Find a
Schedule an 

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.


  • 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.

Are You A lasik candidate?
Cataract Lifestyle Questionnaire
Are You Interested in Cosmetic Surgery For Your Eyes?

*Use our secure online portal to refer your patients. It is easy to use, completely secure, and utilizes digital communications to update you on the status of all your referrals and allows you to have 2-way digital communication with NTEC/Prism. This same portal keeps your patients updated on their appointments.

Contact Us

Our Services and Direct Contact

Main Line: 416-748-2020

General and Appointments:
Main Line or 416-748-4858 or

Cataract, Pterygium, Cornea Surgery:
Ext #308 or 320 or

Eyelid Surgery:
Ext #306 or

Ext #309 or

LASIK, Crosslinking, and Intacs:
Ext #319 or

Ext #305 or