Intralipotherapy Treatment Information and Consent

General Information

Before illustrating the risks and benefits of the proposed treatment it is important for you to know that the purpose of aesthetic medicine is to correct defects or dysmorphia of various kinds.

The purpose of the following consent form is to provide the patient, in addition to the pre-treatment interview with the practitioner, with all information concerning the characteristics and the risks connected to intralipotherapy treatment using sodium deoxycholate-based solutions. Therefore, we ask you to read the document with care and to discuss with your practitioner with regard to the explanation of all terms that are not clear, before signing as confirmation of fully understanding the information received.

Non-localised fat deposits are subcutaneous adipose tissue accumulations in specific anatomical areas that alter the body silhouette. They are unsightly and unresponsive to the normal signals to activate the metabolism (low calorie diet, physical exercise). They can be successfully treated with intralipotherapy. It uses adipocitolytic solutions that are solutions containing natural cleansers that cause fat cell lysis. Using intralipotherapy, the solution is released parcel style and evenly, directly into the fat layer, gradually reducing the size. The treatment can be repeated after a suitable period. The solution is slow-acting and the gradual action needs time to achieve the treatment aim the fat cells in the layer treated with sodium deoxycholate will undergo lysis and then a process of degradation and disposal through the lymphatic system.

Non-Surgical Fat Reduction

Before carrying out the treatment, it is necessary for the patient to undergo careful examination while standing. The treatment includes injection of the substance directly into the fat layer, using the special intralipotherapy needle. Needle access is limited (generally 1-3 per area). It is possible to feel mild-moderate pain during the treatment, although this is typically easily tolerated / ignored. The treatment is followed by slight pain, redness, swelling and bruising. These problems are very frequent, transitory and should be considered a normal consequence of the treatment. If the patient notes anomalous symptoms during the period after treatment, meaning anything not described by the qualified practitioner, they must contact him / her without delay.

Post-treatment Period

Edema, bruising and pain in the treated area are extremely frequent (more than 50% of cases) but generally do not limit a normal social life or physical activity. Containment means (sleeves, girdles…), lymph drainage or pressotherapies are strongly recommended for the days after treatment. It is in any case important to follow the instructions of the qualified practitioner, which will vary according to each case, based on different factors such as the body area treated, the patient’s characteristics and the progress of the post-treatment period.

Alternative Treatments

Surgical and other alternatives include liposculpture, laserlipolysis, cryolipolysis, ultrasound therapy, gas contouring and mesotherapy. Each of these methods has risks and potential complications.

Treatment Risks

• Prolonged pain – this may last for days or even weeks
• Allergic reactions (<0.002%) – are possible and will require systemic treatment
• Nodules (0.05%) – Transitory and only permanent in very exceptional circumstances. In case of persistence, they can be treated with dedicated therapy (localised infiltration, gas, excision)
• Unsatisfactory results (<0.3%) – it is possible to be disappointed with the results of the treatment. This may be due to partial correction or the occurrence of flabby skin, asymmetry, and irregularity
• Damage to deep structures (<0.01%) – deep structures such as nerves, vessels, and muscles, can be damaged during the procedure. The damage may be temporary or permanent.
• Discolouring (<0.002%) – these are generally temporary and often related to bruising, but in rare cases, they can become permanent. It is important to protect the skin against external factors through to the healing of the skin (avoid skin, UV lamps, saunas etc.)
• Necrosis of the skin (0.0076%) – blisters and bruising are a cause for the patient to be alert. When these occur, it is essential for frequent medication and specific provisions as envisaged in specific treatment protocol.

Intralipotherapy (Fat Dissolving) Consent Form

Informed Consent

I hereby authorise the practitioner and the staff of the same to change, according to science and conscience both during treatment and in the period following it. I hereby accept to undergo medical and physical treatment that is prescribed to me in the period post-operational, since I am informed that if this is not the case, I will compromise the outcome of treatment. Since medicine is not a precise science and since the exact result cannot be programmed beforehand, nor can the occurrence of complications, since these events depend not only on the method used but even more so, on the body’s response to it. I consent to being photographed before, during and after the intervention for the purpose of clinical documentation that the practitioner undertakes to use only in a scientific context and with guarantees of absolute anonymity. I have also been informed of all possible complications. I am aware of the fact that during the treatment and in the period after, it may be necessary, at the opinion of the practitioner, to undergo additional procedures or procedures other than those illustrated previously. I accept to return for further examination as and at the intervals required by the practitioner. I am aware that failure to attend the check-ups after treatment may be a cause of complications, even severe. I confirm that I have received extensive information and that I have received answers to all my questions. Therefore, I consent to undergo intralipotherapy treatment using adipocitolysis solution. I authorise the practitioner and his or her staff to perform the medical and surgical treatments required before and after. I also state that I will follow all the post-operative instructions as prescribed by the practitioner.