State-of-the-art, personalized skin care
from experienced professionals
“A regular skin checkup can literally save your life.” Jennifer Krasnoff, MD

Microdermabrasion is an aesthetic procedure that involves the use of a machine to remove the epidermal layer other the skin. A hand piece emits crystals onto the surface of the skin, resulting in a gentle abrasion or “polishing” process while simultaneously being vacuumed up. The combination of removing the outer layer of dead skin cells and increasing the blood circulation leaves a smoother texture and promotes the growth of healthy new skin cells.

Indications for the use of Microdermabrasion include the treatment of fine lines, wrinkles, sun damaged skin, age spots, blackheads, oily skin and for the epidermal peeling of the face, neck and other parts of the body.

The goal of Microdermabrasion, as in any cosmetic procedure, is aesthetic improvement and not perfection. The number of treatments will vary among individuals.

I am aware of the following possible complications with Microdermabrasion:

  • Mild discomfort
  • Redness and swelling for up to 3 days
  • Itching and mild irritation immediately following the procedure
  • Skin peeling and or flaking for up to 7 days following the procedure
  • Herpes (fever blisters on the face and lip) if the virus is present in the body. If you are prone to breakouts an anti-viral should be taken 1 day pre-treatment and 3-7 days post treatment.

The potential risks, benefits and results of the Microdermabrasion procedure have been fully discussed with me. I request the procedure described above.

Cancellation Policy: I understand that a 24-hour notice is required for all cancellations or appointment changes or the full appointment fee will be charged to my account.

I agree that pre- & post-operative clinical photographs and videos may be taken to monitor my treatment progress and for patient educational purposes. I understand that my identity will be protected.

I certify that I have read and understand the contents of this consent form. I have been given the opportunity to ask the doctor/staff any questions that I have about the procedure, and all of my questions have been answered. The doctor/staff has explained the procedure and its alternatives to me, and I both understand and accept the risks involved in this procedure.

Please download this PDF form to sign.





Petaluma Office
165 Lynch Creek Way
Petaluma, CA 94954
 M-F, 8:00am-5:00pm
(707) 762-5531
Fax: (707) 762-5976



Hercules Office
500 Alfred Nobel Dr., Ste. 245
Hercules, CA 94547
M-F, 8:00am-5:00pm
Open Saturday for aesthetic services
 (510) 741-7418
Fax: (510) 741-7456


Billing office
Fax: 510- 741-7493

At Dermatology Associates of the Bay Area, our board-certified dermatologists serve patients at our Petaluma and Hercules offices. We are committed to the highest standards, and we offer a full range of cosmetic, medical, and surgical dermatology procedures, as well as quality skin care products.

Dermatology Associates of the Bay Area
165 Lynch Creek Way | Petaluma, California 94954 | Phone: (707) 762-5531 | Fax: (707) 762-5976
500 Alfred Nobel Drive, Suite 245 | Hercules, California 94547 | Phone: (510) 741-7418 | Fax: (510) 741-7456