This is an informed-consent document
that has been prepared to help your plastic surgeon inform
you concerning face lift surgery, its risks, and alternative
treatment.
It is important that you read this information carefully and
completely. Please initial each page, indicating that you
have read the page and sign the consent for surgery as
proposed by your plastic surgeon.
INTRODUCTION
Facelift, or rhytidectomy, is a surgical procedure to
improve visible signs of aging on the face and neck. As
individuals age, the skin and muscles of the face region
begin to lose tone. The facelift cannot stop the process of
aging. It can improve the most visible signs of aging by
tightening deeper structures, re-draping the skin of face
and neck, and removing selected areas of fat. A facelift can
be performed alone, or in conjunction with other procedures,
such as a brow lift, liposuction, eyelid surgery, or nasal
surgery.
Facelift surgery is individualized for each patient. The
best candidates for facelift surgery have a face and neck
line has begun to sag, but whose skin has elasticity and
whose bony structure is well defined.
ALTERNATIVE TREATMENT
Alternative forms of management consist of not treating the
laxness in the face and neck region with a facelift
(rhytidectomy). Improvement of skin laxity, skin wrinkles
and fatty deposits may be attempted by other treatments or
surgery such as chemical face peels or liposuction. Risks
and potential complications are associated with alternative
forms of treatment.
RISKS of FACELIFT (Rhytidectomy) SURGERY
Every surgical procedure involves a certain amount of risk
and it is important that you understand the risks involved
with facelift (rhytidectomy). An individual’s choice to
undergo a surgical procedure is based on the comparison of
the risk to potential benefit. Although the majority of
patients do not experience the following complications, you
should discuss each of them with your plastic surgeon to
make sure you understand the risks, potential complications,
and consequences of facelift (rhytidectomy).
Bleeding- It is possible, though unusual, that you may have
problems with bleeding during or after surgery. Should
post-operative bleeding occur, it may require emergency
treatment to drain accumulated blood or require a blood
transfusion. Do not take any aspirin or anti-inflammatory
medications for ten days before surgery, as this contributes
to a greater risk of bleeding. Non-prescription "herbs" and
dietary supplements can increase the risk of surgical
bleeding. Hypertension (high blood pressure) that is not
under good medical control may cause bleeding during or
after surgery. Accumulations of blood under the skin may
delay healing and cause scarring.
Infection- Infection is unusual after this surgery. Should
an infection occur, additional treatment including
antibiotics or surgery may be necessary.
Scarring- Although good wound healing after a surgical
procedure is expected, abnormal scars may occur within the
skin and deeper tissues. Scars may be unattractive and of
different color than the surrounding skin. There is the
possibility of visible marks from sutures. Additional
treatments may be needed to treat scarring.
Damage to deeper structures- Deeper structures such as blood
vessels, muscles, and particularly nerves may be damaged
during the course of surgery. The potential for this to
occur varies with the type of facelift procedure performed.
Injury to deeper structures may be temporary or permanent.
Asymmetry- The human face is normally asymmetrical. There
can be a variation from one side to the other in the results
obtained from a facelift procedure.
Surgical anesthesia- Both local and general anesthesia
involve risk. There is the possibility of complications,
injury, and even death from all forms of surgical anesthesia
or sedation.
Nerve injury- Motor and sensory nerves may be injured during
a facelift operation. Weakness or loss of facial movements
may occur after facelift surgery. Nerve injuries may cause
temporary or permanent loss of facial movements and feeling.
Such injuries may improve over time. Injury to sensory
nerves of the face, neck and ear regions may cause temporary
or more rarely permanent numbness. Painful nerve scarring is
very rare.
Chronic pain- Chronic pain is a very rare complication after
a facelift.
Skin disorders/skin cancer- A facelift is a surgical
procedure for the tightening of skin and deeper structures
of the face. Skin disorders and skin cancer may occur
independently of a facelift.
Unsatisfactory result- There is the possibility of a poor
result from the facelift surgery. This would include risks
such as unacceptable visible deformities, loss of facial
movement, wound disruption, and loss of sensation. You may
be disappointed with the results of surgery. Infrequently,
it is necessary to perform additional surgery to improve
your results.
Allergic reactions- In rare cases, local allergies to tape,
suture material, or topical preparations have been reported.
Systemic reactions which are more serious may occur to drugs
used during surgery and prescription medicines. Allergic
reactions may require additional treatment.
Hair loss- Hair loss may occur in areas of the face where
the skin was elevated during surgery. The occurrence of this
is not predictable.
Delayed healing - Wound disruption or delayed wound healing
is possible. Some areas of the face may not heal normally or
may take a long time to heal. Areas of skin may die.
Frequent dressing changes or further surgery may be required
to remove the non-healed tissue.
Smokers have a greater risk of skin loss and wound healing
complications.
Long term effects- Subsequent alterations in facial
appearance may occur as the result of aging, weight loss or
gain, sun exposure, or other circumstances not related to
facelift surgery. Facelift surgery does not arrest the aging
process or produce permanent tightening of the face and
neck. Future surgery or other treatments may be necessary to
maintain the results of a facelift operation.
ADDITIONAL SURGERY NECESSARY
There are many variable conditions in addition to risk and
potential surgical complications that may influence the long
term result from facelift surgery. Even though risks and
complications occur infrequently, the risks cited are the
ones that are particularly associated with facelift surgery.
Other complications and risks can occur but are even more
uncommon. Should complications occur, additional surgery or
other treatments may be necessary. The practice of medicine
and surgery is not an exact science. Although good results
are expected, there is no guarantee or warranty expressed or
implied, on the results that may be obtained.
HEALTH INSURANCE
Most health insurance companies exclude coverage for
cosmetic surgical operations such as the facelift
(rhytidectomy) or any complications that might occur from
surgery. Please carefully review your health insurance
subscriber-information pamphlet.
FINANCIAL RESPONSIBILITIES
The cost of surgery involves several charges for the
services provided. The total includes fees charged by your
doctor, the cost of surgical supplies, anesthesia,
laboratory tests, and possible outpatient hospital charges,
depending on where the surgery is performed. Depending on
whether the cost of surgery is covered by an insurance plan,
you will be responsible for necessary co-payments,
deductibles, and charges not covered. Additional costs may
occur should complications develop from the surgery.
Secondary surgery or hospital day-surgery charges involved
with revisionary surgery would also be your responsibility.
DISCLAIMER
Informed-consent documents are used to communicate
information about the proposed surgical treatment of a
disease or condition along with disclosure of risks and
alternative forms of treatment(s). The informed-consent
process attempts to define principles of risk disclosure
that should generally meet the needs of most patients in
most circumstances.
However, informed consent documents should not be considered
all inclusive in defining other methods of care and risks
encountered. Your plastic surgeon may provide you with
additional or different information which is based on all
the facts in your particular case and the state of medical
knowledge.
Informed-consent documents are not intended to define or
serve as the standard of medical care. Standards of medical
care are determined on the basis of all of the facts
involved in an individual case and are subject to change as
scientific knowledge and technology advance and as practice
patterns evolve.
My Brazil plastic surgery reminds you that all cosmetic surgery carries a
risk, has limitations which could include disappointment
with the results.
You should agree about the anticipated outcome of your
surgery and concur about your expectations of the results.
You should discuss alternative treatments and thoroughly
understand the risk of the procedures
If any dispute may arise the surgeon is only liable if
litigation takes place in Brazil, under Brazilian Law.
It is important that you read the above information
carefully and have all of your questions answered before
signing the consent.
________________________________________
CONSENT FOR SURGERY/ PROCEDURE or TREATMENT
1. I hereby authorize Dr. ______________________ and such
assistants as may be selected to perform the following
procedure or treatment:
__________________________________________________________
I have received the following information sheet:
INFORMED-CONSENT for FACELIFT (RHYTIDECTOMY) SURGERY
___________________________________________________________
2. I recognize that during the course of the operation and
medical treatment or anesthesia, unforeseen conditions may
necessitate different procedures than those above. I
therefore authorize the above physician and assistants or
designees to perform such other procedures that are in the
exercise of his or her professional judgment necessary and
desirable. The authority granted under this paragraph shall
include all conditions that require treatment and are not
known to my physician at the time the procedure is begun.
3. I consent to the administration of such anesthetics
considered necessary or advisable. I understand that all
forms of anesthesia involve risk and the possibility of
complications, injury, and sometimes death.
4. I acknowledge that no guarantee has been given by anyone
including My Brazil plastic surgery or any of the staff employed by
My Brazil plastic surgery as to the results that may be obtained.
If any litigation may arise as result of the surgery it can
only be done in Brazil under Brazilian Law and that
My Brazil plastic surgery, its management or staff can not be held liable
in any way what so ever.
5. I consent to the disposal of any tissue, medical devices
or body parts which may be removed.
6. IT HAS BEEN EXPLAINED TO ME IN A WAY THAT I UNDERSTAND:
a. THE ABOVE TREATMENT OR PROCEDURE TO BE UNDERTAKEN
b THERE MAY BE ALTERNATIVE PROCEDURES OR METHODS OF
TREATMENT
c. THERE ARE RISKS TO THE PROCEDURE OR TREATMENT PROPOSED
________________________________________
I CONSENT TO THE TREATMENT OR PROCEDURE AND THE ABOVE LISTED
ITEMS (1-6). I AM SATISFIED WITH THE EXPLANATION.
_________________________________________________________
Patient or Person Authorized to Sign for Patient
Date________________________ Witness_______________________
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