Consent for the Vampire Facial® Microneedling Facial Procedure

AERIS MEDICAL AESTHETICSConsent to Treat: PRP, Exosome Therapy & Vampire Facial®For Microneedling, Laser, or Standalone Biologic Therapy
🧬 TREATMENT OVERVIEW
You are consenting to receive autologous Platelet-Rich Plasma (PRP) and/or Exosome therapy for skin rejuvenation, collagen induction, and aesthetic enhancement. These treatments may be performed:

Alone (standalone PRP or exosomes)
In conjunction with microneedling
In conjunction with laser resurfacing or BBL
As part of a Vampire Facial® protocol
These procedures aim to stimulate tissue regeneration, improve skin tone and texture, reduce fine lines, and promote healing.

🧪 TREATMENT OPTIONS DEFINED
PRP (Platelet-Rich Plasma): Your blood is drawn, spun in a centrifuge, and the concentrated plasma portion (rich in growth factors) is extracted and reintroduced into the skin via microneedling or injection.
Exosomes: Derived from human stem cells, exosomes are messenger molecules used to signal skin repair and regeneration.
Vampire Facial®: A proprietary combination of microneedling + PRP, popularized for anti-aging and skin resurfacing.

⚠️ POTENTIAL RISKS & SIDE EFFECTS
As with any aesthetic or medical procedure, side effects may include:

Redness, swelling, bruising at injection or treatment sites
Mild pain, pressure, or heat sensation
Risk of infection, particularly with microneedling or laser
Temporary skin sensitivity or dryness
Allergic reaction to topical products or antiseptics
Scarring, pigment changes, or delayed healing (rare)
Because PRP is autologous (from your own blood), allergic reactions are rare but possible with added products or technique.

⏳ PRE-TREATMENT INSTRUCTIONS
Discontinue NSAIDs (aspirin, ibuprofen), alcohol, and blood thinners 3–5 days prior (unless medically required)
Arrive well-hydrated and having eaten a light meal
Avoid retinoids, harsh exfoliants, or tanning for 5 days prior
Inform staff of recent illness, cold sores, or medications
Do not schedule microneedling/laser within 2 weeks of vaccinations or active illness
If prone to cold sores, consider taking prophylactic antivirals before facial procedures

🧊 POST-TREATMENT CARE
Redness and tightness for 1–3 days is expected
Avoid sun exposure and wear SPF 30+ daily
No makeup or skincare for 24 hours unless directed
Use only gentle, hydrating cleansers and serums for 5 days
No strenuous workouts, heat exposure, or alcohol for 48 hours
Avoid additional treatments (laser, peels, Botox, etc.) for 2 weeks unless approved
Do not pick, exfoliate, or irritate the skin

📌 LIMITATIONS & UNDERSTANDINGS
I understand that PRP and exosome therapy are not FDA-approved for aesthetic use, and are considered off-label.
I understand results are variable, not guaranteed, and depend on my age, skin condition, metabolism, and overall health.
A series of treatments may be required for optimal results.
I am aware that biologic therapies are not a substitute for surgery or more aggressive dermatological procedures.
I will disclose all medications, supplements, and relevant medical history to my provider.

🛡️ WAIVER & LIABILITY RELEASE
I understand the risks, benefits, and limitations of this treatment. I acknowledge that I have had all my questions answered and I am voluntarily consenting to receive:

PRP (Platelet-Rich Plasma)
Exosome Therapy
Vampire Facial®
In combination with:
Microneedling
Laser/BBL

Topical infusion only

I release Aeris Medical Aesthetics, its owners, medical staff, and providers from any liability for complications, dissatisfaction, or unforeseen outcomes, to the extent permitted by law.
I Understand & I Agree to the above*

I Agree
Patient Name*

First NameLast Name
Date*

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Patient Signature*

Sign with your finger or Mouse
(SERVICE PROVIDER VERIFICATION) I have explained the procedure(s), alternative(s) and risks to the person or persons whose signature is affixed above. The patient has verbally communicated to me that they understand the contents of this form.*

I Have
Service Provider Signature*
LEGAL WAIVER & LIABILITY DISCLAIMERI understand that although good results are expected, there is no guarantee—expressed or implied—regarding the success or longevity of any treatment I receive at Aeris Medical Aesthetics. I understand that cosmetic treatments are elective in nature, are not intended to cure or prevent disease, and results vary per individual.I accept that all sales are final, and Aeris offers no refunds on treatments or retail products. I acknowledge that results may require multiple sessions or maintenance, and outcomes may be influenced by personal health, lifestyle, metabolism, or previous procedures.I understand and voluntarily accept the risks of treatment, which may include—but are not limited to—pain, swelling, redness, bruising, scarring, allergic reactions, or dissatisfaction. I agree to follow all pre- and post-treatment care instructions provided to me and to disclose all relevant medical history.I hereby release Aeris Medical Aesthetics, its providers, staff, owners, and affiliates from any and all claims of injury, dissatisfaction, or damages that may arise from treatment, except where prohibited by law. This agreement remains in effect for all current and future treatments unless revoked in writing by either party.I understand that Aeris is a professional, medical environment, and any disruptive or inappropriate behavior may result in termination of care and full payment will still be required.I have read this agreement in full, understand its contents, and consent to treatment under these terms.

I understand and agree.
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AERIS MEDICAL AESTHETICSConsent to Treat: PRP, Exosome Therapy & Vampire Facial®For Microneedling, Laser, or Standalone Biologic Therapy