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Redensifier Firming Nourishing Repair
  • Redensifier Firming Nourishing Repair
Redensifier Firming Nourishing Repair
$85.00

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 multi-faceted treatment moisturizer works to overturn the glycation process and protect the skin’s barrier from environmental aggressors, balancing tone and reducing redness, leading to revitalization previously unseen.

Actions

  • Skin’s firmness, volume and density feel dramatically younger
  • Contours are visibly more defined
  • Fine lines and deeper creases are minimized
  • Resilience returns in weeks
  • Healthy-looking, softer, more supple skin is instantly maximized

Skin Conditions

Glycated | Mature/Maturing | Deep Lines & Wrinkles | Age & Sun Spots | Whistle Lines & Crow’s Feet | Surface Lines | Rough, Dry, Aging Lip Line

 

Action Ingredients

Red Algae | protects and restores elasticity and firmness; transforms stiff, dull skin to resilient, youthful skin
Matrixyl® Synthe’6® | facial architecturalpeptide; supports 6 skin-rebuilding essentials for firmer matrix, and smooth, strong, volumized skin, line-free skin
Rubixyl® | cell-signalling corneotherapy peptide restores cell signaling and prevents inflammaging-induced signs of aging; rehydrates and smoothes deep lines and wrinkles
Seabuckthorn Oil | rich in Omega 3, 6, 7, and 9, replenishes lipids lost due to aging, revives the skin’s barrier
Niacinamide | restructures epidermal barrier, energized skin tone and increased firmness and radiance?
Carob Seed Extract |phyto-repair molecules; accelerates the recovery capacity of the damaged skin, rapidly reducing signs of redness, barrier & tissue damage 
Mung Bean Sprout Stem Cells | reduces signs of sensitivity, enhances firmness and elasticity 
Garden Sprout Extract | supports skin’s natural detoxifying enzymes while enhancing cellular resistance and promoting the elimination of environmental toxins                                                           
Biosaccharide Gum-1 | soothing sugar hydrator, softens, hydrates and imparts immediate and long-lasting softness and comfort

Ingredient List

water (base), caprylic/capric triglyceride (emollient), glycerin (hydrating), dimethicone (slip agent), cetearyl alcohol (emulsifier), bis-diglyceryl polyacyladipate-2 (softening), butyrospermum parkii (shea) butter (softening), panthenol (hydrating), cetearyl methicone (protective silicone), cetyl esters (emollient), cyclopentasiloxane (slip agent), niacinamide (multitasking cell energizer), propanediol (humectant), simmondsia chinensis (jojoba) seed oil (lipid-rich plant oil), coco-glucoside (emulsifier), phytosteryl isostearate (conditioning), hexapeptide-48 HCl (corneotherapy peptide), lepidium sativum sprout extract (antioxidant), palmitoyl tripeptide-38 (volumizing peptide), phaseolus radiatus meristem cell culture extract (firming & soothing), sodium hyaluronate (hydrating), tocopheryl linoleate/oleate (moisturizing Vitamin E), biosaccharide gum-1 (hydrating & soothing), hypnea musciformis extract (firming red algae), linoleic acid (barrier lipid), hippophae rhamnoides oil (omega-rich plant oil), hydrolyzed ceratonia siliqua seed extract (soothing phyto-repair), polyisobutene (emollient), ethylhexylglycerin (skin conditioner), lecithin (emulsifier), phospholipids (barrier lipid), phytosterols (barrier lipid), behenyl alcohol (emollient), ceteareth-20 (mild emulsifier), laureth-4 (mild emulsifier), PEG-100 stearate (emulsifier), polysorbate 20  (mild emulsifier), polysorbate 80 (mild emulsifier), polyacrylate-13 (thickening agent), disodium EDTA (mineral chelator), hydroxypropyl cyclodextrin (skin conditioning), phenoxyethanol (antimicrobial preservative), sodium benzoate (pH adjustor), fragrance. 
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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