Chemical Peel Consent

Elite Clinique | Consent Form

This consent form is specific to chemical peel treatments. This form must be completed in addition to the General Treatment Consent form.

A chemical peel involves the controlled application of an acid solution to the skin to remove damaged outer layers, promote cellular turnover, and reveal smoother, more even-toned skin. The depth and type of peel (superficial, medium, or deep) will be selected by your practitioner based on your skin assessment, Fitzpatrick skin type, concerns, and treatment goals.

ALTERNATIVES: Alternative treatments may include microneedling, laser skin resurfacing, topical retinoid therapy, dermaplaning, or no treatment. Your practitioner will have discussed any alternatives relevant to your presentation.

Risks & Side Effects

Very Common

Affects more than 1 in 10 people

Stinging, tingling, or burning sensation during application (this is expected)
Redness of the treated area (may persist for 1-7 days depending on peel depth)
Skin peeling, flaking, and shedding (typically 3-7 days; this is the intended effect)

Common

Affects up to 1 in 10 people

Temporary skin sensitivity and tightness
Dryness requiring increased moisturisation
Temporary darkening of the skin before peeling occurs

Uncommon

Affects up to 1 in 100 people

Post-inflammatory hyperpigmentation (more common in darker skin types — Fitzpatrick IV-VI)
Reactivation of herpes simplex (cold sores)
Prolonged redness or erythema (particularly with medium-depth peels)

Rare

Affects fewer than 1 in 1,000 people

Scarring (primarily associated with deeper peels or failure to follow aftercare instructions)
Allergic or hypersensitivity reaction to the peel solution

Contraindications

Treatment may not be suitable if you:

✕Active sunburn or significant recent UV exposure
✕Use of topical retinoids (tretinoin, adapalene) within the last 7 days
✕Pregnancy or breastfeeding
✕Facial surgery, laser treatment, or other resurfacing procedure within the last 6 weeks
✕History of poor wound healing or keloid scarring
✕Active cold sores or history of frequent herpes simplex outbreaks (prophylactic antiviral medication may be recommended)
✕Skin conditions such as eczema, psoriasis, or rosacea at the treatment site
✕Use of isotretinoin (Roaccutane) within the last 6 months
✕Known allergy to salicylic acid, glycolic acid, or other peel components

Patient Declaration

By signing this consent form, I confirm that:

1I understand that the peel type and depth have been selected by my practitioner based on a clinical assessment of my skin, and I have been informed of the specific product being used.
2I will strictly avoid direct sun exposure and apply a broad-spectrum SPF 50 sunscreen daily for a minimum of 4 weeks following treatment. I understand that sun exposure significantly increases the risk of hyperpigmentation and other complications.
3I will not pick, peel, scratch, or forcibly remove any flaking or peeling skin, as this may cause scarring, infection, or pigmentation changes.
4I will follow the post-treatment skincare regimen recommended by my practitioner and avoid active skincare ingredients (retinoids, AHAs, BHAs) until my skin has fully healed.
5I understand that a course of treatments may be recommended for optimal results and that results develop over several weeks.
6I will avoid swimming, saunas, steam rooms, and strenuous exercise for 48 hours following treatment.
7I understand that no guarantee of a specific outcome is given or implied, and that individual results vary depending on skin type, condition, and adherence to aftercare.

Note: This is an informational copy of our consent form. The formal consent process takes place in person with your practitioner before treatment.