The following facts should be made clear prior to surgery:
- The aim of the operation is improvement and not perfection. The patient should not have realistic expectations.
- There is always the possibility of minor revision procedures two to six months postoperative.
- Factors that might affect the outcome and are out of the surgeon`s control:Infection, scarring, keloid, wound contracture, irregularities, the effect of age, diabetes, atherosclerosis and skin elasticity.
- The technical skills of the surgeon are limited by:
- Nature and thickness of the investing skin.
- Strength and contour of the nasal cartilages.
- The uncontrollable and unpredictable scar contracture during the healing process.
- The autografts availability.
- The thickness of fatty tissue and facial asymmetry.
- Patient should accept the known risks of surgery such as:
Infection, bleeding, numbness, swelling, discolouration, keloid and dissatisfaction.
- Patient must accept as well the very rare risk of surgery and anaesthesia such as: Blindness, paralysis or even death.
- The patient should understand there is no guarantee whatsoever for surgery, because the surgeon has no control over the natural healing process of the body. However, we should emphasize and reassure the patient that we shall all do our best and use the best techniques that are available to achieve (by God`s help) the best possible results.
- Patient should be informed about possible airways impairments, and vasomotor rhinitis, which are usually transient but rarely persistent.
- Patient should accept using grafts from his ear, ribs, irradiated homografts and the use of necessary implants.
Signed informed consent and preoperative photographs are essential documentation that should be in the hands of the surgeons for good defense in medicolegal cases. Inform consent and good quality documented photographs with good doctor/patient relations will convince many unsatisfied patients to be satisfied and reduce medicolegal cases.
In our practice we use the following consent form:
I, the undersigned,_______________________________________________________
visited Dr. Bizrah’s clinic complaining of (all deformities should be listed)
I authorized Dr. Bizrah to perform the following procedures:
in relation to my case, these additional information explained clearly
I certify that it has been explained to me that the aim of the rhinoplasty operation is to achieve as much improvement as possible and perfection is not guaranteed. It has been explained that secondary procedures may be needed following primary procedures in order to achieve satisfactory results. I certify that it has been explained to me that the power of healing and wound contracture varies from person to person and that infections, fibrosis, scarring, irregularities, notching, pinching, retraction, collapse, deviations and keloids, may all occur due to some problems with wound healing and contracture and has nothing to do with the surgeons skills or surgical techniques. The skin and living tissue are not like wood or marble, so the living tissue may expand and contract and this is beyond the control of the surgeon. I understand that part of this surgery may require external skin incisions that might leave permanent scarring. I allow the surgeon to use cartilage or bony grafts from other areas of my body or from other people or to use medical implants. I understand that airway impairment may occur and might require medical or surgical treatment at a later date although this is rare. I understand and certify that it has been explained to me that the aim of functional nasal surgery is to improve the nasal airways but post nasal phlegm and allergies may persist. Complications of sinus surgery and surrounding structures have been explained clearly to me. Bleeding, septal perforation or adhesion may rarely occur. I allow the surgeon to take photographs and use them for teaching, research and academic purposes. Regarding the computer imaging, I certify that it has been explained to me that the service is only to provide illustrations and what changes might be possible through cosmetic surgery and no guarantees whatsoever are made to the specific outcome. I certify that I understand that complications of surgery and anaesthesia might occur which rarely may be serious. I am convinced that the surgeon and the anaesthetist will do their best and consider the highest possible care and management of my case. Therefore, I read and understand everything written in this consent and I authorize the surgeon and the anaesthetist to perform the required surgery and anaesthesia for my case. I certify that I have been given an informative booklet about my operation and postoperative instructions which I should follow.
Name of patient & signature Witness