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Facial Cleanser used
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Clarisonic used to clease face, and skin prepped with alcohol swab
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Mechanical Exfoliation Preformed
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Light Chemical Peel Preformed
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Chemical Peel Used
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Time left on skin
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Was Peel Neutralized?
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Response
• • •
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Exfoliation Treatment Followed with Masque?
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Masque Used
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Exfoliation followed with Eyebrow wax
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Genesis Laser Settings: Patient is Fitz I or II ONLY
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Treated Fitz I or II with recommended settings: 16-18J/cm2
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Treating Fitz I or II outside recommended settings
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Reason
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J/cm
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Genesis Laser Settings – Patient is a Fitz III or IV ONLY
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Treated Fitz III or IV with recommended settings: 12-16J/cm2
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Treating Fitz III or IV outside recommended parameters
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Reason
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J/cm
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Genesis Laser: Patient is a Fitz V or VI ONLY
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Treated Fitz V or VI with Reccomended settings 8-12 J/cm2
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Treating Fitz V or VI outside recommended parameters
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Reason
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J/cm
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Treated with the recommended number of pulses (5000) - Yes
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Treated outside the Reccomended number of Pulses
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Additional Notes
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Complications occur during this treatment - Yes
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Describe the complication, and actions taken to treat it
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Follow up Recommendations
• • •
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Follow-up for what date? (mm/yy)
/
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