Areola micropigmentation consent form: clearance, privacy and gentle care
Areola restoration is the service where the paperwork has to be as gentle as the appointment. Your client has been through surgery. This consent form should be clear, private, and written so she shares only what she is comfortable sharing.
This exact form is built into SlickChart: send it to your client's phone to sign privately before the visit, and the aftercare below goes home with her.
Be clear that this is cosmetic
My form opens by naming what the service is: cosmetic tattooing that adds color, shape and the look of dimension to the areola. The next sentence is short and deliberate: not a medical treatment.
The rest of the box sets expectations kindly. It promises a private, unhurried visit. It says she will usually need 2 or more sessions, 6 to 8 weeks apart, and that color heals softer and fades over time.
Tell her about sensation
One section is easy to overlook and matters a great deal. Sensation is often reduced after surgery, so she may feel little during the session. The form follows that with why it matters afterward: daily checks while healing, because she may not feel a problem.
Offer the other options
Informed consent includes knowing what else exists. My form lists three alternatives: no treatment, 3D nipple prosthetics, or medical tattooing through her surgeon's office. Naming them respects her choice.
Risks, including scar tissue
The risk list is short and specific:
- patchy color, as scar tissue holds pigment unevenly
- infection, slow healing or long-lasting redness
- implant, flap or graft concerns, which her surgeon clears
- fading or color shift, needing a boost
- an allergic reaction to pigment or numbing products
- color that does not exactly match the other side
Matching is the goal; a perfect match is not something to promise.
Clearance is required
This is the section where the artist steps back and the medical team leads. The checklist heading says it directly:
Clearance is required. Some answers mean we wait. Share only what you are comfortable sharing.
The items cover timing and her surgical history: under 6 months since final surgery or radiation, implants, expanders or flap reconstruction, chemo or immunotherapy in the past 6 months, an open, unhealed or tender area or a rash, keloids, blood thinners, a bleeding disorder or diabetes, lymphedema or an autoimmune condition, pregnancy, and allergies. A free text box follows, and then a yes or no line to record that written surgeon or physician clearance is on file.
The form does not ask you to judge whether she is ready. That is her surgeon's or physician's decision, and the clearance on file is how you know it was made.
Privacy for photos
The photo choices are separated so each one is a real choice. Private chart photos are torso only, with no face. Marketing photos are a separate pick: torso only and no face, or no marketing photos at all. The form says photos never show her face and are never shared without her yes. My general photo release repeats it: areola photos stay in her record only unless she opts in separately in writing.
She also confirms she can stop at any time and withdraw photo permission in writing.
Acknowledgements
She approves the size, placement and color, shares her full health and surgical history including implants, flaps and radiation, and accepts that results vary, scar tissue may heal unevenly, more than one session is usual, and nothing is guaranteed. She agrees to follow aftercare and check the area every day while healing.
Aftercare built around daily checks
My guide begins: take healing gently. On day 0 she leaves the pad on for 2 to 3 hours, washes her hands, rinses with lukewarm water and pats dry, and avoids tight, underwire or rough bras. Days 1 to 3 call for a rice-grain of balm, a fresh sterile pad and a soft, clean bra. During flaking she checks the area daily in a mirror and never picks. No baths, pools or hot tubs for the full 14 days. From weeks 3 to 5, color may look softer or lighter in scar tissue, and some patchiness is evened out at the next session.
The call-me list includes any change near an implant, such as swelling, firmness or pain, alongside spreading redness, fluid after day 3, fever and rash. Trouble breathing or swelling of the face or throat means calling 911.
Questions to decide for your own practice
- What form of written clearance will you accept, and where will you keep it?
- How will you make the visit itself private and unhurried?
- How will you record color and placement so the next session matches? (See what to record in a client chart.)
- PMU and tattoo licensing, health department and bloodborne pathogen rules vary by state and county, so check with your state and local health department and board. This post is not legal or medical advice.
Use this form with your clients
SlickChart has this exact areola restoration consent and aftercare built in for subscribers. The form goes to the client's phone to sign before the visit, or she signs on your device in the room, and any contraindication she checks is flagged for you. The aftercare lands in the client's own app, styled with your logo, and it all works alongside the Square account you already have. If that would save you paperwork, try SlickChart.
Prefer paper? The printable areola restoration set, with the consent form, protocol and aftercare, is in my Etsy shop, ready to print or edit in free Canva.