Liposuction is a body contouring and sculpting technique.  It is a means of reducing localized fat deposits that are difficult to remove with diet or exercise.  Liposuction is not a technique for treating obesity. Having firm, elastic skin will result in a better final contour after liposuction. Hanging skin will not reshape itself to the new contours and may require additional surgical techniques to remove and tighten excess skin. 

In the tumescent technique of liposuction, a very dilute anesthetic solution is injected under the skin into the fatty tissue before it is removed. Afterward, compression garments are worn for drainage and support .

I clearly understand and accept the following:

The goal of liposuction surgery, as in any cosmetic procedure, is improvement – not perfection. The final result may not be apparent for 3 to 6 months post-operatively. In order to achieve the best possible result, a “touch-up” procedure may be required. Areas of “cottage cheese” texture (i.e. cellulite) will be changed little by the liposuction procedure.

Liposuction surgery is a contouring/sculpting procedure and is not performed for purposes of weight reduction, nor as a substitute for healthy diet and exercise. Strict adherence to the post-operative regimen and instructions is necessary in order to achieve the best possible results. There is no guarantee, expressed or implied, that the expected or anticipated results will be achieved.

I have not taken any aspirin or aspirin-containing products for a minimum of two (2) weeks prior to my surgery.

I understand that liposuction surgery is contraindicated in certain patients (see below) and that I am not one of these patients:
Women who are pregnant or believe they might be pregnant
Women who are nursing
Patients with active thrombophlebitis or active infection
Patients with poor circulation or confined to bed
Patients with a history of pulmonary embolism or blood clots in the lungs
Patients with uncontrolled diabetes mellitus or uncontrolled collagen vascular disease (e.g. Lupus, etc.)
Patients with a history of uncontrolled bleeding

POSSIBLE SIDE EFFECTS                                         

Normal temporary side effects associated with liposuction surgery include soreness, inflammation, bruising, swelling, numbness, and minor irregularity of the skin. Some of these effects can take several months to resolve.

Skin irregularities, lumpiness, hardness, and dimpling may appear post-operatively.  Most of these irregularities disappear with time and/or massage, but localized irregularities may persist permanently.  If loose skin is present in the treated area, it may or may not shrink to conform to the new contour.  Very rarely, significant skin wounds can occur leading to scarring and delayed healing

Infection is rare, but should it occur, treatment with antibiotics and/or surgery may be required. 

Numbness or increased sensitivity of the skin over treated areas may persist for months. Rarely, it is possible that localized areas of numbness or increased sensitivity could be permanent.

If a laser or internal ultrasound is used, burns can rarely occur on the skin

Objectionable scarring or pigment changes is unusual because of the small size of the incisions used in liposuction surgery, but scar formation or permanent pigment changes are possible.

Slightly or significantly irregular sides or areas, or unevenness from one spot to another.  This can particularly occur if weight gain occurs.

Bleeding, hematomas and collection of blood underneath the skin. Surgical bleeding is very rare using the tumescent technique of liposuction surgery; however, it could theoretically require hospitalization.

Temporary accumulation of fluid under the skin (seroma) may occur, requiring possible surgical drainage.

DVT (blood clot in the leg) and Pulmonary emboli (blood clots that can go to the lung), very rarely.  These are serious and would require a blood thinner. 

Fat Emboli(Fat particle circulating in the blood). This is extremely rare in liposuction.

Any of the serious complications listed above could require hospitalization and significant expense.

 

In addition to these possible complications, I am aware of the general risks inherent in all surgical procedures and anesthetic administration.  Although rare with tumescent liposuction surgery, unexpected severe complications can occur, including but not limited to:  allergic reaction, paralysis, convulsions, blood clots, strokes, heart attack, brain damage, or even death.

 

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.

In the event of an emergency, I hereby give my consent to my transfer to a nearby hospital.  I understand that I am responsible for any transportation expenses incurred for my care during the time I am in transit between institutions, as well as any hospital, physician, laboratory, or radiological expenses.

 

Alternative forms of management consist of not treating the areas of fatty deposits. Diet and exercise regimens may be of benefit in the overall reduction of excess body fat. Direct removal of excess skin and fatty tissue may be necessary in addition to liposuction in some patients.

 

Realistic Expectations:  Although the results of liposuction are often quite spectacular, it is not realistic to expect perfection.  It is impossible to guarantee the precise amount of improvement that will result from liposuction.  Patients should not have unrealistic expectations.  Although patients can usually expect to achieve at least a 50% improvement, it is unreasonable to expect 95% improvement or near perfection.  For the perfectionist, or for liposuction of a very large area, maximum improvement may require a second procedure for which an additional fee may apply. Patients who would be satisfied with a 50% improvement would be reasonably good candidates for liposuction.  The “50% Improvement” is intentionally a vague measure.  It indicates a definite perceptible improvement, but something short of perfection.  If a 50% improvement would make a patient happy, then it is likely that these expectations will be met.

Longevity of Results:  The fat cells that are removed by liposuction do not grow back.  If the patient later gains or loses weight, the change tends to be distributed proportionately over the entire body.  Although one can expect some changes with aging, provided that the patient does not gain large amounts of weight, the new, more pleasing silhouette is relatively permanent.

Cosmetic Surgery - A $500.00 non-refundable scheduling deposit is required to secure a surgery date. This deposit will be applied to your surgical fees unless the surgery is cancelled or rescheduled within 10 business days of the scheduled surgery date. The remaining balance is due 10 business days prior to your surgery.  You are responsible for x-ray, laboratory, pathology, and medication fees if necessary.  Cosmetic surgery procedures are not covered under health insurance.

Revisions are occasionally necessary in cosmetic surgery and will be performed within one year of surgery with no separate surgeon fee at the doctor’s discretion. However, facility and anesthesia fees will apply for revision procedures.

I have read and understand the above Financial Policy. I have had the opportunity to address questions about this Policy, and all my questions have been answered to my satisfaction. I agree to be bound by the terms of this Policy.

 

I authorize Dr. Brett Kotlus, and/or his representative(s), to take photographs or film/video of me or parts of my body for the for medical purposes and to be used for my care, medical presentations and/or articles.

In addition, I authorize the use of these images, without compensation to me, for the following specific purposes: (Please check the boxes marked Yes or No for each item)

I have been informed by Brett Kotlus, M.D. and his staff, that the risks of all aspects of surgery are significantly increased in patients who smoke or have been a smoker. I understand that it is recommended to discontinue smoking for a minimum of six weeks prior and three weeks following surgery. Despite such precautions, there are still additional risks such as infection, scarring, bleeding and tissue loss in patients with a smoking history. I recognize and accept these additional risks as well as any other treatment or procedures that may be required.

I have read this informed consent and certify that I understand its contents in full.  I have had enough time to consider the information from my physician and feel that I have had enough time to consider the information from my physician and feel that I am sufficiently advised to consent to this procedure.  I hereby give my consent to this procedure and I have been asked to sign this form after my discussion with the physician.  I agree to have my photos taken for record keeping, comparison and research purposes.