Phenol Peel

In accordance with GMC guidelines, Kinvara Private Hospital requires a minimum two-week cooling off period between your initial consultation and any cosmetic surgery procedure. By signing this consent form, you confirm that this cooling off period has been observed, or where it has not been possible, that you have chosen to proceed with your full understanding and acceptance.

I confirm that I have truthfully disclosed my smoking and nicotine use status to my Consultant. I understand that smoking and the use of nicotine products significantly impairs wound healing and increases the risk of surgical complications. I have been advised to refrain from smoking and all nicotine products for a minimum of six weeks before surgery and until my Consultant confirms it is safe to resume.

I understand that a urine or blood test may be carried out immediately before surgery to confirm the absence of nicotine, and that if nicotine is detected, my procedure may be postponed at the discretion of my Consultant.

I understand that all forms of anaesthesia and sedation carry risks, including the possibility of complications, injury, heart attack, stroke, and in rare cases, death.

I understand that surgery carries a risk of blood clots, including Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE), and that preventative measures may include early mobilisation, compression devices, and anticoagulation therapy. Thrombosed veins may also develop around intravenous (IV) sites, which usually resolve without treatment. I have informed my Consultant of any relevant history, including blood clots, cancer, varicose veins, heart or lung conditions, recurrent miscarriage, obesity, recent long-haul travel, prolonged immobility, family history of clotting disorders, personal history of thrombophilia, or use of the oral contraceptive pill or hormone therapy. I have been advised by my Consultant whether to temporarily stop taking oral contraceptive pills, hormone replacement therapy, or any other oestrogen-containing medication before surgery, and I have followed this advice.

I understand that pulmonary complications such as chest infection, partial lung collapse, or fat embolism may occur, and that these risks are higher in smokers and those with pre-existing respiratory conditions. I understand that cardiac complications are a risk with any surgery and anaesthesia, even in patients without symptoms. If I experience shortness of breath, chest pains, or unusual heartbeats after surgery, I will seek immediate medical attention.

I understand that allergic reactions or adverse responses to anaesthetic agents, medications, or surgical materials may occur, ranging from mild skin irritation to severe anaphylaxis. I have provided my Consultant with a full list of all medications, supplements, and any known drug allergies.

I understand that where repositioning is required during surgery, there is a small risk of nerve injury or pressure-related skin damage.

I have informed my Consultant if I have been diagnosed with, or have symptoms suggestive of, obstructive sleep apnoea, including heavy snoring, witnessed breathing pauses during sleep, daytime drowsiness, or use of a CPAP machine. I understand that sleep apnoea increases the risks associated with general anaesthesia and that narcotic pain medications used after surgery may further compromise breathing during sleep.

I understand that ileus (temporary disruption of normal bowel function) may occur after surgery, particularly following general anaesthesia and the use of pain medications. Symptoms may include abdominal distention, nausea, and vomiting. In rare cases, aspiration of stomach contents into the lungs may occur, which can lead to pneumonia.

I understand that I must follow all Consultant instructions carefully, as this is essential for the success of my outcome. I understand that surgical incisions must not be subjected to excessive force, swelling, abrasion, or motion during the time of healing, and that personal and vocational activity needs to be restricted. I will not remove protective dressings or drains unless instructed by my Consultant.

I understand that successful postoperative function depends on both surgery and subsequent care, and that physical activity that increases my pulse or heart rate may cause bruising, swelling, fluid accumulation and the need for return to surgery. I understand that I must not drive a vehicle until advised by my Consultant that it is safe to do so, and that I must not drive while taking prescription pain medication. I have been advised to check with my car insurance provider regarding any restrictions on driving following surgery. I understand that I must attend all scheduled post-operative appointments as advised by my Consultant, and that failure to attend may compromise my outcome.

I understand that the cost of my procedure includes the fees for the surgery stated in my quote. I acknowledge that this quote does not cover any potential future costs for additional procedures that I may elect to have, or that may be required in order to revise, optimise, or complete my outcome.

I understand that should complications arise, additional costs may be incurred, and that any secondary surgery, further hospital admissions, or revision procedures will be charged separately and will be my financial responsibility.

I understand that complications arising from elective cosmetic surgery are generally not covered by private health insurance or the NHS, and that any treatment required for such complications will be my financial responsibility. I confirm that I have received and understood my quote prior to signing this consent form, and I accept responsibility for all associated costs, including any future treatments that may become necessary.