BeautiFill is a closed system fat harvesting machine that utilizes a small cannula with an integrated laswe fier connected to a suction machine, performing simultaneous lase and suction, removing unwanted fat deposits.  Utilization of this device results in a reduction of treatment time, minimal body trauma (i.e. hematomas, bruising and swelling), faster recovery, high-quality fat with high fat-cell viability and enhanced skin tone and texture, among other benefits.

• Obesity: I understand that BeautiFill laser-liposuction is NOT a surgery to lose weight.
• Cellulite: I understand liposuction does NOT treat cellulite, a skin change characterized by irregularities and dimpling, mostly present in the abdomen and lower extremities.
• Weight Gain: The fat cells that are removed during liposuction do not return, but weight gain following liposuction can result in heaviness in other non-treated body areas.
• I understand that fat transfer is a procedure for augmentation of volume and/or correction of a defect and that NOT 100% of the fat transferred will be retained after the injection/transfer.
• I agree that the area(s) to be treated by BeautiFill laser-liposuction is/are:

	Upper Abdomen		Lower Abdomen		Flanks (“Love Handles”)		Bra-Line		Upper Back
	Breast - Tail		Arms		Inner Thighs		Outer Thighs		Hips
	Mons Pubis

• Fat Transfer Areas:

	Face		Hands		Breasts		Buttocks		Vulva
	Knees		Shoulder		Back (Facet)		Wrists		Ankles
	Feet

• I have had the opportunity to discuss with Dr. Richardson at Southern Grace Pain & Regenerative Medicine, the details of the operation, the alternatives of treatment, including not doing anything, the risks and complications of the surgery and what results to expect from the procedure.
• I understand that the surgery requires external incisions which will leave permanent scars whose locations have been described and demonstrated to me. The healed scars and their appearance may heal in a manner unknown at this time to either party.
• I realize that every surgery involves risks, including severe allergies to medications, excessive bleeding, damage to nerves and cardio-pulmonary complications that can be fatal.
• Risks of BeautiFill laser-liposuction and fat transfer:
  • Infection
  • Bleeding
  • Bruising
  • Hardening beneath the skin
  • Skin irregularities that may or may not disappear with time and may or may not need additional corrective surgery.
  • Increase or loss of sensibility of the skin which usually corrects over time.
  • Inappropriate wound healing à leading to keloid formation (a thick, hypertrophic and unattractive scar).
  • Poor retraction of the skin leading to loose skin.
  • Seroma formation
  • Skin burns

  • The most common complication associated with fat transfer include:

    • Necrosis of grafted fat by placement of too much fatty tissue in a small area.
    • Formation of lumps and bumps
    • Infection

Anesthesia: I authorize Dr. Richardson to administer local tumescent anesthesia with or without oral sedation during my procedure and I fully understand all the risks that are related to anesthesia administration during my procedure. Photography:

• I understand that the use of photographs and/or video is important for the evaluation and planning of the surgery and I agree that photos and/or video be taken before, during and after my procedure.
• I understand and authorize that in case of the unrestricted use of pre and post-operative photos, video and/or my surgical experience for public relations, advertising and internet site purposes, I will not be identified by name and that I will derive no compensation and/or benefits from their use.

I am aware that the practice of medicine and surgery is not an exact science and I acknowledge that no guarantees and/or assurances have been made to me concerning the results of my operation and If I am not entirely satisfied with the results of my surgery, additional surgery can be performed at an additional cost. I have received all pre and post-operative instructions and agree to read and follow them to the best of my ability, before, during and after surgery. I compromise myself to cooperate in all aspects of the post-operative care and notify of any complications and/or unusual symptoms that may arise during the course of the recovery period.

By signing this consent, I certify that all the medical information gathered during the pre-operative evaluation is complete, accurate and correct and I accept all the benefits and risks of my BeautiFill laser-liposuction and/or fat transfer procedure.  I am satisfied with the explanations of the surgery given to me.