Thread Lift Informed Consent Form

After thorough consultation, I hereby request that Dr. Ramin Amighian perform Thread Lift to improve my facial appearance/signs of ageing.

Dr. Amighian has explained to me:

• The potential benefits of the proposed procedures
• Alternative procedures that may be suitable for my condition
• Likely outcomes of the proposed procedure
• The reasonable anticipated consequences if the procedure(s) is not performed
• The major risks involved in the proposed procedure(s)
• Possible temporary complications as well as the recovery period.
• Results may be temporary and several sessions with other complementing treatments over the course of the year may be needed for optimal results.

• I understand that final results of the procedure may not be seen for a period of at least 6-10 weeks.
• I have been invited to ask questions and received satisfactory answers. I have advised my doctor of any medical conditions or other circumstances which, to my knowledge, may render this treatment unsafe for me.
• Having discussed the various aspects of the procedure, the realistic expectations and having had all my questions answered by Dr. Amighian, I hereby authorise and direct Dr. Amighian to perform the procedures listed above on myself and any other procedure(s) that deem necessary during the course of the above procedure, should any unforeseen circumstances arise.
• I agree to have pre/post-operative photographs taken of the treatment site(s) and have them remain in the property of Dr. Amighian for clinical records, patient education.
• I understand that the practice of medicine is not an exact science and although good results are expected, they are not guaranteed.

I certify that I have discussed all the above with the patient and have answered all questions regarding the procedure. I believe that the patient fully understands what I have explained.