Saline Brow Removal Consent Form

Saline removal is a non-laser method. A saline solution is implanted into the pigmented area to gently draw old pigment (microblading, ombré, powder brows, or permanent makeup) up and out as the area heals and scabs.

It is a gradual process that requires multiple sessions, typically spaced 6–8 weeks apart. The number needed varies by how much pigment is present, its depth, and its color.
Results are lightening / lifting. Complete removal is not guaranteed, and some pigment may remain.

Avoid alcohol, aspirin, ibuprofen, and other blood thinners for 24 hours before (unless prescribed).
No sun, tanning, or self-tanner on the brow area for 2 weeks before.
The area must be fully healed and healthy. If you have any recent PMU/tattoo work in the brows, it must be fully healed first.
Arrive with clean skin and no makeup on or around the brows.

Do not pick, scratch, or peel the scabs. Let them fall off on their own. Picking is the leading cause of scarring and poor results.
Keep the area clean and dry. Avoid soaking, swimming, saunas, and heavy sweating while healing.
No makeup, brow products, or actives (retinol, acids) on the area until fully healed.
Once healed, protect the area from the sun with SPF.
Wait the full 6–8 weeks between sessions so the skin can recover.

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Section A — Client Information

First Name *

Last Name *

Phone *

Email *

Date of Birth *

Today's Date *

City

State

Postal Code

What are we removing?

Emergency Contact Name

Emergency Contact Phone

I agree to receive booking confirmations and appointment reminders at my email address above. * Text me booking confirmations, reminders, and updates at my phone number above. Message & data rates may apply; reply STOP to opt out.

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Section B — Photo & Video Release

I grant I Am Beautiful by Mia permission to take before/after photos and video, including filming during my session, and to use them on social media, website, and marketing. I understand I will not be compensated, and I may withdraw this consent in writing for future use at any time.

Name preference for photos & video

Use my name No name Fictitious name

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Section C — Medical History

List any known allergies

List all current medications

Skin type / complexion

How was the original brow work done?

Approximately when was it done?

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Section E — What to Understand

I understand saline removal is a gradual process requiring multiple sessions, spaced about 6–8 weeks apart, and the number I need cannot be promised in advance. * I understand results are lightening / lifting of pigment and that complete removal is not guaranteed; some pigment may remain. * I understand the risks, which can include scarring, infection, prolonged redness, changes in skin color, and incomplete removal. * I understand that not picking the scabs and following all aftercare is essential, and that picking can cause scarring and poor results. * I understand this is a non-laser saline method, not laser removal. *

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How Saline Removal Works

Before Your Appointment

Aftercare

Section A — Client Information

Section B — Photo & Video Release

Section C — Medical History

Section D — Contraindications

Section E — What to Understand

Section F — Client Consent & Signature