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Blepharoplasty

Patient Information & Consent

SIGN ONLINE

As a digital practice, all our consents and required documentation are completed and signed online. Before undergoing surgery at Inigo Cosmetic you will be required to complete two (2) forms. The information included on this page is part of the consent process. It is important that you read this information carefully, as proposed by your surgeon and agreed upon by you.

Once you are ready to sign your consent, please click the links at bottom of the page.

WHAT IS A BLEPHAROPLASTY?

A blepharoplasty refers to a surgical procedure to remove excess skin and/or muscle from the upper eyelids.

Blepharoplasty can improve drooping skin and bagginess by selectively removing or repositioning the tissue. This can help improve vision in older patients who have hooding of the 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. It will not remove “crow’s feet” or other wrinkles, eliminate dark circles under the eyes, or lift sagging eyebrows.

Results can be seen immediately, with final results noticeable after about 6 months when swelling has completely subsided. Results are dependent on genetics and lifestyle factors such as diet, sun exposure, smoking status, and overall skin health.

If required, patients may have additional procedures to tighten the surrounding skin.

The following patients may be unsuitable for treatment: patients with excess skin laxity around eyebrow area (will often suffer from dry eyes or produce a lack of tears), patients who suffer from glaucoma, patients with detached retina(s).

Patients must provide the clinic with clearance from their eye doctor prior to treatment.

ALTERNATIVE TREATMENTS

Alternative forms of management consist of not undergoing a blepharoplasty.

BLEPHAROPLASTY RISKS & COMPLICATIONS

Every surgical procedure involves a certain amount of risk and it is important that you understand these risks and the possible complications. In addition, every procedure has limitations. 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 these complications, you should discuss each of them with your surgeon to make sure you understand the risks, potential complications, and consequences.

BLINDNESS

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.

TEAR PRODUCTION ISSUES

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 should proceed with caution.

EYELID DISPLACEMENT

Displacement of the lower eyelid away from the eyeball is a rare complication (ectropion). 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.

HAIR LOSS

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.

SCARRING AND WOUND ISSUES

There is a possibility of visible marks in the skin from sutures.  this may require additional treatment or surgical intervention.

BLEEDING

Bleeding may occur after surgery which may require emergency treatment to drain accumulated blood or a blood transfusion. To minimise this risk, patients should follow the provided preoperative instructions: no blood thinning medication for 2 weeks before and after surgery.

INFECTION

Although infection is unusual after this type of surgery, it may appear in the immediate post-operative period. Treatment may include antibiotics. If an infection does not respond to antibiotics, hospitalisation may be required.

Individuals with an active infection in their body should not undergo surgery. It’s important to notify your surgeon of any other infections, such as ingrown toenail, insect bite, or urinary tract infection. Infections in other parts of the body, may lead to an infection in the operated area.

It is important that you understand the signs and symptoms of infection and notify the clinic as soon as possible of any concerns. Preventative antibiotics may need to be considered for future dental or surgical procedures.

SKIN CONTOUR IRREGULARITIES

Contour irregularities and depressions may occur. Visible and palpable wrinkling of skin can occur. Residual skin irregularities at the ends of the incisions or “dog ears” are always a possibility when there is excessive redundant skin. This may improve with time or it can be surgically corrected.

ASYMMETRY

Results may not be asymmetrical, this may require additional surgery to correct.

NOT LIFETIME RESULT

Although this surgery provides a permanent result. Changes in the appearance of your body, which may occur as the result of ageing, sun exposure or other circumstances not related to your surgery may affect your result.

CHANGE IN SKIN SENSATION

You may experience a loss or increased sensitivity in the surrounding skin which usually resolves in in 6 to 8 weeks. Partial or permanent loss of the skin is rare.

SKIN LAXITY

Patients with significant skin laxity will continue to have the same lax skin after surgery. The quality or elasticity of the skin will not change after surgery, and will in fact, get worse over time due to the ageing process. This may occur quicker for some than others.

UNSATISFACTORY RESULT

Although good results are expected, the precise degree of improvement cannot be guaranteed. There is no warranty expressed or implied, on the results that may be obtained. The outcome’s subjective nature also means dissatisfaction is a possible outcome regardless of the successful outcome of the surgery. In some situations, it may not be possible to achieve optimal results with a single surgical procedure. It may be necessary to perform additional surgery to achieve your desired results.

GENERAL SURGERY RISKS & COMPLICATIONS

SURGICAL ANAESTHESIA

Both local and general anaesthesia (including sedation) carry risks and complications. These may include injury and even death.

ALLERGIC REACTION

Local allergies to tape, stitches, topical preparations, or injected agents can occur. Serious life-threatening, systemic reactions including shock (anaphylaxis) may occur in response to the drugs used during surgery and/or medication prescribed after surgery. Allergic reactions may require additional treatment.

CARDIAC AND PULMONARY COMPLICATIONS

Pulmonary complications may occur secondarily to both blood clots (pulmonary emboli), fat deposits (fat emboli) or partial collapse of the lungs after general anaesthesia. Pulmonary emboli can be life-threatening or fatal in some circumstances.

Inactivity and other medical conditions may increase the incidence of blood clots. Notify your surgeon of any history of blood clots or swelling in the legs prior to surgery. Cardiac complications are a risk with any surgery and anaesthesia, even in patients without symptoms.

If you experience shortness of breath, chest pain, or unusual heart beats, seek medical attention immediately. Should any of these complications occur, you may require hospitalisation and additional treatment.
SHOCK

In rare circumstances, surgery 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, hospitalisation and additional treatment are required.

PAIN

Pain of varying intensity and duration may occur and persist after surgery. Chronic pain may occur as a result of trapped nerves in scar tissue or due to tissue stretching.

After your surgery you will be given a full course of prescription pain medication. We DO NOT provide repeat scripts for schedule 8 narcotics, benzodiazepines, or other drugs of dependence.
BLEEDING

If a bleed occur during surgery, it may require emergency transfer to a tertiary facility. A bleed that occurs after surgery is often known as a hematoma; this usually occurs within the first 3 weeks but can occur at any time. It may require emergency intervention to drain accumulated blood.

If a blood transfusion is necessary to treat blood loss, there is the risk of blood-related infections such as hepatitis and HIV (AIDS).

Increased activity too soon after surgery can lead to increased chance of bleeding. It is important to follow pre and postoperative instructions. Heparin medications that are used to prevent blood clots in veins can produce bleeding and decreased blood platelets. Unless cleared by your surgeon, avoid herbal supplements, aspirin, anti-inflammatory medications for at least 14 days before and after surgery.

HEALING ISSUES AND WOUND SEPARATION

The surgical area may not heal normally or may take a long time to heal. Areas may become necrotic (die). Wounds may separate after surgery. This may result in colour changes, shape changes, swelling, bleeding, or infection. It may require frequent dressing changes or further surgery; resulting in prolonged recovery and additional expense.

Issues with healing are more common in patients who smoke, have used steroid drugs, after chemotherapy/radiation to the treatment area, diabetes or other medical conditions, after massive weight loss, or excessive heat or cold therapy.

DAMAGE TO DEEPER STRUCTURES

There is the potential for injury to deeper structures including nerves, blood vessels, muscles, and lungs (pneumothorax) during any surgical procedure. The potential for this to occur varies according to the type of procedure being performed. Injury to deeper structures may be temporary or permanent.

FAT NECROSIS

Fatty tissue found deep in the skin might die and may result in areas of firmness within the skin. Additional surgery to remove areas of fat necrosis may be necessary. There is the possibility of contour irregularities in the skin that may result from fat necrosis.

SEROMA

Although swelling usually occurs after surgery. Excessive fluid may accumulate following surgery, trauma or vigorous exercise. This may require drainage.

LYMPHEDEMA

Persistent swelling (lymphedema) can occur in the legs after surgery.

VENOUS THROMBOSIS

Thrombosed veins, which resemble cords, occasionally develop in the area of the breast or around IV sites, and usually resolve without medical or surgical treatment. It is important to discuss with your surgeon any birth control pills you are taking. Certain high estrogen pills may increase your risk of thrombosed veins.

SKIN SENSITIVITY

Bruising and swelling normally occurs after surgery. Although uncommon, swelling and skin discolouration may persist for long periods of time and, in rare situations, may be permanent. 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 be permanent.

Nerve endings may become involved with healing scars during surgery. While there may not be a nerve injury, the small nerve endings during the healing period may become too active producing a painful or oversensitive area due to the small sensory nerve involved with scar tissue. This can usually be resolved with non-surgical intervention.

SUTURES

Most surgeries involve sutures, these may be dissolvable or may require removal by a medical professional. There are usually multiple layers of deep internal sutures. You may notice these sutures after your surgery. Sutures may spontaneously poke through the skin, become visible or produce irritation.

SCARRING

All surgery leaves scars, some are more visible than others. Abnormal scars may occur within the skin and deeper tissues. Internal scarring may result in excessive firmness to the area. Scars may be asymmetrical or a different colour to the surrounding skin. Scars may require additional treatment to correct. This may include, laser, IPL, topical creams, skin needling, or surgical intervention.

ADDITIONAL ADVISORIES 

SUN EXPOSURE

Surgical incisions are susceptible to damage from UV rays for up to 12 months following surgery (even if covered) and may result in pigmentation issues.

TRAVEL PLANS

Any surgery holds the risk of complications that may delay healing and delay your return to normal life. There are no guarantees that you will be able to resume all activities in the desired timeframe.

LONG-TERM RESULTS

Subsequent alterations in the appearance of your body may occur as the result of ageing, sun exposure, weight loss, weight gain, pregnancy, menopause, smoking, drug & alcohol use, or other circumstances not related to your surgery.

FEMALE PATIENT INFORMATION

Many medications including antibiotics may neutralise the preventive effect of birth control pills, allowing for conception and pregnancy.

INTIMATE RELATIONS AFTER SURGERY

Activity that increases your pulse or heart rate may cause additional bruising, swelling, or bleeding. This may require additional surgery. Refrain from intimate physical activities as instructed on the postop instructions.

MENTAL HEALTH AND ELECTIVE SURGERY

All patients who undergo elective surgery must have realistic expectations which focus on improvement rather than perfection. Complications or less than satisfactory results are sometimes unavoidable and stressful. Although many individuals may benefit psychologically from the results of elective surgery, effects on mental health cannot be accurately predicted.

SMOKING & NICOTINE PRODUCTS

Smoking, second-hand smoke, the use of tobacco or nicotine products (patch, gum, or nasal spray), greatly increases the risk of surgical complications. Risks include, tissue necrosis, delayed healing, wound breakdown, infection, scarring, hematoma formation, bleeding, increased or prolonged bruising and skin colour changes. This may require additional surgeries with expense.

Patients with breast implants are at a higher risk of developing capsular contracture. Patients with breast implants and poor wound healing issues are at a greater risk for requiring implant removal.

Patients must abstain from smoking and/or the use of nicotine products for at least 6 weeks before and after surgery (ideally 12 weeks).

The clinic may request a nicotine test prior to surgery. If the test returns a positive result your surgery will be cancelled, and the total cost of hospital and anaesthetic fees for the scheduled surgery will be forfeited and not returned.

The clinic is able to recognise the signs of poor wound healing which result from smoking/ nicotine products and may request a nicotine test. If a secondary surgery is required, patients are required to pay an additional surgeons’ fee of $1000. This is separate to third-party fees.

REVISIONS AND ADDITIONAL OPERATIONS

Every surgical procedure has associated risks and complications. The practice of medicine and surgery is an art, not an exact science. Although good results are expected, they are not guaranteed. There is no warranty expressed or implied, on the results that may be obtained.

In some situations, it may not be possible to achieve optimal results with a single surgery. Additional surgeries may be necessary at some time in the future and it is impossible to predict when.
When working with tissue and skin, results can be unpredictable and it is unknown how your tissue may respond or how you will heal after your surgery.
Results may depend on: skin quality, genetics, environmental factors, smoking, alcohol & recreational drug use, sun exposure, hormonal influences, general health of your body, ageing, pregnancy, stomach sleeping, implant size, implant texture, implant shape, and patient compliance.
If you develop a complication as a result of your original surgery you may need a revision. This will require further expenditure, which may include:
  • Hospital fee with general anaesthetic: $2200 – $9000, dependant on time required.
  • Clinic fee with local anaesthetic: $500 – $1500, dependant on time required.
  • Surgical fee based on situation and complexity: $500 – $4000.

Patients who are not in a good financial position to be able to afford a potential revision should NOT undergo surgery.

POSTOP INSTRUCTIONS

For a successful outcome – it is vital that you follow the postoperative instructions that have been provided to you.

SUPPORT PERSON

It is the patient’s sole responsibility to provide a support person for the ongoing care after surgery. If a support person and a health care professional needs to be arranged this will incur additional fees.

DISCLAIMER

Informed-consent documents are used to communicate information about the proposed surgical treatment along with disclosure of risks and alternative forms of treatment(s), including no surgery. 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.

You may be provided with additional or different information that is based on all the facts in your case and the current 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 based on all the facts involved in an individual case and are subject to change as scientific knowledge and technology advance and as practice patterns evolve.

  • The surgeon has provided me with medical advice, and I have agreed based on that advice to undergo the recommended surgical procedure of BLEPHAROPLASTY.
  • I have received the BLEPHAROPLASTY Patient Information & Consent Document which I have read and understood IN FULL.
  • I understand that I cannot have surgery if I am pregnant, breastfeeding and/or under the age of 18 and confirm that I am not pregnant, breastfeeding nor under the age of 18.
  • I consent to the administration of any anaesthetics that are considered necessary or advisable by the surgeon. I understand that all forms of anaesthesia involve risk and the possibility of complications, injury, and sometimes death.
  • I have been advised by the surgeon and I recognise and understand that during the operation, unforeseen conditions, which may not be known to the surgeon at the time the procedure has commenced, may require different procedures than those stated above.
  • I authorise and agree to the surgeon performing any such procedures that are in the exercise of his professional judgment necessary and desirable.
  • The surgeon has explained the limitations of surgery and the risks involved in these surgical procedures, and I understand and accept these risks.
  • I have had the opportunity to explain my goals to the surgeon and I understand which desired outcomes are realistic and which are not. I understand that there are no warranties implied or guaranteed about my outcomes.
  • I consent to the disposal of any tissue, medical devices or body parts that may be removed during surgery.
  • I consent to the utilisation of blood products should they be deemed necessary by the surgeon and I am aware that there are potential significant risks to my health with their utilisation as explained in the Information Document.
  • I consent to the collection and storage of my personal medical information and for it to be disclosed for my ongoing care or if required by law.
  • I consent for appropriate portions of my body to be photographed or filmed before, during, and after the procedure for marketing, medical, scientific or educational purposes, provided my identity is not revealed.
  • The surgeon is a Cosmetic Surgeon; therefore, Medicare rebates or Private Health Insurance rebates do not apply. I understand that most cosmetic procedures are not covered by Medicare.
  • All my questions have been answered, and I understand the inherent risks of the procedure that I have consented to undergo, as well as those additional risks, possible complications, benefits, and the alternative treatments available to me.
SMOKING
  • I understand that patients who smoke or use tobacco or nicotine products (patch, gum, nasal spray, or vaping) are at a greater risk for significant surgical complications.
  • I understand that if I am currently smoking or use nicotine products, or if I have not abstained for the recommended amount of time, additional risks and complications will apply as explained in the Patient Information & Consent Document.
  • I understand and accept that the clinic may request a nicotine test prior to surgery. If the test returns a positive result my surgery will be cancelled, and the total cost of hospital and anaesthetic fees for surgery will be forfeited and not returned.
  • I understand and accept that the clinic may request a nicotine test at any stage during the recovery period. If the test returns a positive result and if a secondary surgery is required, I will be required to pay an additional surgeons’ fee of $1000.
COVID-19
  • I understand that any symptoms of COVID-19 must be reported to the clinic. If I do not report symptoms my surgery will be cancelled and I will be responsible for the associated hospital and anaesthetic fees.
  • I understand that if I need to cancel or reschedule my surgery due to COVID-19, I will NOT be financially penalised – provided the clinic has been notified with supporting documentation.
REVISIONS AND UNEXPECTED OUTCOMES
  • I understand that my result may be unsatisfactory as the precise degree of improvement cannot be guaranteed. The outcome’s subjective nature also means dissatisfaction is a possible outcome regardless of of effectiveness of treatment.
  • I understand that ALL surgical procedures carry risks, complications, and unforeseen problems that may require further expenditure. I accept and recognise that the fees paid are for a performance of the surgery only, and not a guaranteed result.
  • I understand most cosmetic procedures have a 5% – 10% chance that a revision procedure is required to “touch up” or correct a complication that may have occurred: consistent with best practices worldwide.
  • I will be financially responsible for fees associated with any future procedure. This may include (but not limited to): airfares, accommodation, carer, time off work, loss of income, medications, pathology, diagnostic investigations, surgical garments.
  • If I require any future procedure, I will be responsible for the cost of third-party fees associated with hospital, anaesthetist, and implants (if required) – these prices are listed below.
    • Hospital fee with general anaesthetic: $2200 – $9000, dependant on time required
    • Hospital fee with local anaesthetic: $500 – $1500, dependant on time required
    • Surgical fee based on situation and complexity $500 – $4000
  • I understand that the surgeon’s fees are separate to aforementioned third-party fees. If a future procedure is required outside of the 12-month postoperative period, further expenditure will be required.
  • I accept that the need for, and timing of revisions will be determined solely by the clinic.
  • I understand and accept that where subsequent revision procedures become necessary all subsequent revision procedures provide results lower than results of a primary surgery.
  • I understand that any future procedure that I require or elect to have, is not covered by the original quote or fees previously paid.
  • I acknowledge that I have been informed of the risks and consequences associated with surgery. I accept responsibility for all clinical decisions, along with the financial costs of all future treatments.
ACCOUNTS AND PAYMENTS
  • A $1000 booking deposit is required to be collected at the time of booking in order to secure my surgical date and time. This amount is NON-REFUNDABLE.
  • I understand payment is required in full, 14 days prior to surgery. If payment has not been received, surgery will be cancelled and I will lose my booking deposit. An additional booking deposit may be required to reschedule.
  • ALL rescheduling, for whatever reason, will be determined solely by the clinic.
CANCELLATIONS AND RESCHEDULING
  • I understand that if I, for any reason, cancel my surgery more than 21 days prior to the date, all payment made, minus the $1000 booking deposit will be refunded.
  • I understand that if I, for any reason, cancel my surgery less than 21 days prior to the date, the booking deposit + 50% of the payments made will be refunded. The remaining 50% will be forfeited and not returned to me.
  • I understand that if I, for any reason, fail to attend my surgery without providing notice, all fees will be forfeited and not returned to me.
  • I understand that if I, for any reason, reschedule my surgery, this must be done more than 21 days prior to the date.
  • I understand that if I, for any reason, reschedule my surgery less than 21 days prior to the date, the booking deposit + 50% of the payments made will be forfeited and not returned to me. Additional payment will be required to reschedule.
  • I understand that if the clinic needs to reschedule my surgery, I will be financially responsible for any out of pocket expenses associated with surgery, including but not limited to: airfares, accommodation, travel.
DISPARAGEMENT CLAUSE
  • I agree that I will not make any disparaging comments about the surgeon that may cause hurt or embarrassment, damage their reputation, or defame them.
  • This includes any comment or statement published either orally or writing on any digital, print, electronic or online media, including my own or third party internet sites, private or public forums without the written consent of Inigo Cosmetic.
CONFIRMATION OF CONSENT
  • I hereby provide my fully informed consent to the surgeon to perform the surgical procedure, BLEPHAROPLASTY.
  • I understand this is purely, ELECTIVE COSMETIC SURGERY. I accept responsibility for the clinical decisions, along with the financial costs of any future procedures to revise, optimise, or improve outcomes.

SIGN YOUR CONSENTS ONLINE

Before undergoing surgery, you are required to complete the following form. These forms are signed online. These do work best in a Chrome web browser; if you are unable to complete these forms please contact the clinic.

Blepharoplasty Consent