Treatment form
Refined Pre-Treatment Form
Thank you for choosing Refined to perform your Permanent Cosmetics Procedure. We look forward to meeting you at your appointment. If your previous answers to any of the below questions have changed since our last contact, please call us immediately on 07877 777162.
- Are you pregnant or breastfeeding?
- Do you suffer from any illness?
- Do you take any medications?
- Do you have any known allergies?
- Do you have any skin conditions including problematic scarring?
The next stage of assessing your suitability for the treatments to perform a sensitivity patch test. The test must be completed as soon as you receive it and no less than 24 hours before your Permanent Cosmetics procedure. If you do not comply with these instructions your appointment may be rescheduled or cancelled.
Please note, a negative sensitivity patch test result does not guarantee that you will not have an allergic reaction. Please read these instructions and perform the sensitivity patch test as instructed. If you experience a reaction or have any questions, please contact us immediately.
1. Place the pigment sample on one of the plasters provided in this envelope ( if the pigment has dehydrated, add a drop of water).
2. Place the topical anaesthetic on the other plaster provided.
3. Position each plaster on to one of the following areas:
- Behind each ear
- On top of each arm
- On each thigh
- On each buttock
- Do not place in the crease of the elbow or the knee
4. After 24 hours, remove the plasters and examine the skin. If there is no visible reaction, such as redness, swelling, irritation or itching, then we can proceed with the treatment.
5. Should you experience any of the symptoms mentioned during the test, immediately remove the plaster and flush the area with cold water. Then contact your technician to discuss your options.
Please note, the colour enclosed is not necessarily the colour that will be used for your treatments; it is for patch test purposes only.
DECLARATION - I have read and fully understood the above information. I have completed the sensitivity patch test and I have experienced no reaction.
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What is Topical Anaesthetic?
- A topical anaesthetic is a form of anaesthetic used to numb the skin
- This will be applied to the surface of the skin, not injected
During the Treatment?
- The topical anaesthetic will be placed over the treatment area before the treatment commences, then carefully removed prior to the treatment.
- The effects of the anaesthetic vary from individual to individual. We cannot guarantee that you will not experience any discomfort or pain during the treatment or that the treatment area will not be numb completely.
- For eyeliner treatments, you will be asked to keep your eyes closed throughout the numbing period. If for some reason the topical anaesthetic gets into the eye, you must advise your technician at once. The cream will be removed and your eyes will be immediately flushed with a sterile saline solution. It is then safe for the topical anaesthetic to be reapplied.
NOTE - If you experience stinging in the eyes and do not inform your technician immediately, the anaesthetic may numb the eyeball, and a possibly corneal abrasion may occur. This can result in temporary streaming and light sensitivity of the eyes. You may be unable to open your eyes and each time you blink it may be painful and temporary blurred vision may occur. Corneal abrasion, however, is rare. If you experience any of these symptoms, inform your technician and visit your doctor immediately.
Allergic Reactions and Risks?
- Allergic reactions can occur from any topical anaesthetics used during the course of the treatment
- If you do suffer from an allergic reaction after the treatment, you should notify your technician as soon as possible and contact your doctor immediately. If the reaction is very severe, you should go to your nearest Accident & Emergency Hospital department.
- An allergic reaction response may display as severe redness, itching, swelling, a rash, blistering, dryness or any other symptoms associated with an allergy.
After the Treatment
- As a result of the permanent cosmetics treatment, combined with the use of anaesthetics, you can expect to experience swelling and redness that could last up to five days. You should always follow your post-procedure advice.
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IMPORTANT TREATMENT DOS AND DON'TS
ALL TREATMENTS
- Please wear your usual daily makeup to the clinic on the day of the treatment
- A sensitivity patch test will be performed in advance of the treatment unless waived upon request
- Do not take aspirin, Ibuprofen or Coumadin for two days before and two days after the treatment. However, you must not discontinue any prescribed medication before consulting your doctor
- Alcohol must not be consumed in the 24 hours prior to the treatment
- Refrain from using sunbeams and avoid natural sun exposure for two weeks before and two weeks after the treatment
EYEBROW TREATMENTS
- Refrain from waxing at least 48 hours prior to the treatment
- Refrain from having electrolysis for at least five days prior to the treatment
- Eyebrow tinting should not be undertaken for one week prior to the treatment
EYELINER TREATMENTS
- Any eyelash tinting or eyelash perming should be carried out no later than one week before or no sooner than two weeks after the treatment
- You may experience some swelling after the treatment. As a safety precaution, we recommend that you have someone available to drive you home.
- Do not wear contact lenses during or immediately after the treatment. Remember to bring your glasses. You may resume wearing your contact lenses as soon as your eyes feel comfortable (this is normally 24 hours after the treatment).
LIP TREATMENT
- If you have a history of cold sores (herpes simplex), we advise you to contact your doctor who can prescribe medication to minimise such outbreaks
- Alternatively, obtain herpes medication such as Zovirax from your local chemist and use as directed by the chemist or doctor. Permanent cosmetics treatments do not cause cold sores, however, if you carry the virus, it lays dormant in the body and can be triggered by the treatment.
- Lip wax or bleaching treatments should not be undertaken for at least a two week period preceding your permanent cosmetics treatment.
WHAT WILL I HAVE TO DO WHILST I AM HEALING?
The aftercare procedure will be tailor-made for you by your technician with regards to what products they recommend and how to use them in relation to which treatment you have had.
Surface healing time usually takes up to ten days to complete, although each individual will react differently
If you are feeling less than 100% healthy, it may take longer to heal and symptoms can appear more prominent
THE MAIN AFTER CARE RULES ARE AS FOLLOWS
- The treatment area must be kept completely dry whilst it is healing. We recommend a gentle facial cleanser or wipe for the rest of the face during this time
- Keep hair away to prevent infection
- No products should be applied other than those your technician instructs you to use
- Do not expose the treatment area to extreme heat, cold, or moisture for two weeks following your treatment. This includes direct sunlight, tanning beds, saunas, steam rooms, hot tubs, fake tan and swimming.
- Do not pick, peel, or scratch the treatment area as this could result in scarring or infection.
- Avoid applying makeup to the treatment area until the wound has completely exfoliated
- If you are a blood donor, you may not be eligible to give blood for four months after your procedure.
- Avoid all hair removal and tinting treatments for two weeks after the procedure (waxing, threading, tinting etc.).
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Please read the Statements and confirm:
Consultation
IMPORTANT TREATMENT INFORMATION
- This treatment is a form of cosmetic tattooing - Permanent cosmetics may require multiple treatment sessions - For best results, you will be required to return for at least one retouch treatment between 4 and 12 weeks after the initial treatment - Immediately after the procedure , during the healing process the results can appear darker. The pigment colour will fade during the healing process. It is your responsibility to keep the treatment area clean and free from contaminants - Infections can occur - Allergic reactions to topical anaesthetics and pigment can occur - There may be swelling and redness following the procedure - You may experience minor bleeding -A retouch cannot be performed until the treatment area is completely healed - In rare cases, the pigment could migrate under the skin - Application of permanent cosmetics can be painful - The pigment will fade over time and colour-boosting procedure will need to be performed approximately 12-18 months after the original procedure - A negative sensitivity patch test will not guarantee that you will not have an allergic reaction - There are a few effective methods for pigment removal - Possible scarring and inconsistency of colour can occur - After having a permanent cosmetics procedure, discuss with a doctor before having an MRI scan - Those receiving an eye treatment may require someone to drive them home after the appointment - Corneal abrasion may occur during eyeliner procedures. However, this is rare - If you have experienced previous problems with cold sores/ Herpes and wish to receive a lip treatment, you may have a reoccurrence of cold sores following the procedure. Anti-herpes medication is available over the counter or on prescription and has been shown to prevent or minimise such outbreaks - Permanent cosmetics procedure can trigger outbreaks of dormant herpes whether or not you are aware of its existence, but it cannot be the cause of herpes - Lip treatments will appear dry and flaky for approximately one week following the procedure - Camouflage procedures are experimental in nature and procedures will need to be rested for skin colour matching - Possible scarring, inconsistency of colour and loss of eyelashes may occur CLIENT ACKNOWLEDGEMENT AND CONSENT I can confirm that the medical history and information recorded in the pre-treatment and treatment documents is accurate and complete. I certify that I have read and had explained to me and fully understand this full document including the pre-treatment document I previously received.
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