Piele uscată :_____________________Piele

hidratată :__________________________________________

Piele uscată atipică :________________Piele uscată

senilă :__________________________________________

Piele Grasă :_________________ Piele Grasă Asticată :________________________________

Piele grasă
sensibilă :________________________________________________________________________________

Piele grasă seboreică

bogată :________________________________________________________________

Piele mixtă și
acnee:________________________________________________________________________________

VII. DIAGNOSTIC: FIȘA DE DIAGNOSTIC

_____________________________________________________________________________________________ I. DATE PERSONALE

_____________________________________________________________________________________________ Nume și
_____________________________________________________________________________________________ prenume:________________________________________________________________________________

Data de naștere:_____________________________________________________________
VII. TRATAMENT: DEPELING CHIMIC
Stare civila:_______________________________________________________________________
_____________________________________________________________________________________________
Abordare:__________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________ Telefon:___________________________________________________________________________

E-mail:_______________________________________________________________
DATA PRODUS CHIMIC TIMPUL DE EFECT
TOLERANTA Tratament:______________________________________________________________________

Profesie:__________________________________________________________________________
II. DATE PATOLOGICE
DIABET:______________________________________________________________________________
CANCER:________________________________________________________________________________
ASTM:___________________________________________________________________________________
PROBLEME HORMONE:________________________________________________________
CHIRURGIE RECENTĂ :___________________________________________________________________
v. CARACTERISTICI
Antibiotice:___________________Alcool:__________________Tutun:___________________
III. CHIRURGII COSMETICE
Rinoplastie:____________________________________________________________________________
Textura
grosieră :________________________________________________________________________________
Textura
subțire:________________________________________________________________________________
Textura
rugoasă :________________________________________________________________________________
Textura fină și netedă :___________________________________________________________________
Textura
granulată :________________________________________________________________________________
Abdominoplastie:_________________________________________________________________________
_______
Implanturi
faciale:________________________________________________________________________________
Blefaroplastie:_____________________________________________________________________________ Unctuos:___________________Uleos:__________________Stră lucitor:__________________________
___
Comedoane albe sau
Lifting negre:________________________________________________________________
facial:________________________________________________________________________________
Riduri și linii de
IV. ALTERĂRI CUTANATE expresie:___________________________________________________________________

Nevus:______________________________Cloasma:_____________________________________________ Sprâ ncenele

____ periobiculare:_____________________________________________________________________________
___
Peteșii:_________________________Papule:___________________________________________________
_ Naso
Genius:________________________________________________________________________________
Vasicul:________________________Comedoane:______________________________________________
______ Peribucale:________________________________________________________________________________

Lentigus:_________________________ Cicatrice:________________________________________ VI BIOTIP CUTANAT:

Telegentasia:______________________________________________________________________________ EUDERMIC SAU

__ NORMAL :________________________________________________________________

Crustă :________________________________________________________________________________ _____________________________________________________________________________________________

Melasma:________________________________________________________________________________ _________________________ ______________________

Milion:_______________________________________________________________________________ Semnă tura pacientului cosmetician

Acnee:_________________________________________________________________________________

Textura
opaca:________________________________________________________________________________

Pori
inchisi:_________________________________________Dilatati:___________________________________
______

Prost vizibil:
________________________________________________________________________________

Culoare Roz:_________________________ Pal:_____________________________________________

Gri:______________________________Galben:_____________________________________________

Galben rosu:_____________________________________________