INFORMED CONSENT for BROWLIFT SURGERY
This document contains information about browlift (foreheadplasty) surgery including risks, expected benefits, and alternative treatments. Please read each paragraph completely. If you have questions or encounter words you don’t know, ask Dr. Laverson. Your signature on the final page confirms your understanding and indicates your desire for the browlift (foreheadplasty) procedure.
The forehead, eyebrows, and upper eyelids often age visibly. Descent of these structures causes heavy appearing brows, eyelid skin redundancy, an appearance of fatigue, forehead furrows, and frown lines. In browlift surgery, these landmarks are lifted to smooth the forehead, raise the eyebrows, and improve frown lines. A browlift may be performed alone or simultaneously with facelift or other procedures.
There are several techniques for browlift. The selected approach depends on your aging, skin type, hair density and distribution, and your personal preferences. Browlift is individualized for each patient. Scar position varies with the technique selected. Browlift does not stop the process of aging.
Alternatives include no browlift surgery, or improvement of the aging forehead and brows by other methods such as Botox®, laser, injectable fillers. Risks and potential complications are associated with these alternative treatments.
RISKS of BROWLIFT SURGERY
Every surgical procedure involves risk. You should understand potential complications associated with browlift surgery. Your choice to undergo a surgical procedure is based on a comparison of risk to expected benefit. Although most patients do not experience complications, the following are the most frequently associated with browlift (foreheadplasty) operations.
Bleeding– It is possible, though unusual, to experience a bleeding episode during or after surgery. Should post-operative bleeding occur, it may require emergency treatment to drain accumulated blood (hematoma). Do not take any aspirin or anti-inflammatory medications for ten days before surgery, as this may increase the risk of bleeding. Accumulations of blood under the skin may delay healing and cause scarring. Non-prescription “herbs” and dietary supplements can increase the risk of surgical bleeding.
Infection‑Infection is unusual after this type of surgery. Should an infection occur, treatment including antibiotics or additional surgery may be necessary.
Change in skin sensation– Diminished (or loss) of skin sensation in the face and scalp area may not totally resolve after browlift surgery. Chronic itching sensations can occur within the scalp and brow following a brow lift. Abnormal sensation and/or scalp itching may be temporary or permanent.
Skin scarring‑ Excessive scarring is uncommon. In rare cases, abnormal scars may result. Scars may be unattractive and of different color than surrounding skin. There is the possibility of visible marks from sutures, staples, or hardware used during a browlift. Additional treatments including surgery may be necessary to treat abnormal scarring.
Change in surgical approach for browlift– In some situations, depending on factors discovered only at the time of surgery, your surgeon may have to make changes in surgical technique and approach to the browlift procedure. This may require changing from an endoscopic (closed) or limited incision procedure to a standard (open) browlift.
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– There is the potential for injury to both motor and sensory nerves during a browlift procedure. Weakness or loss in movements of the forehead or upper eyebrow may occur after surgery. Most individuals will notice a return of motor function; permanent weakness is rare. Injury may also occur in the sensory nerves of the forehead, scalp, and temple regions. Diminished sensation may normally occur in the scalp region after a brow lift surgery. Permanent numbness or painful nerve scarring is rare.
Damage to deeper structures– Deeper structures such as the eye, nerves, blood vessels, skull bone, and muscles may (rarely) be damaged during the course of surgery. The potential for this to occur varies with the type of browlift surgical procedure performed.
Asymmetry– The human face is normally asymmetrical. There can be a variation from one side to the other in the results obtained from a browlift procedure.
Delayed healing– Wound disruption or delayed wound healing is possible. Some areas of the brow and scalp may heal abnormally and slowly. Some areas of skin may die, requiring frequent dressing changes or further surgery to remove the non-healed tissue. Smokers have a greater risk of skin loss and wound healing complications.
Allergic reactions– In rare cases, local allergies to tape, suture material, or topical preparations have been reported. Systemic reactions which are more serious may result from drugs used during surgery and prescription medicines. Allergic reactions may require additional treatment.
Seroma– Fluid accumulations infrequently occur beneath the skin. Should this problem occur, drainage of the fluid may be indicated.
Long term effects– Subsequent alternations in forehead and upper eyebrow appearance may occur as the result of aging, weight loss or gain, sun exposure, or other circumstances not related to browlift surgery. Browlift surgery does not arrest the aging process or produce permanent tightening of the forehead. Additional surgery or other treatments may be necessary to maintain the results of a browlift procedure.
Eye irritation– Irritation or dryness in the eyes may occur after a browlift or when the patient has eyelid surgery performed at the same time.
Pain– Very infrequently, chronic pain may occur after browlift.
Hair Loss– Hair loss may occur within the scalp or surgical incisions. The occurrence of this is not predictable. Hair loss may resolve slowly or in rare cases be permanent.
Hardware and deeper sutures– Some surgical techniques use small screws or permanent deep sutures or absorbable Endotines® to suspend brow structures. In very unusual circumstances, a screw could penetrate through the skull. Intracranial injury is rare, but possible. If this occurs, additional treatment may be necessary. It may be necessary to remove hardware or deeper sutures at a later time.
Eyelid disorders– Disorders that involve abnormal position of the upper eyelids (eyelid ptosis), loose eyelid skin, or abnormal laxness of the lower eyelid (ectropion) can coexist with sagging forehead and eyebrow structures. Brow lift surgery will not correct these disorders. Additional surgical procedures may be necessary.
Unsatisfactory result– You may be disappointed with the results of surgery. Infrequently, it is necessary to perform additional surgery to improve your results.
ADDITIONAL SURGERY NECESSARY
There are many variable conditions which influence the long term result of browlift surgery. Even though risks and complications occur infrequently, the risks cited are the ones that are particularly associated with browlift (foreheadplasty). 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.
Most health insurance companies exclude coverage for cosmetic surgical operations such as browlift or any complications that might occur from surgery. Please carefully review your health insurance subscriber-information pamphlet.
The cost of surgery involves several charges for services provided. The total includes fees charged by Dr. Laverson, the anesthesiologist, and the surgery center. Special supplies and equipment needed for your procedure are included. Additional costs may be incurred should complications develop from the surgery. If indicated, the cost of surgical revision would be your responsibility. In rare cases when this is necessary, Dr. Laverson minimizes your associated expenses as much as possible.
Informed consent documents are used to communicate information about the proposed surgical procedure along with disclosure of risks and alternative 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, every patient is unique and this document should not be considered all inclusive in defining other methods of care and risks encountered. Dr. Laverson 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. This Informed consent document is 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.
Please understand the above information before signing the consent below.
CONSENT FOR BROWLIFT / FOREHEAD PLASTIC SURGERY
1. Dr. Steve Laverson and assistant(s) are requested and authorized to perform BROWLIFT / FOREHEAD PLASTIC SURGERY upon me. I have read the above information, and understand risks of forehead plastic surgery/browlift surgery, and alternative treatments.
2. Rarely, during the course of an operation and anesthesia, unforeseen conditions may necessitate different procedures than those above. Dr. Laverson is authorized to perform such other procedures that are in his professional judgment necessary, desirable, and in my own best interest. The authority granted under this paragraph shall include conditions that require treatment and are not known to Dr. Laverson at the beginning of surgery.
3. I consent to the administration of such anesthetics considered necessary or advisable. Although generally safe, all forms of anesthesia involve a small amount of risk and the possibility of complications, injury, and rarely death.
4. No guarantee or warranty is expressed or implied regarding the final result of the procedure.
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 BROWLIFT PROCEDURE
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______________________________