EnnerPeel Consent Form

Please only fill out this form if your stylist has directed you to do so.  Your stylist will require you to read the page in its entirety and fill out this form prior to your procedure.  Please fill out all form fields.

Foreword

ENERPEEL Medical Devices meet the requirements of Directive 93/42/EEC concerning Medical Devices.

Definitions

ENERPEEL Medical Devices consist of, according to the various therapeutic requirements, different acids, in some cases, of the same acids at different concentrations.

Purpose of treatment with the ENERPEEL medical devices

Chemical exfoliation (chemical peeling) is a medical procedure that exerts controlled cutaneous damage through the use of organic acids.

This procedure is carried out to improve specific skin conditions through the removal of dead skin cells of the horny layer, regeneration of new epidermis and dermal remodelling.

Procedure of the treatment with ENERPEEL medical devices and warnings

The chemoexfoliation procedure common to all ENERPEEL Medical Devices consists of three principal moments:

1. DELIPIDATION
2. APPLICATION OF THE CHEMOEXFOLIATINGSOLUTION 3. NEUTRALIZATION

* Important warnings

  1. During application of the EnerPeel Medical Devices a slight burning sensation may be noticed,

    that normally ceases on application of the neutralising solution, EnerPeel neutralizer.

  2. Avoid carrying out chemoexfoliation in the very sunny season. Solar radiation may trigger

    hyperpigmentation.

  3. The chemoexfoliation process causes a thinning of the surface layer of the skin. Therefore the natural barrier functions of the skin are altered.

  4. Smoking can influence the treatment outcome, increasing the risk of developing an irritative reaction.

  5. Phototypes III, IV, V and VI on the Fitzpatrick scale might present a greater risk of developing hyperpigmentation in the treated areas.

    Duration of a single treatment

    The time of application of the ENERPEEL Medical Device solution on an individual cutaneous unit before the neutralisation process is evaluated by the doctor according to the phototype (Fitzpatrick classification), the degree of photoageing (Glogau classification) and the individual genetic racial characteristics.

    When the doctor believes it is necessary, the ENERPEEL Medical Devices may be applied in multilayers

    Cycle of treatments envisaged for achieving the desired result

    To obtain the required result from treatment with ENERPEEL Medical Devices, a cycle of treatments may be needed, spread out over a period of time.
    The number of individual treatments, the time interval between one treatment and the next and the total duration of the treatment cycle are envisaged and evaluated by the Doctor/Nurse who will inform the Patient.

    Possible undersirable effects

    Manifestations that may appear in the post-treatment stage, depending on the type of exfoliation and the patient’s individual characteristics include:

    • oedema
    • erythema
    • desquamation
    • changes in pigmentation

    Post-treatment procedure

    The following points must be scrupulously adhered to in the post-exfoliation phase

    1. Avoid exposure to the sun and to UVA and UVB lamps and always use adequate protection against solar and artificial radiation (protection factor 50+ according to the COLIPA method).

    2. Use very delicate cleansers on the treated area, avoiding any form of rubbing during drying. 3. Avoid using pharmaceuticals and/or cosmetics without first consulting the doctor/nurse.


     

    The patient declares that he/she has read the information leaflet and has been informed of the purpose, the procedures and the characteristics of the exfoliation treatment with ENERPEEL Medical Devices, of the beneficial effects, of all the possible side effects and of the post-treatment procedures to be followed.

    The Patient was given the opportunity to ask questions and these questions were answered exhaustively.

    The Patient declares that he/she has thoroughly considered the information provided in the information leaflet and is knowledgeable of the chemical exfoliation procedure that will be carried out.