Patient Consent Form
Your Medical Consent & Our Legal Disclaimer
Hair Implantation Operation (Follicle Unit Extraction - FUE)
FUE is a procedure that involves transplanting hair from one area of the scalp to a site that needs hair. This information is provided to support informed decision-making before treatment.
Important Information About Your Treatment
This information is provided to support informed decision-making in line with professional guidance and patient safety requirements. You are encouraged to read this carefully and ask questions before providing consent.
1. Alternatives to Hair Transplant Surgery
You have been informed of reasonable alternatives to hair transplant surgery, including:
- Choosing not to proceed with surgery
- Wearing a hairpiece, wig, or toupee
- Hair weaving or attachment systems
- Medical treatments such as topical or oral hair-growth agents (for example, Minoxidil), alone or in combination
- Seeking a second opinion before proceeding
2. Disclosure of Medical Information
- You confirm that you have provided complete and accurate information regarding your medical history, surgical history, medications, allergies, and lifestyle factors, to the best of your knowledge.
- You understand that failure to disclose relevant information may affect the safety of the procedure and its outcome.
- The Surgeon reserves the right to postpone or cancel the procedure if new or previously undisclosed medical information is identified that may compromise patient safety.
- You confirm that you do not have any communicable disease, and you have not been exposed to, or have, hepatitis or AIDS, or you are a carrier of the HIV virus.
3. Nature of the Procedure and Realistic Expectations
You understand that hair transplant surgery is undertaken to improve the appearance of hair loss rather than to cure alopecia or restore hair to its pre-hair-loss state.
No new hair is created during the procedure. Results depend on redistribution of existing donor hair, and outcomes vary between individuals.
Medicine and surgery are not exact sciences, and no guarantee or warranty can be provided regarding the final result.
4. Graft Quality, Number of Grafts, and Density Outcomes
No warranty is provided regarding the survival, quality, or growth of implanted grafts.
Hair growth and final appearance may be influenced by factors including age, genetics, medical conditions, medications, smoking, alcohol intake, stress, nutrition, scalp characteristics, and environmental factors.
The number of grafts transplanted will be determined by the Surgeon based on clinical assessment of the donor area on the day of surgery. Any estimate discussed beforehand is not guaranteed.
5. Treatment Planning and Density Distribution
A pre-operative plan or drawing may be used to support discussion; however, it is indicative only.
The final decision regarding hairline design, graft distribution, density, and recipient areas rests with the Surgeon on the day of surgery and is guided by clinical judgement, patient safety, and donor availability.
The Surgeon may determine that one or more treatment sessions are required. Any additional sessions determined by the Surgeon will be at cost to you.
No warranty is provided regarding density or coverage.
6. Treatment and Administration of Anaesthetics
You consent to the administration of local anaesthetics, medication, injections, intravenous solutions, and materials as deemed necessary for your hair transplant surgery by or under the supervision of the consultant hair surgeon.
You also give permission for blood to be drawn for testing, including for HIV and hepatitis testing, if necessary following an accidental needle puncture or break of the skin by a sharp instrument involving medical staff.
7. Role of Surgical Assistants and Technicians
You understand that the Surgeon may be assisted by trained and appropriately qualified technicians during the procedure.
All delegated tasks are performed under the Surgeon’s direction and supervision, and the Surgeon remains responsible for your care.
8. Substitution of Surgeon
We will always endeavour to ensure that your surgery is carried out by your chosen Surgeon.
However, your chosen Surgeon may not always be available on the day of surgery for reasons including ill health or other circumstances outside of our control.
In that case, a substitute Surgeon who is no less qualified than your original choice may be assigned.
9. Risks, Complications, and Recovery
You acknowledge that all surgical procedures carry risks. Common and expected effects include pain, swelling, bleeding, redness, crusting, and temporary shedding of transplanted or existing hair.
Less common risks include infection, scarring (including hypertrophic or keloid scarring), cyst formation, altered sensation or numbness, shock loss, or suboptimal graft growth.
Rare but serious complications, such as scalp necrosis or nerve injury, have been discussed.
Healing times vary, and final outcomes cannot be properly assessed before a minimum of 12 months post-procedure.
Possible Adverse / Side Effects
- Minor discomfort (pin-prick sensation) from blood draw (venous puncture)
- Dizziness and feeling faint (rare) due to blood sight or white coat syndrome
- A temporary headache after scalp injections
- Redness at the injection sites on the scalp/face for a few days
- Swelling in the forehead and around the eyes, with possible temporary bruising or discolouration
- Reaction to local freezing medications (temporary)
- Temporary hair loss in existing hair, often termed shock loss
- Infection (very rare)
- Itching at the injection sites (temporary)
- Minor bleeding and bruising at the sites of injections
- Injury to neuro-vascular structures during blood collection (very rare)
This is a general list and not an exclusive list of possible adverse reactions or side effects.
10. Patchy Growth, Further Treatment, and Review
Recommendations made during consultation and treatment are estimates and may change later, including the site, size, and design of the recipient area.
Results may be uneven or lower in volume than anticipated, and additional procedures or treatments may be required.
A formal post-operative review will take place approximately 12 months after surgery. Any assessment before that time should not be treated as final.
11. Patient Responsibilities and Compliance
- Follow all pre-operative and post-operative instructions
- Take prescribed medications as directed
- Follow washing protocols and activity restrictions
- Follow lifestyle advice given by the clinical team
- Understand that non-compliance may negatively affect results and increase the risk of complications
12. Scarring and Tissue Injuries
You understand that every incision may result in some scarring. Every effort will be made to make any scar as inconspicuous as possible, but this cannot be guaranteed.
Possible issues discussed include scalp necrosis, keloids, hypertrophic scarring, acne keloidalis, cystic acne, epidermoid cysts, scalp indentation, unexpected scalp thickening, vascular fistula, or vascular aneurysm, although some of these are extremely rare.
Bleeding during surgery is expected, while post-surgical infections are rare.
Superficial crusting or redness in incision areas may occur and is usually temporary, though there is no exact standardised duration.
13. Photography, Recording, and Confidentiality
Clinical photographs and/or video recordings may be taken before, during, and after the procedure for medical documentation, audit, training, and quality assurance purposes.
Any use beyond clinical records, including education or marketing, requires separate consent.
You will not be identified by name, and images will be handled in accordance with data protection and confidentiality standards.
14. Suitability for Surgery and Cancellation on the Day
The Surgeon may determine on the day of surgery that it is unsafe to proceed due to medical findings, such as high blood pressure, or due to non-compliance with pre-operative instructions.
In such cases, the procedure may be postponed or re-scheduled in the interest of patient safety.
Unless you have paid the Protection Premium, you will not be entitled to any refund if the Surgeon decides it is unsafe to proceed following medical assessment or due to your non-compliance with pre-operative instructions.
15. Post Surgery Assessments
You understand that hair restoration is a slow process and requires patience and compliance with the treatment plan and instructions.
You have been informed that a full 12-18 month post-surgery evaluation and tailored therapy programme may be required in order to fully assess long-term results.
Any assessment before that post-surgery evaluation is premature.
16. Acknowledgement and Consent
- You have been given sufficient time to consider your treatment options.
- You acknowledge that you have been provided a minimum of 14 days to review and consider the information relating to your treatment and to make an informed decision regarding final consent. If less than 14 days have elapsed, you voluntarily waive that right and confirm you have still had sufficient time to consider the procedure.
- Material risks and reasonable alternatives have been explained in a way you understand.
- You certify that you have read this consent form and understand its contents, alternatives, and expected results of the Hair Implantation Operation.
- You have had the opportunity to ask questions and receive satisfactory answers.
- If you require translation into your own language, it is your responsibility to arrange a translator/interpreter before signing the consent.
- You acknowledge that your consent is given freely, voluntarily, and without pressure.