Dermaroller Consultation and Consent Form

Client Details

Medical History

Emergency Contact Details


Treatment Information

What is a dermaroller treatment?

A dermaroller is a titanium device that is rolled over the skin to create thousands of tiny contact points. It is a type of microneedling treatment that causes the body to create a wound healing process for rejuvenated, smoother and younger looking skin.


Who is dermaroller treatment good for?

Dermaroller treatment is good for clients who need a large area treated, and is most commonly used to treat the following skin conditions:

  • Dull skin: Rejuvenate tired and dull skin and combat the initial signs of ageing.
  • Wrinkles: Fine lines and wrinkles on the face can be visibly reduced, as dermarolling triggers collagen production.
  • Scarring: Scars from acne and Chicken Pox can be improved and an uneven texture can be smoothed out with dermarolling
  • Pigmentation: Can help to fade dark patches such as pigmentation due to sun damage or ageing. Dermaroller microneedling is a great treatment for you if you have darker skin because it doesn’t involve peels or lasers, which can cause pigmentation issues.

Aftercare Advice

  • During the first 48 hours, refrain from exercise, saunas, hot tubs, and sun-beds.
  • Avoid strong sunlight and do not use sunscreen (after 48 hours, use sunscreen everyday).
  • Avoid touching your treated skin unnecessarily. Always wash hands or use gloves before touching treated skin.
  • Avoid makeup for 24 hours. If you must use makeup within the first 24 hours, please only use a 100% pure mineral powder makeup.
  • For the first few days after your microneedling procedure, you’ll need to avoid any skin care product that contains harsh chemicals meant to exfoliate. Avoid anything that’s scented, and don’t use glycolic acid or alpha hydroxy acids.
  • Retinol A and vitamin C serum should be avoided for the first 48 hours, minimum, after microneedling. Once 2 full days have passed, you might want to gradually add products back into your daily beauty routine instead of doing your usual regimen, especially if you use products that have strong anti-aging formulas.
  • Be sure to run any cleansers, toners, or scrubs that you plan to apply in the 2 to 3 days after microneedling by your provider to make sure the ingredients won’t worsen side effects.
  • Hyaluronic acid can be used following microneedling, and it’s even recommended in some cases to help stimulate collagen production after your procedure.
  • If your skin is feeling dry, it’s generally safe to apply coconut oil as an emollient to lock in moisture and hydrate your face after microneedling. Diluted, alcohol-free witch hazel may also be used to cleanse dry skin. Stick to using gentle, natural ingredients that you’re familiar with.


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