Dr Lanzer - Consent form for Tumescent Liposuction I______________________________, request Dr Lanzer to perform the procedure called Tumescent Liposuction. I have been informed of: 1. The potential benefits and risks of this procedure. 2. The alternatives such as lipectomy (cutting out fat and skin). 3. In particular, I have been warned that there may be residual waviness, indentation or, irregularities of the skin. In the rare circumstance this may require a second corrective procedure. 4. I am aware that all operations have a risk of skin infections, blood loss and clots in leg veins. 5. Cellulite or surface irregularities may not necessarily respond to this procedure and may appear worse. I understand the full cosmetic result can take 3 to 6 months to occur. 6. Bruising, numbness and swelling can all occur with this procedure. 7. I am aware that although death is extremely rare from liposuction by a dermatologist (not reported in the world as a direct complication, as of 2002), it has been reported when performed by non dermatologist under general anaesthetic particularly when combined with abdominoplasty. 8. I also give consent for photographs to be taken and used for medical, educational or research purposes. 9. I will present to Dr Lanzer immediately should any problems arise. 10. 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. 11. 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. 12. I understand that liposuction is not for weight reduction and that the best results occur if the procedure is combined with regular exercise and maintaining a healthy diet. If I am having mega liposuction (large volumes of fat) I am aware that the risks are elevated in particular infection which could cause scarring, bruising, localised fluid collection requiring drainage, bleeding, recovery from the anaesthetic, deep venous clots of the legs and even death. Megaliposuction does not necessarily lower patients weight but will reduce body shape and hopefully enhance weight loss when combined with exercise and diet. Mega-liposuction may require more than one procedure and there is increased risk of loose skin. 13. I have been given the opportunity to ask questions, have had sufficient time to read this consent form and based on the warnings have a reasonable expectation of the end cosmetic result.
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