, smoking, and adhering to Post Procedure care treatment.
Upon completion of the procedure there may be swelling and redness of the skin, which will subside between 1-4 days. In some cases, bruising may occur. I understand I can resume normal activities immediately following the procedure however, using cosmetics, excessive perspiration, steamy showers and exposure of the sun to the affected area should be avoided.
l have been advised that the true colour will be seen 4 weeks after each procedure and that the pigment may vary in colour dependent on skin tones, type, age and conditions. I understand that some skins accept pigment more readily than others and no guarantee to an exact effect or colour can be given.
l agree to follow all pre-procedure and post-procedure instructions as provided and explained to me by Hannah. I confirm that I have received copies of all the relevant aftercare instructions.
Being of sound mind and body, I hereby release any and all responsibility. I accept any and all responsibility myself for any consequence that might arise from my decision to have any permanent cosmetics procedure performed by Hannah.
For the purpose of documentation, I also consent to the taking of "before and after" photographs of said procedure(s) for record purposes and for use in presentation portfolios.

I CERTIFY THAT I HAVE READ AND HAVE HAD EXPLAINED TO ME AND FULLY UNDERSTAND THE ABOVE CONSENT AND PROCEDURE PERMIT; THAT THE EXPLANATIONS THEREIN REFERRED TO WERE MADE AND I ACCEPT FULL RESPONSIBILITY FOR THESE AND OR OTHER COMPLICATIONS WHICH MAY ARISE OR RESULT DURING OR FOLLOWING THE COSMETIC PROCEDURES WHICH IS TO BE PERFORMED AT MY REQUEST ACCORDING TO THIS CONSENT AND PROCEDURE PERMIT.

To my knowledge I do not have any physical, mental, or medical impairment or disability that might affect my wellbeing as a direct or indirect result of my decision to have the procedure done at this time. l am over 18 years of age. I am not pregnant. I am not under the influence of drugs or alcohol.

I have read an understood the above information and been given a Microblading Fact Sheet prior to treatment.

Signed by Client

Anaesthetic Consent

ALLERGIC REACTION - Allergic reaction can occur from any anaesthetics used during the procedure. If you do suffer from an allergic reaction you should contact your GP immediately. Allergic reaction response may display redness, itching, swelling, a rash, blistering, dryness or any other symptom associated with allergy.

NUMBNESS - Hannah cannot accept responsibility if the treatment area does not effectively numb. Each individual is different according to the skin type. Some clients have reported that the area is totally numb while others say they experience some discomfort.

PROCEDURE- For all procedures a cream or gel topical anaesthetic is used. These products are perfectly safe and can be purchased over the counter from any chemist. The anaesthetic is placed over the treatment area for between 20-30 minutes then carefully removed prior to treatment.

As a result of the treatment, combined with the use of the anaesthetic, you can expect to experience swelling and redness that could last between 1 and 4 days. You should always follow your post procedure instructions.

If you experience any of these symptoms, inform Hannah immediately.

I have read and fully understood the above and the risks involved with the use of topical anaesthetic and consent to the use of the anaesthetic for the procedure.

Signed by Client

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