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PDGF+ Consent

Please read carefully. Once you agree to the Ariessence Consent please initial and sign below.

Ariessence pure Platelet- Derived Growth Factor (PDGF) Consent:

This consent forms covers treatments using PDGF+ and skin post- procedural application for microneedling, RF, laser, and peels.The purpose of this consent form is to inform you about the Ariessence pure PDGF+ treatment and any potential side effects or risks associated with the product. It is important that you read the below information carefully and completely. If you are unsure or do not understand any part of this document kindly ask for clarification before signing.

Platelet Derived Growth Factor (PDGF) is nature’s wound healing protein. It is released from the body when the body sustains an injury and is critical in the healing process. It stimulates your body's stem cells to power natural skin rejuvenation and regeneration. It is a topical solution for healthier, more vibrant skin post- procedural application for microneedling, RF, laser, peels. PDGF results in reduction of post-procedural redness and downtime. Pure PDGF is currently used in 4 FDA approved medical treatments, including treating wounds. For Aesthetics purposes, Ariessence is used topically or can be used in an off label indication via injection. It can also be used for hair rejuvenation off label.

These products are not drug products. They are not intended to prevent, treat or cure diseases or medical conditions. They are not intended to be delivered intravenously.

It is important that you read this information carefully and completely. Please initial this section indicating that you have read the section and sign the consent for this procedure as proposed by your master esthetician and agreed upon by you.

RISKS AND POSSIBLE COMPLICATIONS

As with all elective cosmetic procedures, there are risks. I understand that there is a possibility of adverse reactions and side effects including:

Swelling, redness, small ecchymosis, broken blood vessels, bruising, local inflammation, hyper/hypopigmentation, infections, and other unanticipated reactions. These usually disappears within 24-48 hours or after appropriate medical management, but can last longer.
In rare cases localized or systemic allergic reactions to certain ingredients constituting the PDGF+ may
occur. These allergic reactions may require additional treatments.
Unsatisfactory results: The degree of skin rejuvenation is dependent on the age of the patient, skin type
and condition, degree of sun and environmental damage and levels of pigmentation.
Herpes Simplex breakouts.
Mild pain may be experienced by some patients during the application of the product on the skin. This will subside in a few hours. Speak to your Provider if there are any concerns.
There is a possibility of unknown risks, complications and limitations of this treatment that may has not yet been discovered.
The amount of hair regrowth varies from patient to patient.

As with all elective aesthetics laser treatment, some patients will experience partial results and some will experience no improvement at all.

I understand that full payment is due at the time of the service and there are NO refunds or guarantees for elective procedures or the usage of Ariessance.
I understand the pre/post care instructions provided to me and agree to follow the instructions given by my provider.
I understand that there are other options for treatment that are available and each of these other options have been fully explained to.
I have read and understand all information presented to me before signing this consent form. I have been given an opportunity to have all of my questions answered to my satisfaction. I understand the procedure and accept the risks. I agree to the terms of this agreement.
I agree to call my provider and follow up as necessary for any additional treatments or concerns.
I hereby release Skinlogic Med Spa and its providers harmless from liability and damages related to this elective procedure.
I waive the right to any legal claims in undergoing this procedure and understand this procedure give continued consent for ongoing procedures.

PATIENT FOLLOW-UP AND AFTERCARE

I understand that the Ariessence pure PDGF+ Treatment protocol should be followed as discussed by my provider in regard to my treatment plan.
My expectations are realistic, and I understand that the results are not guaranteed and that for maximum results more than one treatment is require along with maintenance sessions. I agree to follow my treatment plan, and patient home care plan.
I will be responsible by following the protocols as recommended by my provider as this can minimize possible negative reactions. I will avoid the following; makeup for 24 hours *unless otherwise discussed, extreme temperatures, saunas, direct sunlight, harsh skincare.

CONTRAINDICATIONS

I confirm that I am over the age of eighteen (18) years of age and I do not have any of the following conditions;
Active Herpes Blisters
Active Skin infections
Active cancer *unless approved by treating provider

Any information that is obtained from this procedure and that can be identified with you will remain confidential and will be disclosed only with your permission or as required by law. I waive the right to any legal claims in undergoing this procedure and understand this procedure gives continued consent for ongoing usage and procedures. By signing this consent form, I am acknowledging the benefits, potential risks and alternative treatment options have all been fully explained to me and that I am opting to proceed with the treatment now and in the future while under the care of “practice name”.

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April 24, 2025 1:19 am PDT

PDGF+ Consent Uploaded by scott smith - scottsm8@gmail.com IP 98.203.141.236