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Microneedling Consent Form

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Microneedling, also known as Collagen Induction Therapy, is a minimally invasive skin treatment that uses fine needles to create controlled micro-injuries in the skin. These microchannels trigger the body’s natural wound healing process, stimulating the production of collagen and elastin, improving skin texture, tone, and firmness.

Microneedling can help improve:

  • Fine lines and wrinkles

  • Acne scars and enlarged pores

  • Stretch marks

  • Sun damage and pigmentation

  • Dull, uneven skin tone and texture

  • Hair loss (in selected protocols)

A course of 4–6 treatments spaced 4–6 weeks apart is typically recommended for best results.


Contraindications


Microneedling should not be performed if you:

  • Are pregnant or breastfeeding

  • Are under 18 years old

  • Have active acne, eczema, psoriasis, cold sores, or skin infections in the treatment area

  • Have keloid scarring or poor wound healing

  • Are on blood thinners or anticoagulants

  • Have had recent Botox or filler (within the last 2 weeks) in the area being treated

  • Are immunocompromised or undergoing chemotherapy

  • Have used isotretinoin (Roaccutane) within the past 6 months

Please ensure you have disclosed any medical conditions, allergies, and current medications to your practitioner.


Possible Risks and Side Effects


Common temporary effects include:

  • Redness, sensitivity, or swelling for 1–3 days

  • A sensation similar to mild sunburn

  • Flaking or mild dryness

  • Small pinpoint bleeding during treatment (usually subsides immediately)

Less common risks include:

  • Bruising or prolonged redness

  • Infection (if post-treatment care is not followed)

  • Post-inflammatory hyperpigmentation or hypopigmentation (especially in darker skin types)

  • Allergic reaction to serums or numbing cream

Complications are rare when treatment is carried out by a trained professional and aftercare is followed properly.


Pre-Treatment Advice

To prepare for microneedling:

  • Avoid retinol, AHA/BHA products, or strong exfoliants for 3–5 days before treatment

  • Do not have facial waxing, laser, or peels within 1 week prior

  • Arrive to your appointment makeup-free, if possible

  • Avoid alcohol and anti-inflammatories (e.g. ibuprofen) 24 hours before if safe to do so


Aftercare Instructions


Post-treatment, it is essential to:

  1. Avoid touching the face or applying makeup for at least 12 hours

  2. Use only post-procedure skincare recommended by your practitioner

  3. Avoid sun exposure, heat (sauna/steam), swimming, or intense exercise for 48–72 hours

  4. Wear broad-spectrum SPF 50 daily

  5. Avoid exfoliating products, retinoids, or actives for 5–7 days

  6. Do not pick or scratch flaking skin — allow it to shed naturally

  7. Drink plenty of water to aid healing

Your skin may feel tighter or look flushed for 24–72 hours. These effects are normal and temporary.


Expected Results


  • Initial improvement may be seen within a week, with full results developing over 4–6 weeks

  • A course of treatments provides cumulative collagen stimulation and visible results

  • Results may vary depending on skin condition, age, and lifestyle factors (e.g. smoking, sun exposure)


Consent Declaration


By signing this form, I confirm that:

  • I have received a clear explanation of microneedling, its purpose, risks, benefits, and aftercare

  • I have disclosed all medical conditions, medications, and allergies truthfully

  • I understand that microneedling involves temporary skin trauma to stimulate repair

  • I understand that results vary, and no guarantees of outcome can be made

  • I understand that multiple sessions may be required

  • I have had the opportunity to ask questions, and all have been answered to my satisfaction

  • I agree to follow pre- and post-treatment advice and attend follow-up sessions if recommended

  • I voluntarily consent to undergo microneedling treatment

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