Dermaplaning Form

First name:*

Surname:*

Contact Number:*

Address:*

Postcode:*

Doctor's Name:*

Surgery Name and Address:*

I am aware that the Beauty Barn may wish to contact me for follow up appointments, details of other treatments, or for marketing purposes and I consent to my contact details being used for these purposes. I also agree with prior consent for any before and after pictures to be used*.

I allow the website to collect and store the data I submit through this form*

Skin Care Products

Cleanser:

Serum:

Night Cream:

Eye Cream:

Day Cream:

What is Dermaplaning?

Dermaplaning is a form of manual exfoliation similar in theory to microdermabrasion but without the use of suction or abrasive crystals. An esthetician grade, sterile blade is stroked along the skin at an angle to gently “shave off” dead skin cells from the epidermis. Dermaplaning also temporarily removes the fine vellus hair of the face, leaving a very smooth surface. As with any type of exfoliation, the removal of dead skin cells allows home care products to be more effective, reduces the appearance of fine lines, evens skin tone and assists in reducing milia, closed and open comedones and minor breakouts associated with congested pores.

Dermaplaning can be an effective exfoliation method for clients that have couperose (tiny blood vessels near the surface of the skin), sensitive skin or allergies that prevent the use of microdermabrasion or chemical peels. Due to the contours of the face, certain areas of the face (such as the eyelids and nose) are not treatable using this method.

Please initial to show that you have read this section:*

As your Aesthetician/Practitioner I take every precaution to ensure that your skin is well hydrated and calm following each session. However, you may experience excessive dryness or even some peeling between sessions, which may or may not be normal. Always contact me if you have any concerns. More sensitive skin may experience some redness after the first couple sessions. This normally goes away after 2 or 3 hours.

Dermaplaning may cause minor superficial abrasions which may not appear until a day or two following your treatment. If this should occur, please contact me so that I can do a post-treatment follow-up with you. After your
treatment, SPF 30+ MUST be worn at all times. Tanning beds should never be used. You are making an investment in your skin, therefore, it is to your benefit to continue to protect it long after your series of treatments is completed.

Please initial to show that you have read this section:*

I give my consent for the following procedure: Dermaplaning to be performed by Beauty Barn. I understand there are contraindications to this treatment, including but not limited to diabetes, cancer, active acne, bleeding disorder, and the inability for blood to coagulate following injury. Certain medications including blood thinners, higher doses of Aspirin and Accutane are contraindicated for this treatment due to the possibility of delayed clotting from a nick or cut. I certify that I am not taking any of the above medications or experiencing any of the above conditions. Alternative treatments such as waxing to remove vellus hair and microdermabrasion for exfoliation, along with their associated risks, have been explained to me as other options.*

Yes

Contraindications

Post-treatment/Home Care

Exercise or vigorous physical activity should be avoided until all redness has subsided. Direct sunlight exposure is to be completely avoided immediately following treatment (including any strong UV light exposure or tanning beds). Although SPF 30+ should already be part of your daily skin care, after Dermaplaning SPF30+ must be applied daily to the treated area for a minimum of two weeks. Twice daily cleanse the treated area with a post-treatment cream and follow with SPF sunscreen.

If you have additional questions or concerns regarding your treatment or suggested home regimen, you will consult your aesthetician immediately.

I confirm to the best of my knowledge that the answers I have given are correct and that I have not withheld any information that may be relevant to my treatment.*

Yes

Signed:

Date:*

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Beauty Barn Turvey

Skin Care Products

Contraindications

Post-treatment/Home Care

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