Hip augmentation consent form template

Key takeaways

A hip augmentation consent form records the patient’s understanding of the two techniques available: silicone implants and autologous fat transfer.

Silicone hip implants are not FDA-approved for cosmetic hip augmentation in the US, so the form must disclose off-label use.

Fat transfer consent must state that only 40-70% of transferred fat survives long term, and a second procedure may be needed.

Results appear at three to six months and settle at 12 months, so record those milestones before surgery.

Practice management software like Pabau captures consent digitally, files it against the client record, and keeps documentation audit-ready.

A hip augmentation consent form is the document that proves a patient understood the procedure, its risks, and its limits before surgery. It has to name the technique chosen, either silicone implants or fat transfer, and disclose the risks that come with it.

Two disclosures decide whether the form holds up. Silicone hip implants carry no FDA approval for cosmetic use in the US, and transferred fat only partly survives. Most consent templates sold to plastic surgery practices skip both.

The template below covers both, plus the extra documentation gender-affirming cases need. Underneath it you’ll find what belongs in each section, and when to hand the form to the patient.

What is a hip augmentation consent form?

A hip augmentation consent form is a legally binding record of the patient’s informed understanding of the procedure, its risks, and post-operative expectations.

The form does two jobs. It protects the practice and the surgeon by showing that the patient was fully informed. It also protects the patient, who signs knowing what the surgery involves and what results are realistic.

Hip augmentation is performed either by implanting silicone devices or by autologous fat transfer using the patient’s own tissue. The form must record which technique the patient chose, the surgeon’s explanation of it, and the risks specific to that method.

In the UK, practices regulated by the Care Quality Commission (CQC) must document consent this way. HIPAA and GDPR rules impose similar duties elsewhere.

Who is a good candidate for the procedure?

Good candidates are in general good health, hold realistic expectations, and want fuller or more contoured hips. The form should verify each of those points before the patient reaches surgery.

• Age 18 or older and mentally competent to give informed consent
• Good overall health, with no uncontrolled diabetes, cardiovascular disease, or immune disorder that impairs healing
• Non-smoker, or willing to stop smoking for 2-4 weeks before and after surgery
• Realistic expectations, meaning improved contour rather than a guaranteed body shape
• Enough donor fat for harvest, which usually means a BMI of 20 or above for fat transfer
• Willingness to follow activity restrictions for 4-6 weeks after surgery

Add a checklist so the surgeon can mark which criteria the patient meets. A consultation form template covers the same ground earlier in the journey. Flag contraindications such as recent surgery, clotting disorders, or pregnancy, and refer those patients to their physician first.

Implants vs. fat transfer

Each method carries different risks and a different recovery timeline, so the form must let the patient select one and confirm what it involves. Set both options out in plain language.

Silicone hip implants

Silicone implants sit subfascially along the iliac crest to widen the pelvis and add definition. One disclosure matters more than any other for US practices. Silicone hip implants are not FDA-approved for cosmetic hip augmentation in the United States. Surgeons use custom or off-label implants, so the form must state that plainly.

Spell out what off-label use means for the patient. There is limited clinical data, no manufacturer warranty, and removal can be harder later. Record the implant type, size, and placement on the form.

• Permanent results, since implants rarely need removal unless a complication occurs
• A more defined, sculpted shape than fat transfer produces
• Surgical time of 60-120 minutes under general anesthesia
• Recovery of 2-3 weeks before light activity and 6 weeks before full activity
• Risks including infection, implant displacement, asymmetry, nerve damage, and chronic pain

Fat transfer to the hips

Fat transfer harvests fat by liposuction from the abdomen, flanks, or thighs and injects it into the hips. The contour looks more natural, but survival of the graft varies. The form must state that only 40-70% of transferred fat usually survives long term. Some patients need a second procedure to reach the volume they wanted.

• Uses the patient’s own tissue, so there is no risk of implant rejection
• A more natural feel for mild to moderate augmentation
• Liposuction of the donor area improves the contour there at the same time
• Surgical time of 90-150 minutes under general anesthesia, longer than implants because of the harvest
• Recovery of 2-3 weeks before light activity and 4-6 weeks before intensive activity
• Fat resorption means the final result may be 40-70% of the volume placed

Risks and complications the form must disclose

A defensible form discloses every material risk, not only the common ones. Compliance requirements for aesthetic practices expect plain language with no minimizing. Itemize the technique-specific risks and the universal surgical ones.

• Infection: surgical-site infection runs at 1-5% depending on technique, and may need antibiotics or revision surgery
• Implant risks: displacement, asymmetry, palpable implant edges, chronic pain, and possible removal later
• Fat transfer risks: variable survival, uneven resorption between sides, and the need for revision
• General anesthesia: nausea, vomiting, allergic reaction, and respiratory complications, with serious events in roughly 1 in 1,000 cases
• Nerve damage: temporary or permanent numbness, tingling, or altered sensation in the hip or thigh
• Seroma or hematoma: fluid or blood collecting under the skin and needing drainage
• Unsatisfactory result: asymmetry, too little volume, or contour irregularities
• Scarring: incision scars with implants, or liposuction scars at the donor sites

Recovery milestones and post-operative instructions

Attach a recovery timeline to the form, or reference one the patient receives separately. Automated patient messages can deliver each instruction by text or email on the day it matters, which cuts calls to reception.

• Weeks 1-2: rest, ice, and wear the compression garment. Avoid sitting for long stretches, since pressure on the hips slows healing.
• Weeks 3-4: light walking and stretching are fine, and most patients return to desk work. Avoid driving until pain-free and off prescription opioids.
• Week 6: most patients are cleared for normal activity and the gym. High-impact exercise waits until 8-12 weeks after surgery.
• Month 3: results are visible, though some swelling may remain.
• Months 6-12: the final result appears as swelling resolves and grafted fat settles.

Include wound-care instructions on the form itself. Keep incisions clean and dry, and watch for fever, spreading redness, or discharge.

Book follow-ups at one week and six weeks, with suture removal billed under CPT code 15851 where it applies. Medical form best practices suggest a checklist the patient initials at each milestone.

Cost, financing, and financial consent

The financial section must state the total cost, broken into surgeon fee, facility fee, and anesthesia fee. It must also name the financing options on offer, and who pays if a complication needs treating.

Cost varies by region, surgeon, and technique. Implants typically run $5,000 to $10,000 (£4,000 to £8,000), and fat transfer $4,500 to $9,000 (£3,500 to £7,000). State the fees agreed at consultation, and confirm the patient understands that revisions may cost extra.

Deposits belong in the same conversation. Chasing them by bank transfer eats hours, and Secret Enhancements saved over five hours a week by taking deposits at booking instead.

Store financial consent securely and, if you prefer, separately from clinical records. HIPAA compliance requirements apply to both. Where insurance may cover a gender-affirming case, a prior authorization form should sit alongside the consent paperwork.

Gender-affirming cases: Extra documentation to include

Gender-affirming hip augmentation needs more than the standard consent record. For transfeminine patients, often described as male-to-female or MTF, the form captures identity, hormone therapy, and psychological readiness too. Few off-the-shelf templates include these fields.

• Identity and goals: record the patient’s gender identity, pronouns, and the aesthetic goal in their own words
• Hormone therapy: note current hormone replacement therapy, how long they have taken it, and the prescribing clinician’s details. It can affect healing, infection risk, and graft survival.
• Psychological readiness: some practices ask for a letter of support from the patient’s mental health provider. Where that applies, note it on the form and attach the letter.
• Other procedures: record the timeline for any other gender-affirming surgery and how it may affect recovery
• Support at home: confirm the patient has help through the 4-6 week recovery and understands the restrictions

Practices that also run hormone therapy programs can pull the prescribing history straight from the client record. That saves a phone call and keeps the consent file complete.

How to use this template

The template is ready for practice use, and you can adapt it to your surgical protocols, fees, and patient population.

1. Download the PDF and load it into your consent system, or print copies for the front desk. Most practices now capture signatures through digital intake software that files the signed form against the client record.
2. Customize the fee schedule, surgeon name, and facility name. Update the figures to your current pricing and set the form in your local currency.
3. Attach your pre-operative and post-operative instruction sheets. The template supplies the consent framework, so your fasting rules, garment type, and follow-up schedule go in as addenda.
4. Have your legal counsel or malpractice insurer review it. Requirements differ by jurisdiction. US practices must disclose off-label implant use, and UK practices must show a CQC-aligned consent process.
5. Give the form at the pre-operative consultation, not on surgery day. Patients need it at least 48 hours ahead so they can read it and ask questions. Record the signing date and the surgeon’s signature.

Pro tip: keep signed forms in an encrypted system that meets HIPAA rules in the US and GDPR rules in the UK and EU. If you run plastic surgery software, link the signed consent to the patient’s chart so it is there at every future visit.

How Pabau keeps surgical consent complete and audit-ready

Most surgical practices still run consent on paper. The form is printed, signed at the consultation, scanned, and uploaded to the patient file by hand. When an inspector or a lawyer asks for it, someone goes looking through folders.

Practice management software like Pabau moves that whole sequence into one system. The patient receives the consent form before the appointment, signs it on their own device, and the signed copy lands in their record. Nothing is scanned, and nothing sits in a tray waiting to be filed.

Because every field is required before the form submits, the off-label implant disclosure and the fat-survival statement cannot be skipped. Compliance management tools flag any missing signature before the patient reaches the operating table.

Every Pabau subscription includes digital forms, client records, and compliance features, so there is nothing to unlock later.

Capture surgical consent without the paperwork

Pabau’s digital forms send the consent document before surgery, capture the signature, and file it in the client record. Your team stops scanning and your documentation stays inspection-ready.

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Conclusion

The consent form is where a hip augmentation practice either protects itself or exposes itself. Two lines decide most of that. Off-label implant status and realistic fat survival are the disclosures patients later say they never heard.

Put them in writing, hand the form over 48 hours before surgery, and the conversation at the six-month mark changes. The patient who understood the odds asks about a touch-up. The patient who did not asks for a refund.

Paper will carry all of this, as long as someone files it every time. Book a demo to see how Pabau captures and stores surgical consent without that step.

Continue your research

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Frequently asked questions