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Microsoft word - microderrm protocols.doc
What is Microderm Abrasion?
Microderm abrasion has been used in Europe for many years. It was first introduced in
the United States during the mid 1990’s. The DiamondTome microderm abrasion system is an
integrated option for advanced skin care and complements most treatment programs.
The treatment removes dead surface skin cells and initiates cellular turnover at the dermis and
epidermis levels, in a safe controlled manner. This approach respects the integrity of the skin and
promotes even healing. Maintaining even cellular growth on the surface aids in the youthfulness
Microderm abrasion has been used to treat the following skin conditions:
What can I expect?
Prior to your first microderm abrasion, you will have a consultation which will include a
thorough skin analysis. If microderm abrasion is not appropriate, you are informed during this
session and an alternative, high-performance series may be recommended instead. If microderm
abrasion is indicated, maximum results are obtained by participating in a series of treatments.
To further enhance your outcome, I will require the daily use of topical skin care products and/or
medications specifically directed toward obtaining correction. Your current daily regimen and
skin care products are reviewed. Every attempt will be made to incorporate your current skincare
products into a more comprehensive program, which complements your in-clinic series.
However, depending on the condition or your skin, medical skincare products may be necessary
to help you achieve the desired results.
Guidelines and Contraindications
*Herpes simplex (Zoverax ™, Valtrex) should be taken as a precaution a day or two before
and a couple of days after treatment). Lysine may be administered one week prior and post
*Active, uncontrollable diabetes (inherent risk that healing can be impaired)
*Keloid scars (medial treatment only)
*Microderm abrasion is not recommended for clients with lesions, eczema or psoriasis,
inflammatory acne or infected pustules
*Telangectasia (condition should be corrected before treatment, however, other areas of the face
can be treated)
*Accutane (should not have been used for at least six months before treatment)
I acknowledge that I do not have any of these pre existing conditions. Initial
____ During your session
DiamondTome microderm abrasion is a relatively comfortable procedure. It has been described
as feeling like a cat licking your skin. Corrective products and sun block will be applied
following your treatment. Additionally every precaution is taken to ensure your skin is well
hydrated and calm, prior to leaving. In a few cases you may experience excessive dryness or
even some peeling between sessions. These symptoms may or may not be normal. I will phone
you the next day following your treatment however, if you have questions or concerns you
should contact me. More sensitive skin may experience some redness after the first couple of
sessions. This normally goes away after 2 to 3 hours. Is there a guarantee?
The majority of my patients receive above average results with their series. Maximum results,
however, are highly dependent on your age, accumulative sun exposure, health, menopause,
lifestyle, genetic traits, general skin condition, and your willingness to follow recommended
Scars respond according to their depth and age. They may require deeper peels.
Pore size can be refined and diminished in appearance; however physiological size is genetically
Be aware that over time many changes may occur deeper within the skin.
To continue the maintenance of your skin after you complete your treatment(s) I may inform you
of long-term age-management programs. My experience shows that incorporating several
modalities over time and during season changes seems to be the best way to consistently
maintain the suppleness and radiance of the skin. Informed Consent
You have the right to be informed about the potential risk of the procedure to be
performed. These risks include, but are not limited to: scarring, burning or a sunburn feeling after
the procedure, minor swelling, and excessive peeling, flares of herpes simplex, erythema, and
excess skin sensitivity, bruising and scabbing. I have been given the opportunity to ask questions about this procedure regarding the benefits and the risks involved. I certify that I have read and fully understand the contents of the form. I understand that no guarantee has been made to me as to the results of the procedure and that adhering to the aftercare instructions provided to me are essential for good results. I believe I have sufficient information to give this informed consent. I release the aesthetician, medical director and Love Skincare Center, LLC from any liability that may result from this treatment. Signed_________________________________________ Date______________ Aesthetician_____________________________________ Date______________
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