This is an informed consent form that has been prepared to help inform you of the potential benefits and risks of PRP (platelet rich plasma) treatment. It is important that you read this information carefully and discuss fully with your practitioner before proceeding with treatment.

It is also important that you take as much time as you need to consider the treatment carefully, weighing up all your options before reaching an informed decision. It is essential that you are aware of your right to have a second opinion and you are encouraged to ask any questions that come to mind throughout the entirety of the process.

Platelet Rich Plasma (PRP) is a cosmetic skin rejuvenation procedure that involves microneedle injection of some of the client’s own blood components back into the skin. It is commonly known as a Vampire facial and involves the following steps. A small blood sample is drawn with a needle system from the patients arm, the same as having a blood test (phlebotomy), the blood sample is then placed into a syringe. The blood is spun in a special centrifuge to separate its components (Red Blood Cells, Platelet Rich Plasma (PRP), Platelet Poor Plasma and White Blood Cells). The PRP component is then separated and injected into the clients skin (e.g. a facial) using a microneedling technique. The PRP is rich in growth factors which promote skin rejuvenation. PRP can be used to improve the appearance of tired and aged skin, fine lines and wrinkles, enlarged pores, acne scars, hyperpigmentation and stretch marks.

PRP is autologous (using your own blood) therefore this virtually eliminates the potential for allergic reactions. PRP has been shown to have tissue regenerating effects. Other benefits include minimal down time, good safety profile and short recovery time.

The entire procedure is normally completed within 30-60 minutes, your practitioner will offer you a topical anaesthetic cream to help minimise any discomfort during the treatment.

More than one treatment will likely be required to achieve or maintain results, but this depends on the treatment aim and client response to treatment. Results can be seen at 2-3 weeks after treatment, but peak results are usually seen at 4-6 weeks. The duration of results varies between clients and there is no guarantee that you will achieve desired results. PRP does not prevent recurrence of the condition being treated. Treatment responses vary between clients and there is no guarantee that you will achieve your desired results.

I understand that several appointments may be necessary to produce optimal results and I will be notified, in advance of each session of treatment, about the location where the next treatment session is going to take place and the identity of who is going to be involved in my care at each stage. I also understand that I will be kept informed of progress and that I can change my mind at any point.

Rare risks of phlebotomy include more extensive bruising (haematoma), skin infection (cellulitis), vein inflammation (thrombophlebitis), accidental arterial puncture causing pain and bruising, nerve injury causing temporary pins and needles or numbness to the affected area in the hand or arm.

I have been advised of the relevant information associated with this treatment and I confirm that I fully understand this advice. This includes advice about:

- the aims/motivations for having the procedure and the desired outcome
- the risks inherent in the procedure
- the risks inherent in refusing the procedure
- the risks specific to me
- the expected benefits of the treatment
- the potential disadvantages of the treatment
- alternative procedures and their pros and cons - including the option of no treatment at all
- any uncertainties about and the likelihood of success of the procedure
- any follow-up treatment that may be required

I understand that this is an "elective” procedure and that payment is my responsibility and is expected at the time of treatment.

I understand that I have the right to discontinue treatment at any time.

I authorize the taking of clinical photographs and videos and their use for scientific and marketing purposes both in publications and presentations. I understand that photographs and video may be taken of me for educational and marketing purposes. I waive my rights to any royalties, fees and to inspect the finished production as well as advertising materials in conjunction with these photographs.

I understand this is an elective procedure and I hereby voluntarily consent to treatment with platelet – rich plasma therapy.  The procedure has been fully explained to me. I also understand that any treatment performed is between me and the doctor/healthcare provider who is treating me and I will direct all post-treatment questions or concerns to the treating clinician. I have read the above and understand it. My questions have been answered satisfactorily. I accept the risks and complications of the procedure and I understand that no guarantees are implied as to the outcome of the procedure. I also certify that if I have any changes in my medical history I will notify the doctor/healthcare professional who treated me immediately. I also state that I read and write in English.

I am the treating Aesthetic Nurse.  I discussed the above risks, benefits, and alternatives with the patient. The patient had an opportunity to have all questions answered and was offered a copy of this informed consent.  The patient has been told to contact my office should they have any questions or concerns after this treatment procedure.

I certify that I have read the above consent and that I fully understand it. I have been given ample opportunity for discussion and all my questions have been answered to my satisfaction. No new information has become available that affects my decision to have the treatment or my decision to consent. I hereby consent to this procedure. This constitutes the full disclosure and supersedes any previous verbal or written disclosures.