Personal Information
Expectation of treatment outcome
Contact Person
Health Questionnaire
Are you taking any medications on a daily basis? If yes list:
Medical History
If yes, please list allergies not listed above:
AFTERCARE ADVICE FOR AESTHETIC PRCEDURES
PDO Thread Aftercare
Gently wash the treated areas on the same day with cool boiled water, but do not rub or massage the face for 2 weeks.
The facial muscles need rest for 2 weeks following the treatment. Do not open mouth too wide for 3-4 and avoid dental treatments if possible.
Avoid vigorous exercises for 1-week post procedure.
A stinging or “pulling” pain or discomfort is normal. Take paracetamol 500mg 1-2 tablets 6-hourly as required. This will subside over a 2-4-week period. Avoid taking any anti-inflammatory medication such as Nurofen for 4-6 days as this could lead to more bruising.
Avoid alcohol for 5-7 days.
Do not take anti-coagulant medication (aspirin, unless prescribed for medical indications) for 7 days.
Avoid Omega 3 and 9 for several days before and after treatment to reduce possibility of bruising.
Refrain from extreme temperatures, such as those found in saunas or steams rooms, for 2 weeks.
Apply SPF 30+ for 2 weeks after treatment to avoid post-inflammatory pigmentation in the areas of thread insertions.
Allow a 10-week gap between PDO threads and Radio Frequency (RF) or any heat producing device (laser, IPL, etc) procedures in the same areas.
Your practitioner may prescribe a course of antibiotics in case of treatment with Cog threads.
Scratchy sensation is possible, this will subside over a 2-3-week period.
Possible complications may include infection, swelling, bruising, foreign body reaction in epidermis (granuloma), and protrusion.
Extremely rare, temporary facial drop may occur due to local anaesthetic, swelling, haematoma or pressure of the cannula or thread on the nerve. Your practitioner MUST be informed immediately if you experience this symptom. If your practitioner can’t be reached contact A&E at once.
Schedule a follow up examination with your practitioner 7 days later.
Combination with other procedures from 7 days onwards: PRP, Derma Roller, fillers.
I grant permission to MB Derma Clinic to use my photos and all forms of media for marketing, promotional literature, educational and social media purposes. I will not require any payment for that. *
Preparing for your appointment
DAY OF PROCEDURE and at least 12 hours prior to NO sweating (no working out); NO caffeine (coffee, energy drinks, etc.) NO alcohol. DO NOT have sunburned skin on the face.
Please shower and tidy your hair as you may not be able to shower 3 days after treatment due to the nature of the procedure
ONE WEEK BEFORE PROCEDURE (5 days): discontinue all blood thinners such as aspirin, vitamin E, ibuprofen, naproxen, niacin, fish oil, herbal supplements (physician clearance is required if blood thinners are medically necessary). NO waxing or threading. Take antiviral medication if you are prone to cold sores/ fever blisters/ HSV to prevent post-treatment outbreak.
TWO WEEKS BEFORE PROCEDURE (14 days): NO eyebrow tinting, tanning bed, sunbathing. NO enzymatic, lactic or chemical peels. NO glycolic or salicylic acids in skincare. NO exfoliating treatments (microblading, dermaplaning, etc.).
THIRTY DAYS BEFORE PROCEDURE (30 days): NO Botox, Dermal Fillers, AHA products, Retinols, and laser skin resurfacing treatments. Discontinue brow and lash growth serum.
ONE YEAR BEFORE PROCEDURE: discontinue Accutane
It's recommended your 2nd session is within 30-60 days.
Please note that you will be more sensitive during your menstrual cycle.
I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. I am aware that it is my responsibility to inform the MB Derma Clinic skin care professional of my current medical or health conditions and to update this history. The treatments I receive here are voluntary and I release MB Derma Clinic and/or the skin care professional from liability and assume full responsibility. Informed written consent must be provided by parent or legal guardian for any client under the age of 18.*
I have read and fully understand the contents of each paragraph and page of this contract. I acknowledge this is a legal & binding contract and that I have received no warranties or guarantees with respect to the benefits to be realized from or consequences of, the aforementioned procedure(s). I further acknowledge that at the time of signing this consent to this procedure(s), I was of sound mind and capable of making independent decisions for myself.
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