INFORMED CONSENT FOR MEDIAL (INNER) THIGH LIFT
This document contains information about medial (inner) thigh lift surgery, its risks, and alternative treatment(s). Please read each paragraph completely. If you have questions or find words you don’t know, please ask Dr. Laverson. When all questions have been answered to your satisfaction, if you wish to have the thigh lift procedure, please affix your signature where indicated at the end.
Medial thigh lift is a surgical procedure to remove excess skin and fat from the medial (inner) thighs. Medial thigh lift is not a surgical treatment for being overweight. Obese individuals who intend to lose weight should postpone all forms of body contouring surgery until they have reached a stable weight. There are several different techniques for medial thigh lift. Medial thigh lift can be combined with other forms of body contouring surgery or performed at the same time with other elective surgeries.
Medial thigh lift is an elective surgical operation. Alternatives to this procedure include no surgery at all, containing and/or camouflaging the excess skin in clothing. Suction-assisted lipectomy (liposuction) surgery may be an alternative for people with good skin tone and localized fat bulging of the upper inner thigh in persons of normal weight. Diet and exercise regimens may be of benefit in overall reduction of excess body fat and contour improvement. Risks are also associated with these treatment alternatives.
RISKS OF MEDIAL (INNER) THIGH LIFT SURGERY
Every surgical procedure involves risk, limitations, and a chance of complications or unanticipated problems. Plastic surgery is not an exact science, and always carries with it an element of unpredictability. It is important to understand the risks and possible complications associated with medial (inner) thigh lift surgery if you are considering the procedure. Your choice to have the operation should be based on a comparison of risk to expected benefit. Although most patients do not experience complications, discuss each of them with Dr. Laverson to be sure you understand all possible consequences of medial (inner) thigh lift.
Bleeding- It is rare, but possible, to experience a bleeding episode during or after cosmetic plastic surgery. Blood transfusions may be required. Should post-operative bleeding occur, it may require an emergency treatment to drain the accumulated blood or blood transfusion. Do not take any aspirin or anti-inflammatory medications for ten days before surgery, as this may increase the risk of bleeding. Non-prescription “herbs” and dietary supplements can increase the risk of bleeding during or after surgery. Hematoma (a blood clot) can occur at any time. If blood transfusions are needed to treat blood loss, there is a risk of blood related infections such as hepatitis and HIV (AIDS). Heparin medications that are used to prevent blood clots in veins can produce bleeding and decreased blood platelets. You have a right to refuse transfusion of blood and blood products.
Infection- Infection is unusual after cosmetic surgery. Should infection occur, additional treatment including antibiotics, hospitalization, or additional surgery to drain the infection may be necessary.
Change in Skin Sensation– Diminished (or lost) skin sensation of the inner thigh and skin over the inner knee and leg is common after medial thigh lift. Diminished (or complete) loss of skin sensation usually improves after a medial thigh lift, but may be permanent.
Skin Contour Irregularities– Contour and shape irregularities and depressions may occur after medial thigh lift. Visible and palpable wrinkling of skin can occur. Residual skin irregularities at the ends of the incisions or “dog ears” are always a possibility as is skin pleating, when there is excessive redundant skin. This may improve with time, or it can be surgically improved or corrected.
Skin Discoloration / Swelling- Bruising and swelling normally develop after medial thigh lift. Skin at or near the surgical site can appear lighter or darker than surrounding skin. Although uncommon, swelling and skin discoloration may persist for long periods of time and, in rare situations, may be permanent. Swelling of knees, legs, ankles, and feet may occur for a variable duration (weeks to months) after medial thigh lift.
Skin Sensitivity-Itching, tenderness, or exaggerated responses to hot or cold temperatures may occur after surgery. Usually this resolves during healing, but in rare situations it may persist.
Sutures– Most surgical techniques use deep sutures (stitches). You may notice these sutures after surgery. Sutures may spontaneously poke through the skin, become visible, and/or produce irritation. The deep sutures may need to be removed.
Fat Necrosis– Areas of fat beneath the skin may die (fat necrosis) and develop scar, becoming lumpy. Areas of firmness may develop within or beneath the skin. Additional surgery to remove these lumps and/or areas of firmness may be necessary. Surface contour irregularity may resulting from fat necrosis.
Sensation of Thigh Tightness– After lifting the thigh skin, there can be a sensation of the thigh skin being tight. Usually this feeling subsides over time. Additional plastic surgery may be required to correct this problem.
Damage to Deeper Structures- There is potential for injury to deeper structures including, but not limited to, nerves, blood vessels, muscles, and lungs (pneumothorax) during any surgical procedure. The potential for injury depends on the type of procedure being performed. Injury may be temporary or permanent.
Pubic Region Distortion– It is possible, though unusual, for women to develop distortion of their labia or public area. Should this occur, additional treatment including surgery may be necessary.
Scarring- All plastic surgery produces scars, some more visible than others. Although good wound healing after surgery is expected, abnormal scars may occur on the skin and in deeper tissues. Scars may be wider or longer than anticipated, and may be unattractive. Scars can be of different color and/or texture than surrounding skin. The appearance may vary within the same scar, and exhibit contour variations and “bunching” due to the amount of excess skin. Scars may be asymmetric (appear different between right and left side of the body). Scars may be difficult to camouflage or conceal with clothing. There is a possibility ofvisible marks in the skin from sutures. Scars may require surgical revision or treatment.
Surgical Anesthesia– All forms of anesthesia involve some risk. There is a possibility of complications, injury, and extremely rarely, death from anesthesia or sedation.
Major Wound Separation- Wounds may open after plastic surgery. If this occurs, healing is delayed. Depending on the size and location of the open wound, additional treatment including surgery may be necessary.
Asymmetry– Symmetrical body appearance may not result from a medial thigh lift. Factors such as skin tone, fatty deposits, skeletal prominence, and muscle tone may contribute to normal asymmetry in body features. Most patients have differences between the right and left side of their body before any surgery is performed. Additional surgery may be necessary to attempt to improve asymmetry.
Delayed Healing– Wound disruption or delayed wound healing is possible. Some areas of the abdomen, flank, back, or buttocks may not heal normally and may take a long time to heal. Some areas of skin may die. This may require 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 materials and glues, blood products, topical preparations or injected agents have been reported. Serious reactions including shock (anaphylaxis) may occur to drugs used during surgery and prescription medications. Allergic reactions may require additional treatment.
Seroma or lymphocele– Fluid accumulation and/or cysts may develop beneath skin of the thigh. Should this occur, additional procedures for drainage of fluid and/or removal of the cyst may be indicated.
Shock– In rare circumstances, a plastic surgical procedure can cause severe trauma, particularly when multiple or extensive procedures are performed. Although serious complications are infrequent, infections or excessive fluid loss can lead to severe illness and even death. If surgical shock occurs, hospitalization and additional treatment would be necessary.
Pain- You will have pain after your surgery. Pain of varying intensity and duration may occur and persist after a medial thigh lift. Chronic (long lasting) pain may occur very infrequently from nerves becoming trapped in scar tissue after a medial thigh lift. Surgical or other treatment may be necessary.
Unsatisfactory Result– Although good results are expected from plastic surgery, there is no guarantee of a good result, or of any particular result. The outcome is never perfect. You may be disappointed with the results of medial thigh lift surgery. Dissatisfaction may arise due to asymmetry, visible scars, unacceptable deformities, bunching and rippling in the skin near the suture lines or at the ends of the incisions (dog ears), poor healing, wound disruption, and/or loss of skin sensation. It may not be possible to correct or improve these adverse outcomes. Additional surgery may be required to improve results.
Persistent Swelling (Lymphedema) – Persistent swelling in the legs, ankles, and/or feet may develop after medial thigh lift surgery.
Deep Venous Thrombosis, Cardiac and Pulmonary Complications- Surgery, especially longer procedures, may cause formation of, or increase in, blood clots within veins. Pulmonary (lung) complications may result from blood clots (pulmonary emboli), fat deposits (fat emboli), or partial collapse of the lungs after general anesthesia. Pulmonary and fat emboli can be life-threatening or fatal in some circumstances. Air travel, inactivity and other conditions may increase the incidence of blood clots traveling to the lungs causing a major blood clot that may result in death. It is important to discuss with your physician any past history of blood clots, swollen legs or the use of high estrogen birth control pills that may contribute to this condition. Cardiac (heart) complications are a risk with any surgery and anesthesia, even in patients without symptoms. If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment.
Long Term Results- Subsequent changes in the appearance of your body may occur as the result of aging, sun exposure, weight loss, weight gain, pregnancy, menopause or other circumstances notrelated to your surgery.
Metabolic Status Of Massive Weight Loss Patients Blood chemistry and protein levels may be abnormal following massive weight loss and weight loss related surgical procedures. Individuals with abnormalities may be at risk for serious medical and surgical complications, including delayed wound healing, infection, metabolic complications or even in rare cases, death.
Female Plastic Surgery Information- Tell Dr. Laverson if you use birth control pills, estrogen replacement, or if you believe you may be pregnant. Many medications including antibiotics may neutralize the preventive effect of birth control pills, allowing for conception and pregnancy.
Exercise and Sexual Activity After Plastic Surgery– Surgery involves coagulating of blood vessels and increased activity of any kind may open these vessels leading to a bleed, or hematoma. Activity that increases your pulse or heart rate may cause additional bruising, swelling, and the need for return to surgery and control bleeding. It is wise to refrain from vigorous exercise and sexual activity until Dr. Laverson states it is safe.
Smoking, Second-Hand Smoke Exposure, Nicotine Products (Patch, Gum, Nasal Spray)-
Patients who are currently smoking, use tobacco products, or nicotine products (patch, gum, or nasal spray) are at greater risk for plastic surgery complications. Skin may die and stink leaving open wounds with prolonged healing and additional scarring. Individuals exposed to second-hand smoke are at risk for similar complications attributable to nicotine exposure. Additionally, smokers may have problems with anesthesia and recovery from anesthesia, including coughing, localized areas of lung collapse, mucus production, and/or pneumonia. Individuals who are not exposed to tobacco smoke or nicotine-containing products have a lower risk of these problems.
DO NOT SMOKE, CHEW, OR OTHERWISE CONSUME TOBACCO PRODUCTS FOR SIX WEEKS OR LONGER CONTINUOUSLY AND CONSECUTIVELY PRIOR TO YOUR PROCEDURE, AND DO NOT RESUME SMOKING OR USE OF TOBACCO PRODUCTS AFTER SURGERY UNTIL PERMITTED BY DR. LAVERSON.
Post-bariatric patients– It is highly recommended that you quit smoking before undergoing this or any plastic surgery as it will adversely affect your outcome. Only under certain circumstances, clearly specified by Dr. Laverson, should this procedure be done on an individual who smokes.
Mental Health Disorders and Elective Surgery- All patients planning elective surgery should have realistic expectations that focus on improvement rather than perfection. Although Dr. Laverson always strives to achieve perfection, complications and imperfect results can be unpredictable and unavoidable, Additional surgery and expense may be needed. This is often are stressful. Please openly discuss with your surgeon, prior to surgery, any history that you have of emotional depression or mental health disorders. Although many individuals may benefit psychologically from the results of elective surgery, effects on mental health cannot be accurately predicted.
Medications– Over-the-counter, herbal, and/or prescription medications may cause adverse reactions. Check with Dr. Laverson about any drug interactions that exist with medications you are already taking. If you have an adverse reaction, stop the drugs immediately and call Dr. Laverson for further instructions. If the reaction is severe, go immediately to the nearest emergency room. When taking the prescribed pain medications after surgery, realize that they can affect your thought process. Do not drive, do not operate complex equipment, do not make important decisions, and do not drink alcohol while taking these medications. Be sure to take your prescribed medication only as directed.
ADDITIONAL SURGERY NECESSARY
Should complications occur additional plastic surgery or other treatments may be necessary. Secondary procedure(s) may be necessary to obtain optimal results. Although complications occur infrequently, risks described above are particularly associated with medial thigh lift. Other complications can occur but are less likely. 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 results that will be achieved. With medial thigh lift surgery, it may not be possible to achieve optimal results with a single procedure. This may require multiple surgical sessions to produce a satisfactory final outcome.
Following all physician instructions carefully is essential for a successful outcome. It is important that surgical incisions are not subjected to excessive force, tension, abrasion, or motion during healing. Personal and vocational activity must be restricted. Dressings and drains should not be tampered with or removed unless instructed by Dr. Laverson. Successful results depend on both surgery and your after care. Excessive physical activity may cause bruising, swelling, fluid accumulation, wound disruption, and the need for return to surgery. Please participate in follow-up care after your procedure to promote an uncomplicated recovery.
Medial thigh lift or complications of surgery may not be covered benefits of your health insurance. Please review your health insurance contract or call your insurance company for more detailed information. Most insurance plans exclude coverage for surgical revision.
The total cost of your surgery includes fees of the surgeon and the anesthesiologist, surgery center expenses, cost of special supplies or equipment, CosmetAssure™ insurance, and other incidentals. Even if surgery is covered by an insurance plan, you will be responsible for co-payments, deductibles, and all charges that the insurance company does not cover. Fees charged for this procedure do not include future costs for additional procedures that you elect to have or require to revise, optimize, or complete your result. Additional expenses may be incurred if complications develop from the surgery. Your signature below confirms that you have been informed of associated risks, alternatives, potential adverse consequences, and that you accept responsibility for the cost of future treatments.
Informed consent documents communicate information about the proposed surgical procedure, including associated risks and alternative possibilities for treatment. The informed consent process attempts to define principles of risk disclosure that meet the needs of most patients in most circumstances. Informed consent documents should not be considered all inclusive in defining other methods of care and risks. Dr. Laverson may provide you with additional or different information based on all the facts in your particular case and the current state of medical knowledge. Informed consent documents do not define or serve as the standard of medical care. Standards of medical care are based on 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 completely before signing below.
CONSENT FOR MEDIAL (INNER) THIGH LIFT SURGERY
1. Dr. Laverson and assistant(s) are authorized to perform MEDIAL (INNER) THIGH LIFT on me. I have read and understood all of the above information about risks, expected outcome, and alternatives to MEDIAL (INNER) THIGH LIFT.
2. Although extremely rare, during the course an operation, unforeseen conditions may necessitate an additional or different procedure. Dr. Laverson is authorized to perform such procedure(s) 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 at the commencement of surgery.
3. I consent to the administration of anesthetics considered necessary or advisable. All forms of anesthesia involve some risk and the possibility of complications, injury, and rarely death.
4. Although expected results have been discussed, no guarantee, warranty, or representation has been articulated by anyone describing the actual results that will be achieved.
5. Photography is authorized before and after the procedure(s) to be performed, including appropriate portions of my body, for medical, scientific or educational purposes, provided my identity is not revealed by the pictures.
6. I consent to the disposal of excess skin and fat which may be removed.
8. In the remotely possible situation that blood products are deemed necessary by Dr. Laverson, I consent to transfusion, and am aware that transfusion may pose risks to my health.
9. The surgeons’ fees are separate from anesthesia and surgery center charges. If a secondary procedure is necessary, further expenditure will be required.
11. I realize that not having the operation is an option.
12. MEDIAL THIGH LIFT HAS BEEN EXPLAINED TO ME IN A WAY THAT I UNDERSTAND, INCLUDING DETAILS OF THE PROCEDURE, ALTERNATIVE TREATMENTS, AND POSSIBLE COMPLICATIONS:
I CONSENT TO THIGH LIFT AND THE ABOVE LISTED ITEMS (1-12). I AM SATISFIED WITH THE EXPLANATION.
Patient or Person Authorized to Sign for Patient
Date __________________________ Witness ____________________________________