Fat Transfer

I, the undersigned patient, hereby grant my informed consent for the medical procedure of fat transfer. I have been provided with detailed information regarding the procedure, its potential benefits, and associated risks. I understand that the procedure is not without potential complications or adverse outcomes, and I willingly accept these risks after careful consideration.

Procedure:

Fat transfer, also known as fat grafting or lipofilling, is a surgical procedure that involves the removal of fat from one area of the body (donor site) and transferring it to another area (recipient site) for the purpose of volume augmentation, contour improvement, or rejuvenation. The procedure may be performed under local or general anesthesia.

Benefits:

1. Natural Volume Enhancement: The primary benefit of fat transfer is the ability to use the patient's own fat cells to augment or restore volume in specific areas, providing a natural-looking and long-lasting result.

2. Contour Improvement: Fat transfer can be used to improve body contours by filling in depressions, correcting asymmetry, and enhancing overall shape.

3. Rejuvenation: The procedure can help rejuvenate certain areas of the face or body by restoring lost volume and improving skin texture.

Risks and Complications:

1. Fat Resorption: After fat transfer, some of the transferred fat may not survive and be naturally absorbed by the body. This can result in a partial loss of volume and may require additional procedures to achieve the desired outcome.

2. Irregularities or Lumpiness: In some cases, the transferred fat may result in irregularities or lumpiness in the recipient area, which may necessitate corrective procedures or further refinement.

3. Infection: Despite adherence to strict sterile techniques, there is a risk of infection at the donor or recipient sites. Infections may require additional treatment, including antibiotic therapy or drainage.

4. Asymmetry: Achieving perfect symmetry may be challenging, and there is a risk of slight asymmetry between the donor and recipient sites or between treated areas.

5. Scarring: Incisions made during the procedure may result in visible scars, but efforts will be made to place them in inconspicuous locations.

6. Changes in Sensation: Temporary or permanent changes in sensation, such as numbness or altered sensitivity, may occur at the donor or recipient sites.

7. Hematoma or Seroma: Collection of blood (hematoma) or fluid (seroma) may occur at the donor or recipient sites, requiring drainage or aspiration.

8. Deep Vein Thrombosis (DVT): Prolonged immobilization after the procedure may increase the risk of developing a blood clot in the deep veins of the legs (DVT), which can be a serious condition.

9. Allergic Reaction: Although rare, there is a risk of allergic reactions to medications, anesthesia, or materials used during the procedure.

I have had an opportunity to ask questions and have received satisfactory answers regarding the procedure, its benefits, risks, and potential complications. I understand that there may be unforeseen risks or circumstances that could arise during the procedure. I acknowledge that no guarantees have been made regarding the results or outcomes of the procedure.

I hereby voluntarily consent to undergo the procedure of fat transfer. I have read and understood the information provided, and I authorize the physician and their designated medical staff to perform the procedure.

Patient's Signature: ________________________

Date: ________________________

Doctor's Signature: ________________________

Date: ________________________

**Please retain a copy of this consent form for your records.**