CELLSTORY Liquid Microneedling

Client Informed Consent Form

You have a right to be informed about your condition and its treatment, so that you may decide whether or not to undergo the procedure after knowing the risks and hazards involved. This disclosure is not meant to scare or alarm you; it is simply an effort to make you better informed so you may give, or withhold, your consent for treatment.

DESCRIPTION OF CELLSTORY

CELLSTORY is a patented eight-step skincare program that utilizes innovative Microspear® which can be described as “liquid microneedles”, creating channels in the skin for better ingredient penetration. This treatment helps to minimize the appearance of fine lines and wrinkles, improve skin texture and deliver bouncy, healthy, and glowing skin. It can also be used on active acne, for visibly clearer-looking skin. The system features a 20 amino acid complex to provide moisture and nourishment, and is made without harmful preservatives, artificial colors, or artificial fragrance. CELLSTORY takes approximately 1 hour with no numbing, needles or downtime.

  1. I voluntarily request that Skin by Sylvie Inc. perform the CELLSTORY Liquid Microneedling procedure. I acknowledge having been informed that this cosmetic eight-step skincare procedure that utilizes innovative Microspear® which can be described as “liquid microneedles”, creates channels in the skin for better ingredient penetration.

  2. I acknowledge the side effects of CELLSTORY, the skin will be red and flushed in appearance and dryness may occur, similar to a moderate sunburn. While rare, mild swelling may occur. I may also experience skin tingling for up to 72 hours after treatment. Redness will diminish significantly within a few hours. Within the next 72 hours, the skin will have returned to normal. After three days, there is rarely any evidence that the CELLSTORY has taken place.

  3. I am not aware that I am pregnant and I am not trying to get pregnant, I am not lactating (nursing). I do not have any current open wounds on the skin. I do not have any allergies to nuts due to a small percentage of Macadamia Oil that is present in the CELLSTORY PLUS Recovery Cream.

  4. I have not received treatment for Botox or fillers within the past 14 days. I have not received any lasers, chemical peels, microneedling or mesotherapy in the past 7 days.

  5. I acknowledge the post care instructions:

    • Lightly cleanse the face with a gentle cleanser that evening or the next morning

    • Apply moisturizer to the skin frequently

    • Use sunscreen daily

    • Drink an ample amount of water

    • Avoid any retinols or exfoliants (physical or chemical) for 72 hours

    • Avoid any face oils or oil-based products for 72 hours

    • Avoid heavy sweating (i.e., saunas, heavy exercise) for 72 hours

    • Avoid sun exposure for 72 hours

    • Avoid chemical peelings or lasers for 1 week

  6. No guarantee, warranty, or assurance has been made to me as to the results that may be obtained. I am aware that follow-up treatments may be necessary for desired results. Most patients require a number of treatments over time with gradual results occurring over this time. Clinical results will vary per patient. I agree to adhere to all safety precautions and regulations during the treatment. No refunds will be given for treatments received.

  7. I have been explained the Pre and Post-Treatment Instructions. I agree to follow these instructions carefully.

I understand and agree that all services rendered to me are charged to me directly and that I am personally responsible for payment. The nature and purpose of the treatment have been explained to me. I have read and understand this agreement. All of my questions have been answered to my satisfaction and I consent to the terms of this agreement. Alternative methods of treatment and their risks and benefits have been explained to me and I understand that I have the right to refuse treatment.