Dr Lanzer - Consent form for for Blepharoplasty I ____________________________ request Dr Lanzer to perform blepharoplasty on my eyelids. I am aware that this is a surgical procedure performed on the eyelids and surrounding skin. The procedure has been explained to me by Dr Lanzer in detail and I have read the information sheets provided to me. I understand the consequences of this procedure may include the following: 1. On the upper eyelid scars may occur at the site of the surgery. There may be temporary thickening of the scars until the eyelid heals, usually with a very fine scar or no scar. Very rarely, thickening or spreading of the scar can occur which would require intervention. 2. Rarely, following lower eyelid surgery, there is temporary lowering of the eyelid. This usually returns to normal once the inflammatory changes have settled, however very rarely further intervention may be required. This side effect called ectropion was very common in the past when the outer skin was cut when this procedure was performed without using the laser. Using the laser, the cuts to remove the bags are located on the inside of the lower eyelids and sutures are not required. 3. Bruising and swelling with surrounding tenderness will occur, however using the laser does dramatically reduce the incidence of these problems. 4. I am aware that there may still be residual unwanted projections of the skin, due to residual fat in the lower eyelids that may require follow up procedures. I understand that there may be a natural difference between ones eyes and on rare occasions this may be visible after surgery. 5. Other complications that may occur include infection, inflammation, bleeding and both dry or over teary eyes. When the inflammation settles, these problems usually return to normal. During the healing phase, ointments may be required for the dryness or any other temporary irritation of the eyes. If I am having laser resurfacing at the same time, I am aware of the risks associated with that procedure e.g. pigmentation, depigmentation and scarring. 6. There is an extremely rare risk that the eye may be damaged as well with blepharoplasty. This could include injury to the outer layer of the eye called the cornea or perforation of the eyeball itself. Partial and even complete blindness has occurred with eyelid surgery, likewise temporary damage to the surrounding muscles could affect vision. The eyeball is covered by a metal, non-penetrable shield, throughout the whole operation and therefore well protected. Blindness may result from bleeding which generally does not occur with laser surgery. Although Dr Lanzer has been performing this procedure for many years and has never had this complication it remains as a rare risk. 7. I am aware that allergic reactions canoccur both to the creams and oral medications that have been given to me and also to the local and general anaesthetics. 8. I am aware that alternative procedures are available such as brow lift and scalpel excision of the skin. Brow lifting is required if the eyebrows sag and this will also improve the loose appearance of the upper eyelid. Some patients require both blepharoplasty and brow lifts to obtain the optimum result. Often patients who really need both procedures do not have the brow lift, which has its own risks and side effects thereby accepting some residual "heaviness" of the upper eyelid. Scalpel surgery can be easier to manoeuvre than the laser in inexperienced hands and is also used to remove loose skin from the upper and lower eyelids. Laser treatment is often combined with BX Muscle Relaxants* injections of the lines around the eyes. (see page 60) BX Muscle Relaxants* reduces the frown and smile lines. Studies have shown that BX Muscle Relaxants* may prolong the results of the laser resurfacing by allowing the collagen to realign more firmly in a stationary position. 9. I agree to let Dr Lanzer know, should any changes happen in the course of my treatment that have not been explained to me. In particular, I will let the doctor know immediately if I develop abnormal vision or pain following the surgery. 10. I agree to follow the pre-operative and post-operative instructions that have been given to me by the doctor. 11. I consent to have photographs taken before and following the surgical procedure and I allow Dr Lanzer to use them for educational, medical and research purposes. 12. I have read this consent in full and I have discussed any points that were unclear to me with the doctor. I have been given ample time to raise any issues that were not clear to me. 13. I am aware that as with all surgery, cosmetic surgery is a serious procedure involving risks and that it should not be rushed into or undertaken lightly or without proper consultation including a discussion of the risks and alternatives which I have received from Dr Lanzer and his staff. 14. I am aware that surgery is not an exact science and involves healing of the body which varies between patients. Therefore, no guarantees of the amount of cosmetic improvement can be given. No promises or representations have been made to myself either orally or in writing by Dr Lanzer or his staff as to a particular outcome or as to the result or permanency of this procedure. * Due to Therapeutic Goods Administration (TGA) laws about advertising trade names in Australia over the internet, it has become necessary to label some treatments products with different names. Please call us on 1800 444 333 for more information or register as a patient online at www.drlanzer.com to access more detailed information.
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