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Skin Booster/Microneedling Consent Form and Medical History
​水光针微针疗程同意书

Patient Information 个人信息

Medical History 医疗历史

Consent Form 同意书

Procedure Understanding. I understand and consent to undergo one or a combination of the following treatments:

  • Mesotherapy (Skin Boosters): The delivery of hyaluronic acid and nutritive components into the dermis via multi-needle suction or manual injection.

  • Microneedling: The use of fine needles to mechanically stimulate the skin, creating micro-channels to induce collagen regeneration and enhance product absorption.

  • RF (Radiofrequency) Microneedling: A combination of mechanical microneedling and RF energy delivered through needle tips to release heat, achieving deep skin tightening and rejuvenation.

I acknowledge that these treatments typically require multiple sessions (usually spaced 3–6 weeks apart) to achieve optimal results. I understand that skin improvement is a progressive process and final outcomes depend on individual skin quality and metabolic rates.


Risks and Potential Side Effects. I understand that all medical aesthetic procedures carry inherent risks. While most patients recover without complications, I have been advised of the following potential side effects:

  • Common Post-Treatment Reactions: Erythema (redness), swelling, heat sensation, tightness, bruising, or pinpoint bleeding at the treatment site. These symptoms typically resolve within 24–72 hours, though bruising may persist for 1–2 weeks.

  • Skin Barrier Changes: Temporary dryness, desquamation (peeling), itching, or "purging" (breakouts due to accelerated skin turnover or deep-seated inflammation being expelled).

  • Pigmentary Changes (PIH): In rare cases, temporary post-inflammatory hyperpigmentation (darkening) or hypopigmentation (lightening) may occur, especially if post-care sun protection is inadequate or due to individual constitutional differences.

  • Thermal Injury & Crusting (Specific to RF Microneedling): Micro-scabs may form after treatment. Forcing these scabs off prematurely may lead to permanent scarring. RF energy carries a rare risk of localized burns or blistering.

  • Infection Risk: Despite sterile techniques, a risk of bacterial or viral infection exists if post-treatment care is improper (e.g., premature contact with contaminated water or makeup).

I acknowledge that an unsatisfactory aesthetic outcome (e.g., subtle improvement in pores or wrinkles) is also a possible risk.


Client Acknowledgement and Consent. My practitioner has advised me to seek immediate medical care in the event of any adverse reaction.

I certify that I have read this document and completely understand the information regarding Mesotherapy /RF Microneedling /Microneedling treatments, including the benefits, risks, potential side effects, and costs.

I have been given all necessary opportunities to ask questions, and all my questions have been answered to my satisfaction. I choose to proceed with this treatment based entirely on the information provided in this informed consent document.


治疗程序知情. 本人理解并同意接受以下一项或多项联合治疗:

  • 水光针: 通过负压多针头或手工注射,将透明质酸及营养成分注入真皮层。

  • 普通微针: 利用细微针头机械性刺激皮肤,开启吸收通道并诱导胶原再生。

  • 黄金微针: 结合微针机械刺激与射频 (RF) 能量,通过针尖释放热能,达到深层紧致与修复效果。

本人知悉治疗通常需要多次疗程(通常间隔 3-6 周)以达到最佳效果。皮肤改善是一个渐进过程,最终效果取决于个体肤质及代谢能力。


风险与潜在副作用. 本人理解所有医疗美容操作均存在风险。虽然大多数患者术后恢复良好,但仍可能出现以下反应:

  • 常见术后反应: 治疗部位出现红斑、肿胀、发热、紧绷感、淤青或轻微渗血。这些症状通常在 24-72 小时内消退,部分淤青可能持续 1-2 周。

  • 皮肤屏障变化: 术后可能出现暂时性干燥、脱屑、瘙痒或爆痘(由于皮肤代谢加速或深层炎症排出)。

  • 色素沉着 (PIH): 极少数情况下,若术后防晒不当或个体差异,可能出现暂时性色素沉着(返黑)或色素减退。

  • 热损伤与结痂(针对黄金微针): 治疗后可能形成微小结痂,若强行剥离可能导致留疤。射频能量可能引发极罕见的烫伤或水泡。

  • 感染风险: 尽管使用无菌操作,若术后护理不当(如过早接触污染水源、化妆),仍存在细菌或病毒感染风险。

本人知悉治疗效果未达预期(如毛孔、皱纹改善不明显)也属于潜在风险。


客户确认与同意. 主治医生已告知本人,若发生任何不良反应需立即就医。本人确认已阅读本文件,并完全理解关于水光针/微针/黄金微针治疗的各项信息,包括其益处、风险、潜在副作用及费用。本人已获得充分提问机会,所有问题均得到满意解答。本人基于本知情同意书所提供的信息,完全自主决定接受此项治疗。

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