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Possible Risks, Hazards, or Complications <br /> ❑ Pain : There can be pain even after the topical anesthetic has been used. <br /> Anesthetics work better on some people than on others . <br /> ❑ Infection : Infection is very unusual. The areas treated must be kept clean, and only <br /> freshly cleaned hands should touch the areas . See "After Care" sheet for instruction <br /> on care . <br /> ❑ Uneven Pigmentation : This can result from poor healing, infection, bleeding, or <br /> many other causes . Your follow-up appointment will likely correct any uneven <br /> appearance. <br /> ❑ Asymmetry : Every effort will be made to avoid asymmetry, but out faces our not <br /> symmetrical so adjustments may be needed during the follow-up session to correct aM <br /> unevenness . <br /> ❑ Excessive Swelling or Bruising: Some people bruise or swell more than others . Ice <br /> packs may help reduce the swelling. The swelling or bruising typically disappears in <br /> 1 - 5 days . Some people don' t bruise or swell at all . <br /> ❑ Anesthetics : Topical anesthetics are used to numb the area to be tattooed. Lidocaine, <br /> Prilocaine, Benzocaine, Tetracaine, and/or Epinephrine creamand/or liquid are used. <br /> If you are allergic to any of these, please inform me now. <br /> ❑ MRI: Because pigments used in Permanent Cosmetic procedures contain inert <br /> oxides, a low level magnet may be required if you need to be scanned by an MRI <br /> machine , You must inform your MRI Technician of any tattoos or permanent <br /> cosmetics . <br /> The alternative to these possibilities is to use traditional cosmetics and <br /> NOT undergo the Semi-Permanent Eyebrow procedure . <br /> I certify that I have read or have had read to me the contents of this form. I understand <br /> the risks and alternatives involved in this procedure(s) . I have had the opportunity to ask <br /> questions, and all of my questions have been answered. I acknowledge that I have <br /> reviewed and approved the material given to me, and I authorize (YOUR COMPANY <br /> NAME/INFO), as my eyebrow microblading technician to perform on my body the <br /> Microblading/31) Eyebrow Embroidery procedure desired today. <br /> Print Name Signature Date <br />