Risks: This authorization is given with the understanding that any operation or procedure involves some risks and hazards. The more common risks can include the following: infection, bleeding, pain, swelling of the forehead and eyes, bruising, numbness, temporary redness of the scalp, ingrown hairs and allergic reactions. Some significant and substantial risks in this operation include poor or less than desirable results, scarring, and the need for additional transplant sessions. There may be additional risks associated with Follicular Unit Extraction (FUE) and recipient site making in particular and may include ingrown hairs in the donor area, inflamed cysts requiring surgical removal, scars larger than 1mm in diameter, less hair growth than would be expected from grafts obtained by strip harvesting methods, and detectability of scars when the head is shaved.
Dugs and Anesthesia: rThe administration of drugs and anesthesia, even local, also involves risks, most importantly, a rare risk of reaction to medications causing death. I consent to the use of drugs and anesthesia as may be considered necessary by (Dr. Germain).
Additional Procedures: If my doctor discovers a different, unexpected condition at the time of the procedure, I authorize her to perform such treatment as he deems necessary.
Permission of Photo use: I give (Marguerite Germain, MD, Germain Dermatology) permission to use my photos on her website, photo book and/or be used for teaching purposes. I understand that my face will be blocked out and my name will not be used without my permission.
No Guarantee: I understand that no guarantee or assurance has been made as to results of the procedure and that it may not cure the condition.
Questions and Answers: I have read and fully understand this consent form, and understand that I should not sign this form if all items, including all my questions, have not been explained or answered to my satisfaction, or if I do not understand any of the terms or words contained in this consent form.