I hereby authorize Connie Christie, DAOM, LAc or any Affinity Acupuncture associate to perform Microneedling Therapy (Collagen Induction Therapy). My medical or cosmetic condition and any risks of harm have been explained to me, and I understand the benefits and risks of the procedure. I have had the opportunity to ask questions and seek clarification.


What to Expect:


  • Depending on the area of your face or body being treated and the type of device used (i.e. needle length), the procedure is well-tolerated and in some cases virtually painless, feeling only a mild prickling sensation.
  • Your practitioner may apply a topical anesthetic to your skin prior to treatment to reduce any pain and discomfort.
  • Your skin will be pink or red in appearance, much like a sun burn, for a couple of hours following treatment.
  • Minor bleeding and bruising is possible depending on the length of the needle used and the number of times it is pressed across the treatment area.
  • Your skin may feel warm, tight, and itchy for a short while. This should subside in 12-48 hours

Possible Side-Effects:


  • Side effects or risks are minimal with this type of treatment and typically include minor flaking or dryness of the skin with scab formation in rare cases.
  • Milia (small white bumps) may form; these can be removed by the practitioner.
  • Hyper-pigmentation (darkening of certain areas of the skin) can occur very rarely and usually resolves after a month.
  • If you have a history of cold sores, this procedure may cause flare ups.
  • Temporary redness and mild-sunburn effects may last up to 4 days.
  • Freckles may temporarily lighten or permanently disappear in treated areas.
  • Other potential risks include: crusting, itching, discomfort, bruising, infection, swelling, and failure to achieve the desired result. Permanent scarring (less than 1%) is extremely rare.

I understand the following contraindications and will notify my provider if any of the following apply to me:


  • Active infections - viral, fungal, bacterial
  • Rashes, warts, skin cancer
  • Active acne
  • Immune-suppressed patients
  • Skin-related autoimmune disorders
  • Pregnant or breast-feeding
  • Cancer
  • Patients on anticoagulants (NSAIDS, ASA, Coumadin/Warfarin)
  • Recent ablative dermal procedures
  • Rosacea
  • Diabetes
  • Actinic (solar) keratosis
  • Keloids