INFORMED CONSENT for FACE & NECK LIFT SURGERY (Rhytidectomy)
This document contains information about face and neck lift surgery, including risks and potential alternative treatments. Please read each paragraph completely. If you have questions or there are words you don’t know, ask Dr. Laverson. Your signature on the final page confirms your complete understanding, and indicates your desire to proceed with face and neck lift surgery.
Face and neck lift, or rhytidectomy, is a surgical operation to improve visible signs of aging on the face and neck. As individuals age, many skin and connective tissue changes occur. These result in an aging appearance. Face and necklift are procedures designed to improve the most visible age associated changes. Structures beneath the skin are exposed and lifted to a more youthful position. Selected areas of skin and fat are removed or repostioned. A facelift can be performed alone or in conjunction with other procedures, such as browlift, eyelid surgery, or other procedures.
Face and necklift surgery is individualized for each patient. The best candidates for facelift surgery have face and/or neck soft tissue that has begun to sag, but whose skin has elasticity and whose bony structure is well defined.
Alternative treatment consists of no surgical procedure at all, or non surgical measures to improve features of aging. Laser treatment, Botox, injectable fillers, chemical peels, and minor office procedures can improve or correct wrinkles and other aging features. Risks and potential complications are associated with these alternative treatments as well.
RISKS of FACELIFT (Rhytidectomy) SURGERY
Every surgical procedure involves risk. Because you are considering face and/or necklift, it is important to understand and consider the risks and possible complications of this procedure. Your choice to have plastic surgery should be based on a comparison of the risk to expected benefit. Although most patients do not experience complications, the following adverse outcomes are those most often associated with face and/or necklift.
Bleeding– It is possible, though unusual, that you may have abnormal bleeding during or after surgery. Should post-operative bleeding occur, it may require emergency treatment to drain accumulated blood and to stop ongoing hemorrhage (bleeding). Do not take any aspirin or anti-inflammatory medications (except Tylenol) for ten days before surgery because this increases the risk of bleeding. Non-prescription “herbs” and dietary supplements can increase the risk of abnormal bleeding. Hypertension (high blood pressure) that is not under good control may also 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 and/or surgery may be necessary.
Scarring– Although good wound healing after a surgical procedure is expected, abnormal scars may develop within the skin and deeper tissues. Scars may be unattractive and of different color than surrounding skin. There is a 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 asymmetric (right and left sides not identical). 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 a possibility of complications, injury, and even (extremely rarely) death from anesthesia or sedation.
Nerve injury– Motor and/or 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 movement and feeling. Recovery of sensation and/or facial movement may or may not occur with the passage of 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 face and/or necklift 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 or scalp where the skin was elevated during surgery. The occurrence, location, and amount of hair loss may be unpredictable.
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
Many conditions influence the long term result from face and/or necklift surgery. Although complications occur infrequently, the risks cited are those particularly associated with face and necklift surgery. Other complications 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 with respect to the final results of your face and/or necklift.
Health insurance plans exclude coverage for cosmetic surgical operations such as the facelift (rhytidectomy), necklift, and any resulting complications. Please carefully review your health insurance contract for more information.
The cost of surgery involves several charges for services provided. The total includes fees charged by Dr. Laverson, the anesthesiologist, the surgery center, and any required specialized surgical equipment, supplies, and postoperative garment(s). If an overnight stay is necessary, this is included in the cost to you. You may be charged for additional treatments if they become necessary because of surgical complications. In the unusual case that it becomes necessary, Dr. Laverson tries to minimize the cost to you of surgical revision .
Informed consent documents communicate information about planned surgical treatment, disclose risks, and propose treatment alternatives. The informed consent process attempts to define principles of risk disclosure that should generally meet the needs of most patients in most circumstances.
However, 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.
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.
Understood the above information before signing the consent for surgery below.
CONSENT FOR FACE LIFT AND NECK LIFT SURGERY
1. Dr. Steve Laverson and assistant(s) are requested and authorized to perform FACE LIFT AND NECK LIFT SURGERY upon me. I have read and understand the above information. My questions have been answered. I am aware that complications may occur after facelift and necklift surgery, that the procedure is associated with risks, and there are alternatives to facelift and necklift surgery.
2. Rarely, during the course of facelift or necklift, unforeseen conditions necessitate additional or different procedures than those planned. 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 all conditions that require treatment and are not known to Dr. Laverson at the commencement of surgery.
3. I consent to the administration of such anesthetics considered necessary or advisable. All forms of anesthesia involve some risk and the possibility of complications, injury, and rarely death.
4. There is no guarantee of a satisfactory result after face lift and neck lift surgery.
5. I consent to photography before, during, and after the procedure, including appropriate portions of my body, for medical, scientific or educational purposes.
6. I consent to the disposal of any tissue, medical devices or body parts which may be removed.
7. IT HAS BEEN EXPLAINED TO ME IN A WAY THAT I UNDERSTAND:
a. FACE AND NECK LIFT SURGERY DETAILS
b. ALTERNATIVE PROCEDURES OR METHODS OF TREATMENT
c. RISKS OF FACE/NECK LIFT AND POSSIBLE COMPLICATIONS
I CONSENT TO FACE AND NECK LIFT AND THE ABOVE LISTED ITEMS (1-7).
I AM SATISFIED WITH THE EXPLANATION.