Stop Paying Department-Store Prices for Creams That Can’t Actually Change Your Skin.

CONSENT FOR BESPOKE PRESCRIPTION TOPICAL THERAPY — DR BRADLEY TOMKINS (MBChB, BSc, MRCGP)

1. Nature of the Medication and Unlicensed Special Status: REVIDA® Orbital Renewal Cream and REVIDA® Facial Renewal Cream are bespoke, prescription-only topical medicines freshly compounded on an individual named-patient basis by Roseway Labs (a General Pharmaceutical Council registered UK compounding pharmacy). In accordance with General Medical Council prescribing guidance, I have been informed that compounded tretinoin formulations are unlicensed medicines ("specials") prescribed off-label for skin rejuvenation, post-laser skin maintenance, collagen remodelling, and pigment stabilisation, rather than licensed over-the-counter cosmetic products. Because these creams are freshly compounded without industrial preservatives, each metered airless pump bottle (dispensing 0.3 ml per pump) carries a strict 35-day shelf life from the date of compounding and must be discarded once expired.

2. Active Ingredients and Clinical Purpose: Depending on my agreed treatment plan, I am consenting to the prescription of one or both of the following formulations:
• REVIDA® Orbital Renewal Cream (15 ml Airless Pump): Contains Tretinoin 0.01%, Caffeine 2.0%, Niacinamide 4.0%, Panthenol 2.0%, Allantoin 0.5%, and Coenzyme Q10 0.5% in a DermaCream base. Formulated to support dermal collagen maturation and improve skin firmness and puffiness around the orbital rim.
• REVIDA® Facial Renewal Cream (30 ml Airless Pump): Contains Tretinoin 0.025% (or Tretinoin 0.05% for clinician-authorised Month 4+ step-up courses), Tranexamic Acid 3.0%, Niacinamide 4.0%, Vitamin C (Liposomal) 5.0%, Cholesterol 1.0%, and Coenzyme Q10 1.0% in a DermaCream base. Formulated to consolidate dermal collagen remodelling, suppress redness and rebound hyperpigmentation, and strengthen the skin barrier.

3. Strict Timing, Finish-Line Rule, and Application Instructions:
• Standalone Skincare or Non-Ablative Laser / Injectable Patients: Begin immediately (or 48 to 72 hours after non-ablative laser or injectable sessions) on intact, uninflamed skin.
• Finish-Line Rule for Ablative Laser Courses (No Use Between Laser Sessions): Neither cream may be used during acute post-laser wound healing or between sessions of a multi-session laser course. Treatment begins only after the final laser session in my treatment plan is complete and only at the exact post-procedure milestone confirmed by Dr Tomkins: Fair Skin Types (Fitzpatrick I–II) Eyelid Laser: Day 14+ once initial surface healing is complete; Fair Skin Types (Fitzpatrick I–II) Full-Face/Full-Field Laser: Week 6+ (or Day 14–Week 4 for lighter fractional procedures only if explicitly instructed by Dr Tomkins) once all pinkness and sensitivity have settled for 7 consecutive days; Melanin-Rich Skin Types (Fitzpatrick III–VI) All Ablative Laser Protocols: Complete the prescribed non-retinoid Skin Tech Blending and Bleaching Cream protocol first, then transition onto REVIDA® from Week 8+ (or 7 days after completing optional Week 8–12 MelanoLight-Q™ laser toning) once pigment stability is confirmed and pinkness has settled for 7 consecutive days. On the evening REVIDA® is started, stop applying Skin Tech Blending and Bleaching Cream at night so two active pigment treatments are not layered together.
• Evening Application & Gradual Titration: Apply at night only to clean, completely dry skin (waiting at least 10 minutes after washing). Begin twice weekly for Weeks 1–2, increasing to alternate nights in Weeks 3–4, and nightly thereafter only as tolerated without redness, stinging, or peeling.
• Strict Orbital Rim Placement (REVIDA® Orbital Renewal Cream): Apply using a clean cotton tip strictly along the outer orbital bone (upper brow bone and lower orbital rim). Never apply onto the mobile upper eyelid, lower tarsal plate, or close to the eyelash margin, as natural blinking can carry the cream into the eye and cause ocular stinging, conjunctival irritation, or dry eye symptoms. Wash hands thoroughly after application.
• Mandatory Sun Protection & Pre-Procedure Washout: Apply broad-spectrum SPF 50+ every morning throughout treatment and for at least three months afterward. Discontinue both creams at least 5 full days prior to any future laser treatment, chemical peel, waxing, or aesthetic skin procedure.

4. Expected Side Effects and Potential Risks:
• Expected Retinisation Phase (Weeks 1–4): Mild transient redness, dryness, tightness, or light flaking is common as epidermal turnover accelerates. If irritation occurs, pause application for 2 to 3 nights, apply a bland barrier moisturiser, and resume at a reduced frequency.
• Potential Complications: Contact dermatitis, persistent redness, eyelid swelling or eye irritation (if orbital cream migrates too close to the lash line), sunburn or heightened UV sensitivity, and temporary post-inflammatory hyperpigmentation (particularly in darker skin types if applied prematurely onto inflamed skin or used without strict daily SPF 50+).
• Personal Use Only: This prescription medicine is compounded exclusively for me and must never be shared with or applied by any other person.

5. Pregnancy, Breastfeeding, and Medical Contraindications: Topical tretinoin is strictly contraindicated during pregnancy, while trying to conceive, or while breastfeeding due to potential risk to an unborn or nursing baby. By signing this form, I confirm that I am not pregnant, not planning a pregnancy during the course of treatment, and not breastfeeding. I agree to use effective contraception where applicable, and to stop using the cream immediately and inform the clinic if I become pregnant. I confirm that I have disclosed my full medical history, any history of eczema, rosacea, or dry eye disease, all allergies, and all current oral or topical medications, and that I have no known allergy to any listed active or base ingredient.

6. Alternatives and Pharmacy Supply Terms: Reasonable alternatives include non-prescription barrier and antioxidant skincare (such as retail Skin Tech products), alternative licensed topical preparations, or choosing not to use maintenance topical therapy. Each bottle is freshly compounded to order upon prescription authorisation, carries a 35-day shelf life, and cannot be returned or refunded once dispensed by the pharmacy (full refund applies if Dr Tomkins declines suitability prior to pharmacy compounding).

7. Patient Declaration: I confirm that I have read and understood this document, have had the opportunity to ask questions via WhatsApp or consultation prior to dispensing, and understand the unlicensed special status, strict timing and Finish-Line rules, orbital application precautions, and pregnancy contraindications. I consent to the prescribing and supply of REVIDA® Orbital Renewal Cream and/or REVIDA® Facial Renewal Cream.