Eyelash Lift and Brow Lamination and Tint Form

Please enable JavaScript in your browser to complete this form.

Patient Data

Patient Name
Emergency Contact Person
Do you have any of the following conditions?
Are you under the age of 18?

POSSIBLE RISKS, HAZARDS, OR COMPLICATIONS

  • Pain: There can be pain even after the topical anesthetic has been used. Anesthetics work better on some people than others.

  • Infection: Infection is very unusual, but can occur. The areas treated must be kept clean and only freshly cleaned hands should touch the areas. See “After Care” sheet for instructions on care.

  • Uneven Pigmentation: This can result from poor healing, infection, bleeding or many other causes. The follow-up appointment can help correct any uneven appearance.

  • Allergic Reaction: If there is any concern for an allergic reaction to pigments, a patch test can be done. However, if an allergic reaction were to occur, it may not show up for a long period of time, making the patch test inconclusive.

  • Asymmetry: Every effort will be made to avoid asymmetry, however, anatomical facial features may not be symmetrical. Adjustments may be needed during the follow-up session to correct any unevenness.

  • Excessive Swelling: Clients with sensitive skin are more prone to swelling. This should dissipate within 24 hours.

  • Acne prone: If acne is present on the forehead area, the brows may not heal correctly. If acne is a consistent issue, please consider that having permanent micro pigmentation done is not in your best interest.

  • Anesthesia: Topical anesthetics are used to numb the area to be tattooed. Lidocaine, Prilocaine, Benzocaine, Tetracaine, and Epinephrine in a cream or gel form are typically used. If you are allergic to any of these, please inform us now.

  • MRI: Because pigments used in permanent cosmetic procedures contain inert oxides, a low-level magnet may be required if you need to be scanned by an MRI machine. You must inform your technician of any tattoos or permanent cosmetics.

WHAT’S NORMAL?

  • Swelling, itching, scabbing, light bruising and dry tightness. Ice packs are a nice relief for swelling and bruising. Aftercare balm isnice for scabbing and tightness.

  • Too dark and slightly uneven appearance. After 3-7 days the darkness will fade and once swelling dissipates unevenness usually disappears. The follow-up touch up is highly recommended as any concerns can be addressed.

  • Color change or color loss. As the procedure area heals the color will lighten and sometimes seem to disappear. This is normal. The procedure area has to be completely healed before we can address any concerns. This takes at least four weeks.

  • Needing a touch up months or years later. A followup touch up is recommended 6-9 weeks after the initial appointment. Thereafter maintenance may be needed every 12-18 months to keep the shape symmetrical and the color refreshed.

Failure to follow after care instructions may result in infections,pigment loss or discoloration.

STATEMENT OF CONSENT AND RECITALS:

PLEASE READ AND CHECK ALL LINES
Clear Signature