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Million Dollar Facial Consent Form

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The Million Dollar Facial is a luxury facial combining multiple advanced techniques to deeply exfoliate, detoxify, and stimulate collagen production. It includes dermaplaning, microneedling, lymphatic drainage, and serum infusion. While this is a non-invasive treatment, it is important that you understand the procedure, potential side effects, and aftercare.


Eligibility & Medical Disclosure


To receive this treatment, you must:

  • Be over 18 years old

  • Be in good general health

  • Not be pregnant or breastfeeding

  • Not be under the influence of alcohol or drugs


Please inform your practitioner if you:

  • Have active acne, eczema, psoriasis, or skin infections

  • Have had recent facial surgery, chemical peels, or laser treatments

  • Are using Roaccutane or have done so in the past 6 months

  • Have a history of keloid scarring or poor wound healing

  • Have any allergies to skincare products, anaesthetics, or latex

  • Have a pacemaker or implanted electrical device

  • Are taking blood thinners, steroids, or immunosuppressants


Risks and Side Effects


The Million Dollar Facial is generally well tolerated. Common side effects may include:

  • Redness and warmth (usually resolves within 24–48 hours)

  • Dryness, flaking, or tightness

  • Temporary sensitivity or tenderness

  • Slight bleeding or pinprick marks from microneedling

  • Breakouts or skin purging


Rare complications:

  • Skin irritation or allergic reaction

  • Infection if aftercare is not followed

  • Pigmentation changes (rare in darker skin tones)


Aftercare Instructions

  • Avoid touching or applying products to the face for at least 4 hours post-treatment

  • Do not apply makeup for 24 hours

  • Avoid sun exposure, swimming, and exercise for 48 hours

  • Use SPF 50 daily and avoid tanning

  • Do not use active skincare ingredients (e.g. retinol, AHA/BHA) for 3–5 days

  • Keep the skin clean and hydrated

Your practitioner will provide personalised aftercare advice based on your treatment.


Consent Declaration


By signing this form, I confirm that:

  • I have disclosed all relevant medical information and understand the treatment

  • I understand the nature, purpose, and expected outcomes of the facial

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

  • I am aware of potential risks, side effects, and the importance of aftercare

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

  • I voluntarily consent to proceed with the treatment

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ADDRESS

1a Piermont Place 
Dawlish 
Devon 
EX7 9PQ

CONTACT

Tel: 07738287979

Email: mel@themodernmuse.co.uk

OPENING HOURS

Mon, Fri & Sat: flexible hours

FORMS

© 2025 by The Modern Muse

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