This is an
informed consent document that has been prepared to help your plastic surgeon
inform you about blepharoplasty surgery, its risks, and alternative
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
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.
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
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
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.
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.
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.
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.
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.
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.
of the lower eyelid away from the eyeball is a rare complication.
Further surgery may be required to correct this condition.
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
may be needed to correct eyebrow sagging which contributes to upper eyelid
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
disruption or delayed wound healing is possible.
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.
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.
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
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.