Aydin Plastic Surgery E-Consultation
N. Bill Aydin, M.D., F.A.C.S. Double Board Certified Plastic Surgeon
How did you first hear about us?
Word of Mouth
Best Way to Communicate
Preferred Time of Day to Communicate
Date of Birth
Describe what it is about yourself that you would like to change.
Interested Surgical Procedures
Gynecomastia (Male Breast Reduction)
Liposuction with Fat Transfer to Buttocks
Butt Augmentation with Implant
Blepharoplasty (Eyelid Surgery)
Expectation: Name a celebrity feature you desire.
Example: Angelina Jolie's nose, Kim Kardashian's butt
What is the maximum amount of time you can take off from work?
A few days
If necessary, is there someone who can help you at home while you recover?
When are you looking to have your surgery?
Within the next 3 months
Within the next 6 months
Within the next 9 months
I don't know, I just want information.
What is your budget?
Are you interested in financing your procedure?
What is your height?
What is your weight?
Are you generally in good health?
Please list any allergies/sensitivities you may have along with their associated symptoms. If none, write None.
Please select all that apply to you.
I am on anticoagulants and/or blood thinning medication/supplements
I am a diabetic.
I am anemic.
I tend to keloid when I scar.
I get cold sores.
I have a pace maker.
I have asthma.
None of the above.
List any medications/supplements you are currently taking. If none, write None.
List any prior surgeries or procedures. If none, write None.
Do you have any disease, condition or medical problem that the doctor should be aware of or know about? Please Describe. If none, write None.
Have you given birth to any children?
Do you plan on having any children after your surgery?
Describe your nicotine consumption (includes cigars, cigarettes, nicotine patch, nicotine gum, e-cigarettes, vaping etc)
I never consume nicotine products.
I consume nicotine products every day.
I consume nicotine products on the weekends.
Describe your alcohol consumption.
I never drink alcohol.
I drink alcohol every day.
I drink alcohol about 2-3 times in a 7 day week.
Please provide photos of the areas you would like to change. Photos should be taken in a well lit area against a blank wall. Try to have someone take photos for you as selfies can block certain views and stretch out your torso. If you are interested in surgery of the breasts, abdominal, or buttock area, it is best to be nude. Photos are confidential and will be for internal use only.
Upload Front View
Upload Left Side View
Upload Right Side View
Upload Rear View
By submitting this form you understand and accept that this e-consultation is not a substitute for meeting with Aydin Plastic Surgery and our doctor. The procedures recommended are preliminary suggestions using the information and photographs provided and are not intended to be used as a medical diagnosis or treatment..
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