The Blepharoplasty Informed Consent is a ready-to-use healthcare & wellness template you can send for signature in minutes. It is written for 1 signer (patient) and, by default, expires 30 days after it is sent if left unsigned. It covers consent, plastic surgery, blepharoplasty, eyelid, cosmetic, surgical. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.
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# Blepharoplasty Informed Consent > **Important — not medical advice.** For use by a licensed provider; tailor to the patient, your protocols, and state law. **Patient Name:** ___________ **Date of Birth:** ___________ **Procedure Date (anticipated):** ___________ **Surgeon:** ___________ **Procedure planned:** ___________ --- ## 1. Procedure Description Blepharoplasty is a surgical procedure that removes or repositions excess skin, muscle, and/or fat around the eyelids to improve appearance and, in some cases, visual function. - **Upper blepharoplasty:** Excess skin and herniated orbital fat are excised through an incision placed in the natural eyelid crease. When excess skin significantly obstructs the superior visual field, the procedure may be functionally indicated. - **Lower blepharoplasty:** Excess skin, redundant muscle, and/or herniated orbital fat are addressed via a subciliary (below the lash line), transconjunctival (inside the eyelid), or skin-only incision. **Planned approach and details as discussed with your surgeon:** ___________ --- ## 2. Indications **Indication(s) documented by your surgeon:** ___________ Common indications include dermatochalasis (excess upper eyelid skin), superior visual field obstruction, periorbital fat herniation ("bags"), lower eyelid skin laxity, and cosmetic improvement of eyelid appearance. --- ## 3. Benefits Potential benefits include removal of excess eyelid skin, reduction of periorbital fat herniation, improved superior visual field (upper blepharoplasty when functionally indicated), rejuvenated periorbital appearance, and increased patient confidence. **Cosmetic results are not guaranteed. Individual outcomes depend on skin elasticity, brow position, midface anatomy, and healing response.**