Click here to download Atlanta Liposuction Operative Consent Form

Click here to download Atlanta Liposuction Surgery Protocol

The patient below signed appears today for the following surgeries (check appropriate box):

1. Liposuction/liposculpture
2. Brazilian Buttock Augmentation

I, the below signed, have had the opportunity to ask questions about the procedure, its limitations and possible complications. By signing below, I express that I clearly understand and accept the following myself or through my legal guardian.

Important key points for Brazilian Buttock Augmentation

It is extremely important that you sleep on your stomach or on your side as well as NOT sit directly on your bottom for at least 2 weeks after the procedure.

While driving or at work or at home sit on a rolled up towel positioned under your thighs or inner tube pillow so the fat transfer area does not have the full weight of your body resting on it.

It is also important to take the supplements after the procedure to enhance the results. In most cases about 70% of the fat remains after the transfer process and what you are left with after 3 months time is generally what will stay permanently with you not unless you have dramatic weight fluctuations.

Other things that can affect the quality of the fat transfer and how successful it is, meaning if you have 70% percent survival or more is to NOT have a history of smoking. Smokers who undergo this procedure may have ALL of the fat disappear after the transfer at a few weeks simply because the fat cells cannot survive in an environment where there is not good blood flow to the transplanted area and smoking causes decrease in blood flow.

Also patients who have had previous abdominal surgeries or liposuctions of any kind as well as lipodissolve have scar tissue buildup and the quality of this fat is generally not as good as virgin fat and the transplanted results are more variable.

It is extremely important to remember that everyone has a different body style and we will strive to our best ability to give you the best bottom we can based on the capacity of how much we can inject into the buttocks area based on your individual makeup and just how much the buttocks will accept.

For some people, we can inject as much as 800 to 900 cc in each buttock and others perhaps only 300 to 400. Everyone is different. Our goal is to give you a nice rounded contoured bottom.

One important point is for those who perhaps get less than the volume they expected on the first fat transfer. Many patients are very satisfied after a second procedure perhaps performed at a later time (several months out) to inject more fat.

1. The goal of liposculpture surgery, as in any other cosmetic procedure, is improvement of appearance; not perfection. It does not guarantee the reduction of any measurements, including the neck, waist and all other areas.
2. The final results will not be apparent for 3 – 6 months post-operatively. There is no guarantee that the expected or anticipated results will be achieved.
3. In order to achieve the best possible results, a “touch-up” procedure may be required. There will be a supply cost charge to you which is $1,500.00.
4. Areas of “cottage cheese” texture (cellulite) will have little change after liposculpture surgery.
5. Liposculpture surgery is a body contouring procedure and is not performed for purposes of weight loss.
6. Strict adherence to the post-operative regiment discussed by Dr. Carter (wearing an elastic garment for at least 4-5 weeks, exercise, diet and all other regimens discussed) is necessary in order to achieve the best possible results.
7. The surgical fee for the operation is paid three to four weeks prior to surgery.
   Although complications following liposculpture surgery are infrequent, I understand they may occur.
8. Bleeding is rare, and in rare instances could require hospitalization and blood transfusion. It is possible that blood clots may form under the skin and require subsequent surgical drainage. A collection of lymph fluid may develop which will require drainage..
9. Skin irregularities, lumpiness, hardness and dimpling may appear post-operatively. Most of these problems disappear with time generally over 4 weeks up to 6 months dependent upon your overall health, your age and the amount of fat that is removed. Rarely localized skin firmness, lumpiness and or irregularities may be persistent but most often can be addressed with touch up procedures. In dark-skinned patients, hyperpigmented scars (dark to black scars) can occur and be permanent. Other objectionable scarring such as keloids are possible. Other complications such as hematomas (collection of blood under the skin) can occur. If loose skin is present in the treated areas, it may or may not shrink to conform to the new contour.
10. Infection is rare, but should it occur, treatment with antibiotics and / or surgical drainage may be required. Hospitalization may be required for infection not responding to oral antibiotics. Those individuals who have diabetes or other conditions that compromise the immune system will have a potentially higher incidence of postoperative infection that MAY require a hospital stay and intravenous antibiotic therapy as well as irrigation and debridement of persistently infected areas.. This extra cost of the hospital stay and treatment should it occur will need to be covered ny the patients insurance or the patient themselves as this is an occurrence that is rare and not factored into the liposuction procedure cost. You may want to discuss the possibility of coverage with your carrier prior to having the surgery performed to see what the coverage will be.
11. Numbness or increased sensitivity of the skin over the treated areas may persist for months. It is possible that localized areas of numbness or increased sensitivity could be permanent.
12. Objectionable scarring is rare because of the small size of the incisions used in liposculpture surgery, but scar formation is possible.
13. Skin necrosis (dead skin) may occur in extremely rare cases as a result of liposculpture and may require skin grafting which will leave significant scarring.
14. Dizziness may occur during the first weeks following liposuction surgery, particularly upon arising from a lying or sitting position. If this occurs, extreme caution must be exercised while walking. Do not attempt to drive a car if dizziness is present.
15. I have been informed about the new Vaser™ (Ultrasound) treatment and have been informed by Dr. Carter that burns of the skin could occur, although every effort will be made to prevent this.
16. Allergic or toxic responses to anesthetic are extremely rare, but possible.
17. In addition to these possible complications, I am aware of the general risks inherent in all surgical procedures and anesthetic administration.

Patient initials:

My signature below certifies that I have read this entire document and discussed the above materials with Dr. Michael Carter. I understand the goals, limitations and possible complications of liposuction surgery and/or Brazilian Buttock Augmentation and I wish to proceed with the operation.

I hereby request, authorize and give my consent to Michael Carter, MD to perform liposculpture surgery and/or Brazilian Buttock Augmentation and whatever operations, treatments or technical procedures which may be deemed necessary or advisable in the diagnosis or treatment of my case.

I further understand and agree that certain procedures may be performed by an associate of Dr. Carter, under his supervision or control. I also give my permission to have such anesthetics administered as are deemed necessary or advisable during the operation, which I, am about to undergo has been explained to me in detail and I understand in general what is to be done, that there are calculated risks, and that Dr. Carter has not made any guarantee whatsoever.

By signing below, I attest that I’ve read this entire consent form, bullet points and numbered paragraphs and give this my consent.