Informed consent and written instructions before surgery

The NHS advises patients to have a consultation with the person who will actually perform the cosmetic procedure before making a final decision. The Royal College of Surgeons similarly warns against agreeing to surgery before meeting the surgeon who will carry it out.

A useful consultation should cover:

• what the procedure is intended to change;
• what it cannot guarantee;
• how it will be performed;
• the type of anesthesia;
• expected recovery;
• important risks and complications;
• alternatives;
• aftercare;
• what happens if the result is not as expected.

You should be able to ask questions directly, not only through a sales representative.

For a structured list, see Questions to ask your surgeon.

A cosmetic procedure can improve a feature, but it cannot guarantee perfection, symmetry or a specific social or emotional outcome.

Ask:

• What change is realistic in my case?
• What cannot be changed safely?
• How much asymmetry may remain?
• How does swelling affect the early appearance?
• When is the result usually judged?
• Could aging, weight change or pregnancy alter the result later?
• What might make revision surgery necessary?

If the discussion focuses only on best-case before-and-after images, the consent process is incomplete.

A long list of complications is not enough if you do not understand what the words mean.

Ask the surgeon to distinguish:

• common temporary effects;
• common complications;
• uncommon but serious complications;
• procedure-specific long-term risks;
• risks related to anesthesia;
• risks related to implants or devices where relevant;
• risks that could delay your travel home.

You can use Understanding risks and complications in plastic surgery to prepare those questions.

Informed consent should include reasonable alternatives.

Depending on the situation, alternatives may include:

• a different procedure;
• a less invasive treatment;
• staged treatment;
• waiting;
• no treatment.

For elective cosmetic surgery, “not now” is a valid option. The NHS specifically recommends taking time to decide and walking away if you are not comfortable.

The anesthesia plan should not remain vague.

You should know:

• which technique is planned;
• who provides it;
• which parts of your medical history matter;
• fasting instructions;
• medication instructions;
• expected recovery;
• important anesthesia-related risks.

If you need a focused checklist, see Questions about anesthesia before plastic surgery.

Before surgery, understand both the advertised price and the costs that can appear if recovery is not straightforward.

Ask what the quote includes:

• surgeon;
• anesthesia;
• operating room or clinic;
• hospital stay;
• medicines;
• garments;
• tests;
• hotel;
• transfers;
• follow-up;
• revision surgery.

Then ask what is not included.

The Royal College of Surgeons recommends clarifying all planned and possible costs, including what may happen if further surgery is needed.

Do not let a deposit or non-refundable booking create pressure to consent before you are ready.

After surgery, pain, tiredness, medication and travel stress can make it difficult to remember verbal instructions.

You should leave with written information covering, where relevant:

• wound care;
• medicines;
• activity restrictions;
• showering or bathing;
• garments;
• signs that require contact;
• signs that require urgent local care;
• follow-up schedule;
• who to contact;
• return-travel restrictions.

Written information is especially important if your follow-up will happen in another country.

Keep copies of important consent and treatment documents.

Before leaving the clinic, ask for copies of:

• consent forms;
• procedure summary;
• implant/device information where relevant;
• prescriptions;
• discharge instructions;
• operative or discharge reports when available.

CDC medical-tourism guidance recommends obtaining medical records before returning home so they can be shared with later healthcare professionals.

You cannot give meaningful consent to information you do not understand.

If you prefer English, French, Arabic or another language, ask how the clinic will ensure that you can understand:

• the procedure;
• the risks;
• the alternatives;
• the consent form;
• postoperative instructions;
• follow-up messages.

If an interpreter is needed, ask whether the person is there to translate rather than to sell or persuade.

Do not sign a form simply because someone tells you it is “standard.”

You may think of consent as a one-time signature, but the decision continues until the procedure.

If something changes—your health, the proposed operation, the surgeon, the implant, the anesthesia plan, or your wishes—ask for the new information before proceeding.

You should also know what happens if you change your mind.

The NHS recommends a cooling-off period after cosmetic consultation and says patients can walk away if they are not comfortable.

Before the procedure, compare the written plan with your understanding.

Check:

• exact procedure name;
• body area and side where relevant;
• whether procedures are being combined;
• planned implant/device details where relevant;
• anesthesia type;
• surgeon name;
• facility;
• expected stay;
• aftercare arrangements;
• price and exclusions.

If something is different from what you discussed, stop and ask.

Consent is incomplete if nobody can explain what happens afterward.

Before surgery, know:

• who answers routine postoperative questions;
• who handles medical concerns;
• where follow-up takes place;
• what happens after you return home;
• what happens if a complication develops;
• what happens if revision is proposed;
• which costs may be yours.

For a practical framework, see Communication after surgery.