Free Rhinoplasty Consent Form Template

Informed Consent for Rhinoplasty (Cosmetic and/or Functional Nasal Surgery)

Patient Informed Consent Documentation

Patient and Surgical Information

Nature and Purpose of the Procedure

Rhinoplasty is surgery to alter the shape, size, or function of the nose and may be performed for cosmetic reasons (to improve nasal aesthetics), functional reasons (to correct nasal obstruction), or a combination of both. In an open rhinoplasty, a small transcolumellar incision is combined with bilateral marginal incisions to elevate the nasal skin as a single flap and expose the underlying bony and cartilaginous framework directly. In a closed (endonasal) approach, all incisions are made inside the nostrils, limiting direct visualization but avoiding a visible external scar. Common surgical maneuvers include dorsal hump reduction (rasping or osteotomy of the nasal bones), tip refinement using suture techniques or cartilage grafting, osteotomies to narrow a wide bony base, septoplasty to correct deviated septum causing airway obstruction, and placement of cartilage grafts harvested from the septum, ear (conchal cartilage), or rib to provide structural support or augmentation. The procedure is performed under general anesthesia and typically takes 2 to 4 hours. A thermoplastic or plaster splint is applied externally for 7 to 10 days. Swelling is significant for the first 2 to 4 weeks and progressively resolves over 12 to 18 months before the final cosmetic result is apparent.

Realistic Outcome Expectations

Rhinoplasty is among the most technically demanding cosmetic surgical procedures. The final result is not apparent until 12 to 18 months after surgery when all residual swelling has completely resolved. Approximately 5 to 15 percent of primary rhinoplasty patients seek revision rhinoplasty for refinement of the result; revision surgery is more complex and carries higher technical risk than primary surgery. Digital morphing or computer simulation images used in preoperative consultation are approximations only and do not constitute a guarantee of the surgical result. The surgeon will strive to achieve the agreed-upon surgical plan, but anatomical variations, skin thickness, healing biology, and cartilage behavior may produce results that differ from preoperative simulations.

Material Risks and Potential Complications

Alternatives

Expected Benefits

The intended benefit of rhinoplasty is aesthetic improvement of nasal shape, size, or proportion consistent with the surgical plan discussed and documented preoperatively. In procedures combining rhinoplasty with septoplasty, an additional expected benefit is improvement in nasal airway patency and reduction of obstructive breathing symptoms. The surgeon will strive to achieve the agreed-upon goals, though final results are subject to healing biology and cannot be guaranteed.

Preoperative and Postoperative Photography Consent

Standard clinical photography will be taken before and after your procedure for your medical record documentation and surgical planning purposes. These photographs are protected health information and will not be shared publicly without your separate written authorization. If you consent to the use of your photographs for educational, teaching, or publication purposes, a separate media release form will be provided. You may decline use of your photographs beyond your medical record without affecting your access to care.

Smoking Cessation Requirement

Smoking substantially impairs wound healing, increases the risk of skin necrosis, graft resorption, and infection, and reduces the predictability of the surgical result. You are required to cease all smoking and nicotine product use (including vaping and nicotine patches) for a minimum of 4 weeks before and 4 weeks after surgery. If you smoke within this window, the surgeon reserves the right to postpone or cancel the procedure. Dishonesty about smoking status prior to surgery may result in poor outcomes that are not subject to revision at no charge.

Right to Refuse or Withdraw Consent

You have the right to refuse this procedure or withdraw your consent at any time before the procedure begins without penalty or adverse effect on your medical care.

Questions and Understanding Confirmation

I confirm that I have had the opportunity to read this consent form and ask questions. All my questions have been answered. I understand that final results take 12 to 18 months to manifest and that computer simulations are approximations only. I believe I am making an informed and voluntary decision.

Language Access and Interpreter Services

If English is not your primary language or if you require assistance communicating, a qualified interpreter is available at no cost. Please notify your care team before signing this document.

Copy of Consent Acknowledgment

I acknowledge that I have been offered a signed copy of this informed consent form for my own records.

Patient Authorization

I understand that rhinoplasty results take 12 to 18 months to fully manifest and that revision surgery may be required. I have reviewed computer-simulated images as an approximation only and understand they are not a guaranteed outcome. I consent to proceed with rhinoplasty as planned.

Signatures and Verification