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Informed Consent



This is an informed consent document that has been prepared to help your plastic surgeon inform you about blepharoplasty surgery, its risks, and alternative treatments. 

 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.



Blepharoplasty is a surgical procedure to remove excess skin and muscle from both the upper and lower eyelids along with underlying fatty tissue.  Blepharoplasty can improve drooping skin and bagginess.  It can help improve vision in older patients who have hooding of their upper eyelids.  Although it can add an upper eyelid crease to the Asian eyelid, it will not erase evidence of one’s racial or ethnic heritage.  Blepharoplasty will not remove “crow’s feet” or other wrinkles, eliminate dark circles under the eyes, or lift sagging eyebrows.

 Blepharoplasty surgery is customized for every patient, depending on his or her particular needs.  It can be performed alone involving upper, lower or both eyelid regions, or in conjunction with other surgical procedures of the eye, face, brow, or nose.  Eyelid surgery cannot stop the process of aging.  It can however, diminish the look of loose skin and bagginess in the eyelid region.



Alternative forms of management include of not treating the skin laxness and bagginess in the eyelids by surgery.  Improvement of skin laxness, fatty deposits and skin wrinkles may be accomplished by other treatments or surgery such as a brow lift when indicated.  Other forms of eyelid surgery may be needed should you have disorders affecting the function of the eyelid such as drooping eyelids from muscle problems (eyelid ptosis) or looseness between the eyelid and eyeball (ectropion).  Minor skin wrinkling may be improved through chemical skin-peels or other skin treatments.  Risks and potential complications are associated with alternative forms of treatment.



Every surgical procedure involves a certain amount of risk, and it is important that you understand the risks involved.  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 blepharoplasty surgery.



It is possible, though unusual, to have a bleeding episode during or after surgery.  Bleeding may occur under the skin or internally around the eyeball.  Should you develop post-operative bleeding, it may require emergency treatment or surgery.  Do not take any aspirin or anti-inflammatory medications for ten days before surgery, as this may contribute to a greater risk of a bleeding problem.  Hypertension (high blood pressure) that is not under good medical control may cause bleeding during or after surgery.  Accumulations of blood under the eyelids may delay healing and cause scarring.


Blindness is extremely rare after blepharoplasty.  However, it can be caused by internal bleeding around the eye during or after surgery.  The occurrence of this is not predictable.



Infection is very rare after surgery.  Should an infection occur, additional treatment including antibiotics may be necessary.



Although good wound healing after a surgical procedure is expected, abnormal scars may occur both within the eyelid and deeper tissues.  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 in the eyelid or small skin cysts from sutures.  Additional treatments may be needed to treat scarring.


Deeper structures such as nerves, blood vessels, and eye muscles may be damaged during the course of surgery.  The potential for this to occur varies with the type of blepharoplasty procedure performed.  Injury to deeper structures may be temporary or permanent.



Permanent disorders involving decreased tear production can occur after blepharoplasty.  The occurrence of this is rare and not entirely predictable.  Individuals who normally have dry eyes may be advised to use special caution in considering blepharoplasty surgery.



The human face and eyelid region is normally asymmetrical.  There can be a variation from one side to the other following a blepharoplasty surgery.  



Chronic pain may occur very infrequently after blepharoplasty.


A blepharoplasty is a surgical procedure to tighten the loose skin and deeper structures of the eyelid.  Skin disorders and skin cancer may occur independently of eyelid surgery.



Displacement of the lower eyelid away from the eyeball is a rare complication.  Further surgery may be required to correct this condition.



Some patients experience difficulties closing their eyelids after surgery and problems may occur in the cornea due to dryness.  Should this rare complication occur, additional treatments or surgery and treatment may be necessary.



There is the possibility of a poor result from eyelid surgery.  Surgery may result in unacceptable visible deformities, loss of function, 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.  Additional surgical procedures such as a browlift may be needed to correct eyebrow sagging which contributes to upper eyelid problems.


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 may occur in the lower eyelash area where the skin was elevated during surgery.  The occurrence of this is not predictable.  Hair loss may be temporary or permanent.



Wound disruption or delayed wound healing is possible.


Subsequent alterations in eyelid appearance may occur as the result of aging, weight loss or gain, sun exposure, or other circumstances not related to eyelid surgery.  Blepharoplasty surgery does not arrest the aging process or produce permanent tightening of the eyelid region.  Future surgery or other treatments may be necessary to maintain the results of a blepharoplasty.



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.



If hooding of the upper eyelids interferes with your vision, your health insurance company may cover blepharoplasty surgery for the upper eyelids only.  Most health insurance companies exclude coverage for cosmetic surgical operations such as the lower eyelid blepharoplasty or any complications that might occur from surgery.  Please carefully review your health insurance subscriber information pamphlet.



There are many variable conditions in addition to risk and potential surgical complications that may influence the long term result of eyelid surgery.  Even though risks and complications occur infrequently, the risks cited are the ones that are particularly associated with blepharoplasty surgery.  Other complications and risks may 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.



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. 



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.  




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