Client Informed Microneedling Consent

The concept of microneedling is based on the skin’s natural ability to repair itself when it suffers physical damage such as: cuts, burns, abrasions, or other injuries. Immediately after an injury to the skin, our body begins the healing process, triggering new collagen synthesis. The Dermapen® is a microneedling device that intentionally creates very superficial “micro-injuries” to the outermost layer of the skin to induce the healing process that includes new collagen production. Microneedling has been shown to reduce the visibility of acne scars, fine lines, and wrinkles; diminish hyperpigmentation; and improve skin tone and texture, resulting in smoother, firmer, and younger-looking skin.

Microneedling is performed using Dermapen®. The Dermapen® microneedling procedure is performed in a safe and precise manner with a single-use, sterile needle head. The treatment session usually takes about 30-60 minutes, depending on the area(s) being treated. Throughout the procedure, activating agents will be applied to stimulate the rejuvenation process. Then a hydrating facial mask will be applied for hydration. After the procedure, your skin will be red with mild swelling and/or bruising, and it might feel tight and sensitive to the touch. Although these symptoms may take two to three days to completely resolve, they will diminish significantly within a few hours after the treatment.

Although the majority of patients do not experience any complications with microneedling, it is important that you understand that risks do exist. The microneedling procedure is minimally invasive and uses a set of microneedles to inflict multiple, tiny, punctures or lacerations to the outermost layer of the skin. Because microneedling penetrates the skin, it inherently carries health risks, including but not limited to those listed below. You should discuss any and all health concerns with your esthetician or attending healthcare provider PRIOR to signing the Client Informed Microneedling Consent Form that will be provided to you upon the arrival of your microneedling or after your consultation appointment.

INFECTION – An infection is very unusual. However, viral, bacterial, and fungal infections can occur any time the integrity of the skin is compromised. Should an infection occur, you must contact or return to our location immediately, as an additional treatment will likely be necessary.

PIGMENT OR COLOR CHANGE (HYPERPIGMENTATION) – Because the dermal penetration associated with microneedling is so superficial that it does not extend into the layer of the skin containing melanocytes, hyperpigmentation is very rare. However, failure to follow post-procedure instructions can put you at risk for hyperpigmentation. You MUST avoid sun exposure for one to two weeks after a microneedling treatment. You should also wear a daily SPF facial moisturizer, which your esthetician can recommend. Lastly, avoid picking and/or peeling the skin during the healing period.

SCARRING – Although normal healing after the procedure is expected, abnormal scars may occur in both the skin and deeper tissues. In rare cases, thickened or keloid scars may result, especially if you are prone to keloid scarring. Scars may be unattractive and of a different color than the surrounding skin. Additional treatments may be needed to treat the scarring.

PAIN – There may be a very slight burning, scratchy, and irritated sensation to the skin. This is usually temporary and is gone within a few hours after the treatment. A sudden reappearance of redness or pain is a sign of an infection, and you should immediately notify our location.

PERSISTENT REDNESS, ITCHING, AND/OR SWELLING – Itching, redness, and swelling are normal parts of the healing process. These symptoms rarely persist longer than 24 hours. However, treatments received less than four weeks apart may induce prolonged symptoms.

ALLERGIC REACTION – Microneedling is performed with a device head that contains 12 sterile, hypodermic needles, which makes an allergic reaction nearly impossible. However, in conjunction with the microneedling procedure, a variety of products may be used on the face; those products could cause an allergic reaction. Additionally, since microneedling increases the penetration of topical substances, it could cause you to become hypersensitive to products used on the face. If an allergic reaction were to occur, you must immediately contact our location, as it may require further treatment.

LACK OF PERMANENT RESULT – Microneedling will not completely or permanently improve skin texture, tone, elasticity, hyperpigmentation, or scars, or minimize fine lines and wrinkles. It is important that your expectations are realistic and you understand that the procedure has its limitations. Additional procedures may be necessary to achieve your desired effects.

UNSATISFACTORY RESULT – Although rare from microneedling, there is a possibility of a poor result from any cosmetic procedure. Microneedling may induce undesirable results, including but not limited to: skin-sloughing, scarring, permanent pigment change, and/or other undesirable skin changes. There is always a possibility that you may be disappointed with the final results of microneedling.

Although it is impossible to list every potential risk and complication, the following are recognized as known contraindications to microneedling. Furthermore, it is your responsibility to fully and accurately disclose all medical history prior to your initial treatment, as well as to provide any necessary updates during all future treatment sessions. If you have any of the conditions listed below, you should bring it to the attention of your esthetician or healthcare provider PRIOR to signing the Client Informed Microneedling Consent Form that will be provided to you upon the arrival of your microneedling or after your consultation appointment.


  • Active acne
  • Hemophilia/bleeding disorders
  • Scleroderma
  • Active infection of any type (bacterial, viral, or fungal)
  • Hormone replacement therapy
  • Skin cancer
  • Blood thinner medications
  • Keloid/hypertrophic scarring
  • Sunburn
  • Cardiac disease/abnormalities
  • Raised lesions (moles, warts, etc.)
  • Tattoos
  • Chemotherapy or radiation
  • Recent chemical peel
  • Telangiectasia/erythema
  • Collagen vascular disease
  • Recent use of some topical Rx.
  • Uncontrolled diabetes
  • Eczema, psoriasis, or dermatitis
  • Rosacea
  • Vascular lesions (hemangiomas)

Your signature acknowledges that you have read and understand the content of the Client Informed Microneedling Consent Form that will be provided to you upon the arrival of your microneedling or after your consultation appointment. You have been given ample opportunity to ask questions, all of which have been answered in a satisfactory manner. You understand that results can vary and that no guarantee, neither expressed nor implied, has been or will be given to you regarding your results. You are aware of the risks and benefits associated with the Dermapen® microneedling procedure, as well as available alternative treatments. You understand that microneedling is an elective procedure performed solely for cosmetic purposes and is not critical to your health. Of your own free will, you are requesting and providing your informed consent to undergo the Dermapen® microneedling treatment(s) at KUR Skin Lab®. You assume all risks as your own and agree to hold harmless: KUR Skin Lab®, its providers, estheticians, and any other staff members, affiliates, and independent contractors. You hereby release them from any liability, both seen and unforeseen, now and forever.












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