ProCell Microchanneling Acknowledgement Form

Procedure

I have had the opportunity to ask questions and understand this treatment's nature, goals, limitations, and possible complications. I have had the chance to discuss alternative forms of treatment and understand that results may vary.

 I clearly understand and accept the following:

MicroChanneling has a low risk of complications. Since this new technology, side effects may be seen as additional patients are treated.

I understand the following side effects or complications may occur:

While MicroChanneling treatments are safe and effective for most women and men, some people will not be good candidates for these treatments. Here is a general contraindication list that should be considered by anyone who is thinking of undergoing MicroChanneling:

• Pregnancy – if you are pregnant or nursing, you are advised not to receive MicroChanneling treatments. To date, there have been no studies conducted to see what effects these treatments may have on the unborn child, but as a general rule, pregnant women should stay away from any cosmetic/elective procedures.
• Diabetes - unstable diabetes patients should not be treated due to problems with healing.
• Accutane or any related acne medication - Accutane or any related drug should be discontinued for at least six months before undergoing MicroChanneling.

• Active Herpes Simplex in the treatment area - treatment is possible once the outbreak is healed; however, it may be advisable to take prescription-strength antiviral medication to keep this condition in remission during the treatment series.
• Dry skin - if your skin is overly dry, you must start moisturizing and ensure the condition is under control before undergoing any treatment.
• Any active inflammatory skin condition, e.g., eczema, psoriasis, infection, rash, or any dermatitis at the treatment site (because it may aggravate the condition).