Plasma Fibroblast Consultation and Consent Form

Client Details

Medical History

Emergency Contact Details


Fitzpatrick skin types:

1) Very pale white skin, often with green or blue eyes and fair or red hair - burns without tanning
2) White skin, often with blue eyes - burns and does not tan easily
3) Fair skin with brown eyes and brown hair - burns first then tans
4) Light brown skin, dark eyes, and dark hair - burns a little and tans easily
5) Brown skin, dark eyes, and dark hair - easily tans to a darker color and rarely burns
6) Dark brown or black skin, dark eyes, and dark hair - never burns but tans darker

Treatment Information

What is Plasma Fibroblast?

Plasma fibroblast therapy targets fibroblasts. These are collagen and protein-producing cells in the dermis, the layer of skin just below your outermost skin layer. Fibroblasts play an important role in helping skin wounds heal as well as maintaining skin firmness and tightness.

Plasma fibroblast therapy uses a pen-like device that discharges a high-frequency electric current to small areas of the skin. The plasma tip doesn’t directly touch the skin, but instead releases a targeted current just above the skin. The hot current creates small holes, or micro-injuries, in the skin’s layer.

Healthcare providers may also call this approach plasma skin resurfacing.

Plasma fibroblast therapy may be used to treat the following conditions:

  • Acne scars
  • Photo aging, including age spots
  • Seborrheic keratosis
  • Wrinkled skin, including the eyelids, neck, jawline, and above the lips

Possible Side Effects

The Plasma Fibroblast treatment will produce side effects after the procedure. This is common and normal.

Side effects expected include:

  • Redness
  • Swelling
  • Mild hypopigmentation (light spots)
  • Mild hyperpigmentation (dark spots)
  • Skin peeling and crusting


Eye Treatment Area

  • Day of treatment: Some swelling. Feels hot like a sunburn. This feeling can last for up to 3 hours +
  • Day 1 (Next day post-treatment): Lots of swelling (the most swelling), especially in the morning.
  • Day 2: Swelling.
  • Day 3: Itchy sensation and tightness. Swelling decreases. Dots dry and may start to fall off.



You will notice most of the swelling on the first morning after treatment, particularly around the eyes. Swelling usually lasts two to three days. To minimise swelling try the following:

  • Follow Lymphatic Drainage Protocols
  • Sleep elevated the first night - Use as many pillows as you can tolerate
  • Avoid salt and alcohol
  • Body dry brushing
  • Jade rolling



Feeling hot like a sunburn stinging sensation is normal immediately after the treatment and for the rest of that night.



You will start to feel itchy from the 3rd day. Do not pick at the dots. The itchiness sensation means that the dots are starting to heal and are getting ready to dry and fall off.


Dry skin

Your skin may feel dry, peel or flake. You may notice a “sandpaper” texture a few days after treatment. This is the treated tissue working its way out of your body as new fresh skin is regenerated.



Most redness resolves during the first week after treatment, but a rosy “glow” can remain for several weeks. After the carbon crusts (dots) have fallen off, 5 to 7 days after the treatment, that’s when you can apply your normal coverage of makeup.


Bronzing, Crusting and Small Dark Dots

The treatment causes destruction to microscopic cylinders of skin which then exfoliates during the healing process. The treatment can make the skin look bronzed, or small areas appear crusted (do not try to scratch them off). Scratching off any carbon deposits (dots) may result in infection, scarring and hypo-pigmentation of the skin that may not be able to be reversed. Please refrain from scratching any areas that are healing.


Raw Skin

If you develop areas of raw skin post treatment, you do not need to apply band-aids, but keep the areas moist and do not pick at them. They will heal very rapidly on their own and without problems.



Initially, after treatment and for a day or so afterward, there may be occasional weeping (yellow pus). This is simply plasma and is a natural healing response. This simply flakes off after a few days but in some cases can take over 1 week.


Please read carefully.


For 1 week after treatment

  • Wash the area gently with warm water, carefully pat dry.
  • Apply aftercare cream twice a day - Your practitioner can advise you on the best type of cream to use
  • No makeup
  • No swimming
  • Do not use Actives or Anti Ageing Creams (Retinols, Tretonin, Retin A)
  • No sauna
  • No exposing the area to sunlight


For 2 weeks after treatment

  • Moisturise the area twice a day, using products that are hydrating and repairing. Ingredients such at Hyaluronic Acid and Centella help heal the skin as well as hydrating it.
  • Gentle cleansing
  • Do not use AHA’s, Glycolics or Retinols
  • Do not use exfoliating products


At all time during the course of treatment

  • Sun exposure should be avoided. If not possible, wear a sunscreen with a minimum SPF 50
  • Moisturise the area twice a day, using products that are hydrating and repairing. Ingredients such at Hyaluronic Acid and Centella help heal the skin as well as hydrating it. You want to ensure that the skin is prevented from drying out and peeling.
  • No sunbeds or tanning/sunbathing


Skin Care Products

All of your skin care products should be non-irritating and non-clogging for the first week or so after the treatment. For best results, we advise to use products that contain healing and hydrating ingredients such as Hyaluronic Acid and Centella. Do not use abrasive scrubs, toners, or products that contain glycolyic acids or Retin A. Read the product labels if you are unsure. Resume your normal skin care regimen only when your skin has fully healed.



You should first apply sunscreen 20 minutes before going outside, and again, immediately before. After that, reapply your sunscreen every 2 hours. If direct sun exposure is necessary, wear a hat and clothing that covers the treated area. Use this regimen during the healing period and always.



Remember that peeling and/or flaking is normal during the healing process. Therefore, the product should be non-irritating and non-clogging, or else you could develop breakouts. During the healing period your normal moisturiser may be too occlusive. Your practitioner can advise you on the best type of moisturiser to use. Reapply whenever your skin feels dry.


Cosmetic Treatments

Do not have any of the following cosmetic treatments on the treated area until the skin is fully healed.

  • Skin Needling
  • Laser Hair Removal
  • Laser Carbon Peel
  • PRP
  • Botox/Fillers
  • BB Glow
  • Active Peels (AHA, Enzyme, etc)

Please seek advice from your practitioner before having any other cosmetic treatments whilst your skin is still healing.


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