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RETINOL RESURFACING COMPLEX
  • RETINOL RESURFACING COMPLEX
RETINOL RESURFACING COMPLEX
$72.00

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
Retinol, the purest form of anti-aging Vitamin A, is blended with two scientifically-proven age-fighting complexes in an instant re-texturizing, line-diffusing base to gently smooth surface wrinkles, even skin tone and restore skin’s youthful texture within days. 

Actions


      • Rough, dry, flaky skin becomes noticeably smoother overnight*

      • Surface lines visibly soften within one week*

      • Whistle lines, crow’s feet, and deeper wrinkles become less noticeable within one month*

      • Age spots, sun spots, and discolorations from inflammation seem to fade within days to weeks*

      • Lips feel softer, smoother, and slightly plumper within minutes to days


*Results based on a six-week study of consumers aged 30 to 68 showing visible aging due to a variety of causes, including sun damage, stress, diet, and chronological age 

Skin Conditions

Rough | Dry | Flaky | Surface Lines | Rough, Dry, Aging Lips |Deeper Wrinkles | Age Spots | Sun Spots | Discoloration from Inflammation | Whistle Lines | Crow’s Feet. 

Home Care

Apply a small amount to clean the skin before bedtime. It may be applied to the outer eye area and on the lips. \n

 Ingredients

Retinol | pure bioactive vitamin A works inside the skin’s surface, where dryness and wrinkles develop Matrixyl® Synthe’6® | facial architectural peptide supports six skin rebuilding essentials for a firmer matrix, and a smoother, stronger, volumized line-free skin Glucosamine HCL | non-acid sugar complex gently exfoliates to deliver the same results as AHAs Dipotassium Glycyrrhizate | soothing agent from licorice.
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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