Informed consent to lipografting


Operations such as lipografting, reduction of nasolabial faults correction
of lips etc., etc. are carried out in local anesthesia eventually in
analgosedation (the venous administration of an analgesic together with sedatives). Recovery time is about 10 to 14 days.


I agree that I will freely and knowingly undergo a surgical procedure at Dr. Michael Entner surgical practice. I do confirm that I have received the necessary information of the type of procedure and the informed consent to the surgical procedure. I understand fully all information provided to me and agree with it and I attach my signature freely and voluntarily. The procedure will be performed with due care and caution, using all the capabilities and experience of the doctor and his medical staff. In spite of this the complications may happen. In the case of unforeseen complications I authorize the doctor to undertake necessary course
of action. I also agree to undergo medical examinations during standard post-operative checkups, which will také place at recommended regular intervals. I accept and agree the fact that the
doctor and his team of medical persons do not bear responsibility for complications of a general or individual nature which may occur.
I agree/ do not agree to use of my photographs for publication or for educational purposes. With my signature, I also confirm that I have not withheld from the doctor or medical team any essential information which may result in possible complications such as: disease of chronicle nature, condition following an operation, injuries, intake of drugs or alcohol etc..
I'm aware of the possible consequences should an instruction be breached or not adhered to before, during
and after procedure as the doctor has informed, explain and submitted me before the operation.

Type of operation............................................................................................................................................

Clients Name and Surname.........................................................................................................................

Signature of the client.................................                      Signature of the doctor......................................................

date..........................................................................................