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B3/Enzyme Exfoliating Creme
  • B3/Enzyme Exfoliating Creme
B3/Enzyme Exfoliating Creme
$42.00

Latisse Patient Consent Form

Thank you! Your medical questionnairehas been submitted successfully.
Please fill out all required fields.

1. Ocular History (Eyes)

Are you currently using any prescription eye drops for Glaucoma or ocular hypertension? (e.g., Lumigan, Xalatan, Timolol)
Have you ever been diagnosed with high eye pressure (Ocular Hypertension) or Glaucoma?
Have you had any eye surgery in the last 6 months (Cataract, LASIK, etc.)?
Do you have a history of eye inflammation (Uveitis or Iritis)?
Do you have any active eye infections or chronic "dry eye" symptoms?
Do you wear contact lenses? (Note: Lenses must be removed before application)

2. Medical History

Do you have any known allergies to Bimatoprost or other prostaglandins?
Are you currently pregnant, planning to become pregnant, or breastfeeding?
Do you have a history of skin sensitivity or eczema on your eyelids?

3. Informed Consent & Risks

Please initial next to each point to acknowledge you understand the potential side effects:

Permanent Pigmentation: I understand that Latisse may cause increased brown pigmentation of the colored part of the eye (the iris), which is likely permanent.
Skin Darkening: I understand that darkening of the eyelid skin may occur but is typically reversible if the product is discontinued.
Hair Growth: I understand that hair growth can occur in any skin area that Latisse frequently touches; I will blot any excess solution.
Common Irritation: I understand that eye redness, itchiness, and dryness are common side effects.

Patient Attestation

I certify that the information provided above is true and accurate to the best of my knowledge. I have been informed of the potential side effects and the proper application technique.

Details

This gentle, creamy, smooth, non-granular exfoliant combines a potent, yet soothing form of Vitamin B3/Niacinamide with the natural double exfoliating fruit enzyme action of Papaya and Pineapple to gently smooth, refine, brighten and clarify the complexion.

Actions

  • Gently resurfaces and refines skin for an ultra-smooth texture
  • Brightens and evens skin color
  • Softens surface comedones and eases their removal
  • Minimizes surface lines and enlarged pores
  • Reveals fresh, young, glowing skin

Skin Conditions

Environmentally Damaged | Pigmented | Uneven Tone & Texture | Sensitive | Rosacea-Prone | Maturing | Dry/Dehydrated | Combination | Oily | Acne-Prone | Energy Depleted | Sluggish & Tired Looking Skin | Post-Procedure

 

 

Action Ingredients

Papaya Enzyme | dissolves dulling dry skin cells, softens impactions in pores and gently lifts unwanted pigment from the skin’s surface
Pineapple Enzyme | gently dissolves dead skin cells; softens and evens skin tone
Niacinamide | a multitasking form of Vitamin B3 that works quickly to soothe, energize and brighten complexion
Kaolin Clay | highly absorbent, deeply cleansing mineral clay
Safflower & Sunflower Oils | oils rich in Omega-6 that keep your skin soft, hydrated and calm by fighting off free radicals that destroy skin’s natural moisture barrier
Safflower Oleosomes | lipids from the safflower seeds revive and retain skin’s natural moisturizing barrier during exfoliation

Ingredient List

water (base), carthamus tinctorius (safflower) seed oil (lipid-rich plant oil/antioxidant), glycerin (hydrating), bentonite (absorbent clay), helianthus annuus (sunflower) seed oil (lipid-rich plant oil/antioxidant), behenyl alcohol (mild emulsifier), kaolin (absorbent clay), glyceryl stearate (emollient), PEG-100 stearate (mild emulsifier), propanediol (humectant), niacinamide (multitasking B3 Vitamin), bromelain (proteolytic enzyme), glycine soja (soybean) seed extract (moisturizing), papain (proteolytic enzyme), tocopherol (stabilized Vitamin E), carthamus tinctorius (safflower) oleosomes (moisturizing, antioxidant), ethylhexylglycerin (skin conditioner), cetearyl alcohol (emulsifier), polysorbate 80 (emulsifier), xanthan gum (thickening agent), phytic acid (chelator), tetrasodium glutamate diacetate (antimicrobial preservative), titanium dioxide (absorbent mineral), phenoxyethanol (antimicrobial preservative), citrus aurantium bergamia (bergamot) fruit oil (fragrant essential oil), citrus aurantium dulcis (orange) peel oil (fragrant essential oil), limonene (allergen), linalool (allergen).
Materials + Care

We prioritize quality in selecting the materials for our items, choosing premium fabrics and finishings that ensure durability, comfort, and timeless appeal.
Shipping + Returns

We strive to process and ship all orders in a timely manner, working diligently to ensure that your items are on their way to you as soon as possible.

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