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Consent Form Oculoplastic (Eye Lid or Blepharoplasty) Surgery

Are you considering oculoplastic surgery? Blepharoplasty is a great solution for drooping eyelids that can obstruct vision or result in a tired appearance.

Eyelid surgery can be performed on either the upper or lower eyelids, or on both – this will depend on an assessment of your eyes and desired outcomes.

Below are key considerations and consents for eye lid surgery or blepharoplasty at North Toronto Eye Care:

Risks of Treatment *

  • Infection following surgery: I understand that this is unlikely if I use the medications that will be prescribed for me and if I follow all recommended post-operative instructions.
  • Nerve damage: I may experience numbness in the operative area, but this is unlikely and generally self-limited.
  • Sensitivity: I may experience some transient hypersensitivity. In most instances, the sensitivity will be self-limiting and resolve in a period of days to months.
  • Recurrence: I am aware that recurrence in my eyelid condition is possible, and that repeat surgery is a possibility.  By and large, recurrences, if they occur, will happen many years after the initial surgery but in some cases, these can occur sooner.  It is possible in the case of a recurrence that surgery may need to repeated. 
  • Failure: I am aware that there is a minor chance that the intended procedure may not achieve the desired results.
  • Cosmesis:  I am aware every effort will be made to ensure a satisfactory and pleasing cosmetic outcome.  I understand however that no guarantee can be made in the cosmetic outcome of my surgery.   
  • Normal Post-Operative Sequelae: Post-operative pain, discomfort, swelling of the face,) discomfort, pain at the IV site (if sedation is given), bruising, or unanticipated allergic reactions.

Consent

  • Modifications / Additional Procedures: I understand that unforeseen conditions may call for modification or change from the anticipated surgical plan. These may include, but are not limited to, alteration in the surgical approach, additional procedures to repair unforeseen surgical obstacles, or termination of the procedure prior to the completion of all the surgery originally outlined.  
  • Revision: There is no method that will accurately predict or evaluate how my eyelids will heal. I understand that there may be a need for a revision procedure if the initial results are not satisfactory. In addition, the success of eyelid procedures can be affected by medical conditions, dietary and nutritional problems, smoking, alcohol consumption, concomitant eyelid conditions, previous eyelid surgeries, and medications that I may be taking. To my knowledge, I have reported to the surgeon any prior drug reactions, previous surgeries, allergies, diseases, symptoms, habits or conditions which might in any way relate to this surgical procedure.
  • Alternatives: I understand that alternatives to eyelids surgery include: no treatment, with the expectation of possible advancement of my condition.

No Guarantee: I acknowledge that no guarantee has been given to me that the proposed treatment will be 100% successful. In most cases the treatment should provide benefit in reducing the cause of my condition. Due to individual patient differences, the surgeon cannot predict certainty of success.

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Our Services and Direct Contact

Main Line: 416-748-2020

Cataract, Pterygium, Cornea Surgery:
Cataracts@northtorontoeyecare.com or Ashanna at Ext 212

Eyelid Surgery: Eyelids@northtorontoeyecare.com or Becca at Ext 110 or 416 748-4858

General and Appointments:
Drs@northtorontoeyecare.com or Lissa at Ext 111

Retina, Medical and Surgical:
Retina@northtorontoeyecare.com or Mirella at Ext. 109

LASIK, Crosslinking, and Intacs:
LASIK@northtorontoeyecare.com or Becca at Ext 110 at 416-748-4858

Co-management for Dry Eye and LASIK: LASIK@northtorontoeyecare.com or Becca at Ext 110 at 416-748-4858