I understand that Dermastamp Treatment utilizes fine micro-needlings to puncture the skin surface. As a consequence, the repair process releases numerous growth and healing factors that stimulate new collagen to be deposited under the skin surface. The repair process will actually extend over a twelve to the sixteen-week period after treatment. I also understand that I may require a series of treatments to achieve the maximum cosmetic result. The procedure and complications have been explained to me and I have had the opportunity to have my questions answered.
I have been advised that the object of the procedure I have requested is an improvement in appearance, not perfection. It is possible for imperfections to persist, and the result might not live up to my expectations or goals. I fully understand that the practice of medicine and surgery is not an exact science and that any reputable physician cannot guarantee results. I acknowledge that no written or implied verbal guarantee, warranty, or assurance has been made to me regarding the outcome of the procedure that I herein requested and authorized. I also understand the limitations of this procedure.
I understand the complications of a Dermastamp Treatment to be as follows:
Erythema: The skin may remain red for generally 24 hours up to four days after Dermastamp treatment. As the skin heals the erythema will resolve. Six hours after treatment mineral makeup can be used to camouflage the erythema.
I understand that a Dermastamp can be combined with the application of serums, nutritional factors and vitamins to stimulate optimal collagen productions.
I understand bruising may occur as a result of treatment.
Hyper-pigmentation: A small number of patients may experience hyperpigmentation of the skin surface (especially if the skin is not protected from the sun's rays). This will resolve in several weeks and may be treated with a pigment gel cream.
I understand in order to avoid possible postoperative hyperpigmentation that I need to refrain from any intensive sunlight exposure and/or solarium for a period of 2 weeks. I shall use a sunblock with a protection factor of 15 or higher.
I understand in order to avoid possible postoperative infections that I need to refrain from any exercise immediately post-treatment for a period of 12 hours.
I shall follow the prescribed post-procedure skincare to avoid infection.
I understand that I may require additional treatments in order to achieve maximum results and that some imperfections are not amenable to a Dermastamp treatment.
I understand that patients with a history of herpes simplex (cold sores) may experience a flare-up of the disease. If I have had herpes scores, I will inform the physician so that he can pre-treat me appropriately.
I understand that infection is a rare possibility.
I hereby give permission for photographs of the intended treatment site for diagnostic purposes and to enhance the medical record. I agree that these photographs will remain the physician's property.
I agree to follow the instructions given to me by the clinic to the best of my ability before, during and after the procedure. I understand that patient responsibility and proper performance of the postoperative care and regular return office visits are critical to the success of the treatment. I have thoroughly read and understood the postoperative instructions and reviewed them with the physician's staff. I acknowledge that I have read and filled out the patient registration and medical history form fully and correctly to the best of my knowledge and that the information that I have supplied is correct.
