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PATIENT RESOURCES
How to Choose a Plastic Surgeon
Many health care providers are now performing plastic surgery procedures, but that doesn't mean they are all qualified to perform plastic surgery. ASPS Member Surgeons are trained in cosmetic and reconstructive procedures of all types.
Credentials
Members of the American Society of Plastic Surgeons (ASPS) are certified by the American Board of Plastic Surgery or the Royal College of Physicians and Surgeons of Canada. The ABPS is approved by the American Board of Medical Specialties to certify physicians in plastic surgery of the face and all areas of the body.
When you choose an ASPS Member Surgeon you know that your surgeon:
Has at least 6 years of training and experience in surgery, with 3 years specifically in plastic surgery
Is certified by the American Board of Plastic Surgery
Operates only in accredited medical facilities
Adheres to a strict code of ethics
Fulfills continuing education requirements, including patient safety techniques
Will be your partner, working to achieve your goals
To make sure your surgeon has these outstanding qualifications, look for the ASPS Member Surgeon symbol, or look them up at the ASPS website, www.PlasticSurgery.org.
Consultation
Before you have plastic surgery, you will meet with your ASPS surgeon for a consultation. During the consultation, you will want to discuss your goals. Your surgeon will examine you and advise the best procedure to achieve your desired results.
Your Plastic Surgeon Should
Answer all of your questions thoroughly and clearly.
Ask about your thoughts to recommended treatment.
Offer alternatives, where appropriate, without pressuring you to consider unneeded or additional procedures.
Welcome questions about your procedure and his or her professional qualifications, experience, costs and payment policies.
Make clear the risks of surgery and possible outcomes.
Give you information about the procedure you want.
Leave the final decision to you.
Step 1: Questions to Ask When Choosing a Plastic Surgeon
Are you an ASPS Member Surgeon? (If he or she answers "yes," you can rest assured that your surgeon is board certified in plastic surgery, has hospital privileges and only performs surgery in accredited facilities.)
Are you board-certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada?
Do you have hospital privileges to perform this procedure? If so, at which hospitals?
Is the surgical facility accredited?
Step 2: Questions to Ask Your ASPS Member Surgeon
It is important to talk to your ASPS Member Surgeon about your goals and your treatment.
Feel confident asking about your doctors credentials, experience, outcomes or safety record. It is your body, your safety and your life.
Am I a good candidate for this procedure?
What will be expected of me to get optimal results?
What are the risks involved with my procedure?
How long of a recovery period can I expect, and what kind of help will I need during my recovery?
Will I need to take time off work? If so, how long?
Summary
The main concept in choosing a plastic surgeon is that it is an important decision one that influences your health and the outcome of your procedure.
Take your time in creating a short list of candidates- based on recommendations and word of mouth.
Then do your homeowrk and confirm their background, credentials and experience.
Finally, meet them and ensure that the communication level is excellent in both directions.
Once you have met and committed to the right surgeon you will undoubtedly have a wonderful, life-enhancing experience.. Enjoy!
Making Sense of Certification
Physician Certification:
Almost everyone has heard that they should look for board certification when seeking out an aesthetic surgeon (or any other physician for that matter). Most people dont really understand exactly what board certification means
At BASILE PLASTIC SURGERY we have gone to great effort and expense to ensure the highest standard of safety for our patients. As you consider plastic surgery, we hope the following information will help you evaluate the choices available to you.
The American Board of Medical Specialties (ABMS)is an agency that oversees 24 specialty medical boards. One of its board members is the American Board of Plastic Surgery. Dr Andrea Basile is certified by the American Board of Plastic Surgery.
The ABPS selects those physicians who have trained in a General Surgery for 3 to 5 years after medical school, then have had an additional 2-3 years of training exclusively in all aspects of Plastic Surgery. After passing a two-day written examination the candidates then collect patient data for two more years and return with it for a two-day oral examination. If successful they are certified by the board.
You may easily check at www.PlasticSurgery.org to make sure the surgeon you are considering is ABPS certified.
You may have heard names of other boards as well. There are several other similar-sounding titles used in the media and advertising. Other than this ABMS board of qualification, the American Board of Plastic Surgery, there are no other boards that give you, the patient, the same level of protection.
Licensure is designed as minimum standard necessary to practice medicine. It is a public function, administered by the states. The standards are established through a public process and all actions taken both in granting a license and in restricting or withdrawing a license are matters of public record. Licensure is not specialty specific and permits an individual to provide to the public any medical or surgical service he/she desires.
Accreditation of Facilities:
The quality of care at the facility where your surgery will take place is another factor to investigate and understand. When a facility seeks accreditation, its entire operation is reviewed for patient safety, quality of care, peer review, and continuous quality improvement.
The surgicenters we like use are accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), a not-for-profit organization that is independent of any group of medical specialists, and the nations predominant standards-setting and accrediting body in health care, since 1951.
Anesthesia Options:
Whenever you choose to have surgery it is also prudent to review the credentials of the person to whom you will entrust your health and life, during the administration of sedation and or general anesthesia.
In the surgicenters we use, the anesthesia is provided by a combination of CRNAs and MD anesthesiologists, and is designed for safety and prompt recovery, thus making your experience as pleasant as possible.A Certified Registered Nurse Anesthetist (CRNA). A CRNA is an RN (registered nurse) who has completed an additional two years of specialized training in a nationally accredited school of anesthesia. The State of Florida Board of Nursing and the American Association of Nurse Anesthetists Council on Recertification of Nurse Anesthetists oversees their qualifications. CRNAs commonly administer anesthesia at day surgery centers and in hospitals. An Anesthesiologist is an MD physician who has specialized, through specific residency training, in the administration of anesthesia. Furthermore, the aensthesiologists who work at outpatient surgicenters have the ultimate experince at working with healthy patients who will go home to recover, and therefore are very effective at minimizing anesthesia side-effects. They oversee every procedure. You can meet with the anesthesia providing team at either of the two surgicenters we use, if you so desire.
Frequently Asked Questions
LIPOSUCTION FAQ's
What is the Tumescent technique?
The tumescent technique refers to the injection beneath the skin of a large volume of salt water mixed with xylocaine and epinephrine. By introducing this fluid into the fat before suctioning it, the surgeon is able to numb the tissues in question, and shrink the blood vessels thereby reducing bleeding, bruising, and swelling. This technique allows some patients to undergo the procedure without general anesthesia, or at least minimizes the amount of anesthetic they need and so shortneing their post- anesthetic effects such as drowsiness and nausea.
Who is a good candidate for Liposuction?
Generally, people with a localized area of protruding fat are able to achieve the best reuslts. It is best to be at or slighlty above your normal weight. Good skin elasticity also permits the skin to shrink down to size and best shape after the removal of the fat underneath. Whereas the grossly obese patient may not be a good candidate, there is no absolute age limit for this liposuction.
What areas of the body are most frequently treated?
In women, the most common area treated is the outer thigh. The next most common is the stomach, followed by the inner thigh, flanks and upper back behind the breasts. In men, the flanks or love handles is the most commonly treated area.
Liposuction seems very simple n concept. Is it safe?
Although liposuction is very safe and effective, it is still a surgical procedure and carries with it the risks of complication and poor outcome like any other surgery. These problems are rare when Liposuction is performed by a properly trained specialist with board certification and experience.
Is it permanent?
Yes and no. The fat cells which are removed will never grow back! Gone ! Bye-bye! The relatively small number of fat cells left behind in the area can swell if the patient puts on a large amount of weight. The contour in the operated part of the body therefore can slightly increase over time during an unhealthy shift in body weight, but can never increase in the same proportion as it used to before the surgery!
BREAST AUGMENTATION FAQ's
Why is Breast Augmentation So Popular?
Indeed augmentation mammaplasty is currently the most popular cosmetic surgery procedure in the country having taken the lead from liposuction three years ago. It is performed over 350,000 times a year.
Breast augmentation with implants has become, in the right hands, a very predictable, controllable, and safe procedure.
Women have chosen to use this surgical approach for many reasons. Sometimes the issue is simply that a woman never really developed quite enough breast tissue to give appropriate shape to their torso. Many times the size they had before pregnancy is lost afterwards, along with a firmness and shape they now miss. The breasts tend to suffer most of life's changes from adolescence, pregnancy, menopause, losing weight/getting in shape, and of course gravity.
The breast augmentation procedure is popular because it can make some profound changes in a woman's posture, confidence level and self esteem.
What is Silicone?
Silicone is derived from silicon, a semi-metallic or metal-like element that in nature combines with oxygen to form silicon dioxide, or silica. Beach sand, crystals, and quartz are silica; in fact, silica is the most common substance on earth. Heating silica with carbon at a high temperature can produce silicon. Further processing can convert the silicon into a long chemical chain, or polymer, called silicone which can be a liquid, gel, or rubbery substance.
Various silicones are used in lubricants and oils, as well as in silicone rubber. Silicone can be found in many common household items, such as polishes, suntan and hand lotion, antiperspirants, soaps, processed foods, waterproof coatings, and chewing gum. The FDA has approved many medical devices made of silicone, including replacement heart valves.
Clinical Trials for Silicone Implants
Since 1992, women could receive silicone gel-filled breast implants only if they become part of a clinical trial, or a controlled study designed to track the potential effects of silicone implants. Clinical trials are required for all drugs and devices regulated by the FDA before they can be used in the general market
What are the Advantages of Silicone Implants?
Many surgeons and patients with breast implants have the opinion that silicone implants have a more natural look and feel than saline implants due to the fact that silicone gel has a texture similar to breast tissue.
What are the Advantages of Saline Implants?
Saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are usually seen almost immediately.
However, saline implants carry many of the same risks, albeit rare, as silicone gel-filled implants, including capsular contracture, infection, pain, and nerve damage, need for re-operation.
How long will my Implants Last?
Implants, whether filled with saline or silicone, are not a lifetime device and may need to be replaced. As time goes on the chance that an implant will fail increases proportionately. The rate really depends on the type of implant, its fill volume or its size, and the soft tissue covering it. Implant rupture is only one of many little reasons why a breast augmentation patient might require a reoperation. We often exchange old implants during a surgical revision even if the implant is intact. Therefore the implant longevity statistics are imprecise.Suffice it to say that implants are not "forever", and even a perfect result will need some maintenance at some point in the future.
When Can I Go Back to Work?
The answer, of course, depends on exactly what constitutes your kind of 'work'. Most of our patients could return to non-stressful work within a few days, though they are encouraged to take a week off. 'Week two' is limited from upper body straining like waitressing, nursing, or pool cleaning (to name a few examples of physically demanding roles). Chest exercise is off-limits as well. After four weeks there are no more limitations of activity. Rest assured, that at every postoperative visit with the doctor, your permitted activity level is very carefully reviewed, to optimize your healing, safety, and results.
NON-SURGICAL AESTHETICS FAQ's
Can I Avoid Having Surgery with the Non-Surgical Aesthetic Procedures?
Well, this so-called class of techniques and products are designed precisely to try to obtain significant results without the downtime and risks associated with a surigical intervention.
BOTOX® has become the most used Cosmetic Medicine in the world, mostly due to the fact that it is predictable, safe, and wonderfully effective at correcting and preventing the deterioration of skin texture. When used correctly and at the right time it can delay and sometimes avoid the need for surgery. Alternatively, it can be used to prolong the positive effects of a surgical procedure. Injectable fillers are tools which, similarly, can be used to stave off the need for something more invasive.
The trick is to start early enough to maintain control of age-related changes.
How does BOTOX® Cosmetic work?
BOTOX® Cosmetic is a prescription medicine that is injected into muscles and used to improve the look of the frown lines between the eyebrows (glabellar lines). It works by blocking nerve impulses to the injected muscles. This reduces muscle activity that causes persistent lines to form between the brows. "Off Label" use of BOTOX includes use in many other areas of the face, as well, where facial expressions have created folds, wrinkles, and creases in the facial skin.
How long does BOTOX® Cosmetic last?
Visible results on average last 4 months. Your own results may vary. We will discuss what you can expect at your appointment.
Will I still be able to make facial expressions?
Although the results are visible, a treatment with BOTOX® Cosmetic will not radically change your facial appearance or make you look as if youve had work done.
What will happen to the frown lines between my brows if I choose not to continue treatments?
If you do not continue treatments, the moderate-to-severe frown lines between your brows will gradually return to the way they looked before treatment.
What is hyaluronic acid?
Hyaluronic acid is a naturally occurring substance found in all mammals that helps to hydrate and add volume to your skin. In addition to its use as an aesthetic treatment, hyaluronic acid has also been used for more than 20 years for injection into arthritic joints to aid movement as well as for eye surgeries and wound repair.
How are injectable fillers used in treatment?
Dr Basile, himself, eases the injectable filler into the skin using a fine needle to temporarily fill in and augment the treatment area and smooth moderate to severe facial wrinkles and folds such as smile lines or parentheses (nasolabial folds) and marionette lines (oral commissures). Fillers protect the treated areas of skin from further folding and devlopement of creases. Fillers can add volume to certain facial features like the lips or cheeks. Fillers may give the skin appearance of a smoother surface and healthier glow.
How long do results last?
It depends on the filler used.
As an example, JUVÉDERM® is a hyaluronic acid (HA) filler FDA approved to last up to 1 year. We will discuss what you can expect at your appointment.
How can I find out more?
Call or email us to set up an appointment for evaluation and treatment. Welcome!
Patient Testimonials
What can we say? Most of our patients are inspired to sing our praises!
We are so very appreciative when they take the time to write us notes of expression.
We wish to share some of these with you.
Enjoy their generous words in the transcribed list, or in original form in the image gallery:
Greeting card---8/26/99
Dear Andrea P. Basile,
I appreciate that your careful hands gave me one more chance and I didn't lose my faith in what is the most important thing in a womans life.
Thank you for providing for me that quality work that I can say is just top.
I wish you a long and successful career and lots of happiness, and love in your life.
Best regards
yours sincerely,
--Zsuzsanna
________________________________________________________________________
Patient's Verbal Greeting---Every time I see her in the office
"You're my hero"
--Deborah
Greeting card--- 5/03
I want you to know I think you are Super! I am not able to say enough good things about you and Karen. You have an excellent reputation especially among the staff at the Naples Surgery center. I see a very bright future for you and your family here in the Naples area. We are pleased to have you among us.
Thank you.
--Ellen
_______________________________________________________________________
Greeting Card---- 5 /28/03
Not only do I think you to be a very outstanding doctor but a very fine person!
--Sue
Greeting card----6/29/03
I peeked and am thrilled-no-ecstatic-at the results. M. and I are grateful to have found the best Doctor for our needs. Thank you for being there for us.
--Anne
______________________________________________________________________
Greeting Card --- 07/07
Dear Dr. Basile,
Thank you so much for the excellent care, and results you have given me.
I have been very appreciative of all the time you have taken to make sure all was perfect.
--Vivian
FINANCIAL policy
We are excited for you that you are considering aesthetic surgery!
Please review our policies in regards to payment for you procedure.
FEE QUOTATION
The fee quotation includes fees for the described procedure, associated outside services, and materials listed. It also includes all the related pre- and post-operative visits.
The quotation is valid for 90 days.
PAYMENT OPTIONS
It is customary and expected for elective cosmetic plastics surgery to be paid in full two weeks prior to your surgery.
We provide multiple payment options which may be used individually or combined according to your preferences:
CASH
CHECK: personal, or cashiers,
CREDIT CARDS: Visa, Mastercard, American Express
FINANCING: Multiple programs are available to you which are facilitated by the fact that we participate with them often. You are welcome to use your own program as long as their payment structure provides payments in full as described above.
CANCELLATION POLICY
A situation may arise that may cause you to postpone your surgery. Please understand that such changes affect not only yourself, but the surgeon, staff, facility staff and other patients and surgeons as well. The doctor's time, as well as that of the operating room staff is a precious resource, so we request you courtesy and concern.
A $500 nonrefundable deposit is required to reserve a space on the surgery schedule. After the surgery is scheduled, the staff spends a significant amount of time assembling documents, test results, and other information for your surgery. If you cancel your surgery after paying the scheduling deposit, the money will not be refunded.
Should you find it necessary to cancel your surgery within two weeks of the scheduled surgery date, all but 20% of the surgery fee is refundable, unless the cancellation s caused by severe illness that prohibits surgery, or death in the immediate family.
OTHER FEES
Prescription medications related to surgery vary from patient to patient. They represent a separate expense and are not included in this quote.
Pre-surgery testing fees such as laboratory blood tests, x-rays, mammograms, EKG and or medical clearances are not reflected in the quote and may be billed to you by the provider.
Fees associated with pathologic examination of tissues for biopsies taken during the surgical procedure (which includes all breast tissue) are not included in the fee quote and are the responsibility of the patient.
In the unlikely event that additional surgery is required, such as for an emergency, complications, or semi-elective purpose, the costs for anesthesia and operating room fees will be the financial responsibility of the patient.
FINANCING options
The links listed to the side represent the three main companies which arrange loans for individuals seeking cosmetic surgery procedures.
Click on their banners to view their sites and find more information.
Articles Written by Dr. Basile
Gulfshore Life magazine article on breast reconstruction surgery by andrea basile m.d.
article; abdominoplasty. tummy tuck, by andrea basile, m.d.
article on Breast Reduction Surgery by andrea basile, m.d.
non
cosmetic surger trends; article; by andrea basile m.d.
choosing a plastic surgeon; article; by andrea basile, m.d.
article; experience of a plastic surger patient; andrea basile, m.d.
overview of breast cosmetic surgery; article; andrea basile m.d.
Media Interviews with Dr. Basile
Plastic Surgery- Not Just for the Rich; WINK-TV; 12/05
Absolute Lipodissolve; WINK-TV; 07/07
Breast Reconstruction; Gulfshore Life Magazine; 10/03
DIRECTIONS to BASILE PLASTIC SURGERY, from all points
from the North:
Using Route 41(Tamiami Trail), travel South from Ft Myers, Estero, and Bonita Springs, until entering North Naples. Continue further, crossing Immokalee Road, and continue until Vanderbilt Beach Road is reached.
Turn right (west/towards water), and travel about 100 yards until the first traffic light.
As you approach the light you will see our office on Vanderbilt Beach Road, on your right; the facade faces east. Turn right at the light and loop around the building you just passed, back to the east wall.
Parking is reserved directly in front of the entrance.
Using Highway 75, travel South from points north of Naples until exit 111. Turn right/west as you exit and travel along Immokalee Road until Route 41(Tamiami Trail) is reached.
At 41 turn left/south.
Approximately 2 miles south you will reach Vanderbilt Beach Road.
Turn right (towards water) and travel about 100 yards until the first traffic light
As you approach the light you will see our office on Vanderbilt Beach Road, on your right; its facade faces east. Turn right at the light and loop around the building you just passed, back to the east wall.
from the South:
Using Route 41(Tamiami Trail), travel North from Old Naples, Everglades City, Miami. Cross Pine Ridge Road, and continue until Vanderbilt Beach Road is reached.
Turn left (west/towards water), until the first traffic light.
Using Highway 75, travel North from points south of Naples until exit 111. Turn left/west as you exit and travel along Immokalee Road until Route 41(Tamiami Trail) is reached.
At 41 turn right/north.
from the West:
From the Ritz-Carlton Hotel, stroll, bike or be accompanied by hotel shuttle along Vanderbilt Beach Road away from the water. Before reaching Route 41, you will find our office on your left, on Vanderbilt Beach Road at the northeast corner of Vanderbilt and Gulf Pavilion Drive. We share the building with the urgent care center. Our front entrance faces east. Welcome!
From the Gulf of Mexico, Secure your vessel appropriately. Hail a cab and give them the directions: " 803 Vanderbilt Beach Road; West of 41. Southwest corner of the Pavilion Plaza"
from the East:
From the Ritz-Carlton/Tiburon,, travel westward along Vanderbilt Beach Road towards the water; towards Route 41. Continue across Route 41, and travel about 100 yards until the first traffic light
"Fly-in" Patients
Many patients of BASILE PLASTIC SURGERY live elsewhere, or live in Naples only part time of the year. Not to worry. With proper planning, and thorough communication aided by modern technology, we can arrange for a consultation and preoperative testing, remotely.
As long as we can have our patients in town long enough after a procedure, then a succesful intervention can be carried out. Exactly how long is determined on an individual basis.
The links below lead to information about local accomodations and travel.
If you are considering to combine an Aesthetic Surgery procedure, whether it is a breast augmentation or liposuction, or a non-surgical service such as BOTOX or Filler, with a trip to Southwest Florida, you may begin by calling the office and speaking with our patient care coordinator. Alternatively you may use the patient forms and digital photography to begin an email - based consultation.
We look forward to helping you.
Local Accomodations
Transportation
Ritz-Carlton (Beach Resort)
Southwest Florida International Airport
Naples Airport
Ritz-Carlton (Tiburon Golf Resort)
Naples Limousine Company
Inn at Pelican Bay
Doubletree Inn
La Playa Resort
Patient Forms
Patient Questionnaire A - New Aesthetic Surgery Consultation
CONSULTATION AND MEDICAL QUESTIONNAIRE
Name________________________________________________________________
Date of Birth ___________Age_________ Todays Date________________
Address: Home________________________________________________________________
Business/Northern_______________________________________________________
Home Phone_____________________Cell or NorthernPhone_____________________
May we call you at these numbers? YES NO
May we leave a message with person who answers or on machine? YES NO
Social Security Number______--_____--__________Marital Status S M D W Sep Ages of Children____________________
E-mail address: ____________________________________________________________________
How were you referred to us?_____________________________________________
Names of family members who are patients___________________________________
Which areas of the body are you interested to address?
Face Eyes Nose Lips Neck
Breasts Chest Abdomen Arms Flanks
Buttocks Hips Thigh/Legs Back
Other____________________
What specifically do you wish to have corrected?_______________________________
_____________________________________________________________________
When did you begin to consider surgical correction?____________________________________________________________
Is having surgery your idea or is it someone elses idea?__________________________
Why have you decided to have it done at this point in time?________________________________________________________________
Have you consulted with any other doctor about this? YES NO When?______________________________________________________________
Have you discussed this surgery with your family? YES NO
Are they agreeable? YES NO
Do you understand that the objective of any cosmetic operation is improvement in appearance, not perfection? YES NO
Are you aware that the procedure results may not fully meet your expectation? YES NO
Have you had any previous cosmetic surgery? YES NO If so, when and what was done? ________________________________________________________________
____________________________________________________________________________________________________________
Who performed the surgery? __________________________Where?_______________
Were you satisfied with the results? __________ If not, why? ______________________
Have you had any other surgery, or an injury, to the body area in question? _____________________________________________________________________
When? _______________Describe?________________________________________
Has a family member or a close friend had cosmetic surgery? YES NO
What was done? ________________________________________________________ By whom? _________________________________________
PLEASE CONTINUE ON TO MEDICAL HISTORY
MEDICAL HISTORY
No Yes Do you currently take any drugs or medication?
__________ ___________ ___________ ___________
No Yes Do you take Aspirin, Motrin, etc, -containing medications?
No Yes Are you allergic to any medications, creams, make-up or tape?
List them please ____________________________________________
Who is your family doctor? _______________________________________________
Address:_____________________________________________________________
No Yes May we contact him/her in regard to any medical problems that might arise?
When was your last physical examination?____________________________________
No Yes Was everything OK?
No Yes Have you ever received local anesthesia (Novocaine or Xylocaine by a dentist or doctor)?
No Yes Did you have any reaction to the anesthesia?
No Yes Are you considered a healthy person?
No Yes Do you take vitamins regularly?
Do you have? (Circle if yes)
1. Heart trouble 11. Asthma
2. High blood pressure 12. Frequent Chest Pains
3. Excessive bruisability 13. Stomach Trouble/Ulcers
4. Excessive bleeding tendencies 14. Frequent Skin Infections
5. Diabetes 15. History of Blood Clots
6. Thyroid problems 16. Anemia
7. Psychiatric or nerve problems 17. Severe headaches
8. Excessive scarring tendencies 18. Dizzy Spells
9. History of seizures or convulsions?
10. History of bleeding (circle if yes)
From the nose? In the urine?
Vomiting blood? From the rectum?
Coughing up blood?
Other? ____________________________________________
No Yes Have you had any previous surgery?
_______________________________ ________________________________
No Yes Were you ever told you had AIDS?
No Yes Do you smoke cigarettes at all?
No Yes Do you drink more than 4 cups of coffee a day?
No Yes Do you usually have 2 or more alcoholic drinks a day?
No Yes Do you often get depressed?
No Yes Do strange places or people make you afraid?
No Yes Are you considered a nervous person?
No Yes Did you ever have a nervous breakdown?
No Yes Have you ever received medical treatment for a nervous condition?
No Yes Have you ever considered consulting a psychiatrist?
No Yes Has any part of your body ever been paralyzed or numb?
Explain_______________________________________________
No Yes Are you currently under the care of a psychiatrist?
No Yes Do you have any medical problems that have not been covered?
No Yes Are there any reasons you should not have an operation at the present time?
Patient Questionnaire B - New MediSpa Consultation
NEW MediSpa PATIENT REGISTRATION
Name:______________________________________________________Date:______
Address:____________________________________________________Age:_______
_______________________________________________Date of birth: ____________
Home Phone:________________________________
CellPhone___________________________________
Email :_____________________________________
Emergency contact_____________________________
How were you referred to us?: friend / print ad / website / Doctor/ You are a surgery patient
What areas/ topics will we discuss today?
O BASIC SKIN CARE
O SPECIFIC FOCUS (circle as needed)
FACE Wrinkles NECK Wrinkles BODY Wrinkles
Texture Texture Texture
Color Color Color
Looseness Looseness Looseness
Hair Hair Hair
Acne _______
Infection________
Rosacea________
Other___________
Have you ever had treatments with?: most recent application (date)
Botox Y / N ___________
Restylane Y / N ___________
Collagen Y / N ___________
Hylaform Y / N ___________
Radiesse Y / N ___________
Juvederm Y / N ___________
Other ________________ ___________
Medical History(check which apply) Surgical history (check which apply)
High blood pressure Eyelids
Bleeding tendencies Brow lift
Heart disease Midface lift
Diabetes Facial implants
Migraines Face lift
Arthiritis Neck lift
Fever blisters/cold sores Liposuction of face/neck
Neurologic disease Lip augmentation
Are you pregnant or nursing? Y / N
Do you hav any active infections? Y / N
Do you smoke cigarettes? Y / N
Do you develop fever blisters/cold sores? Y / N
Do you take aspirin, ibuprofen, or blood thinners? Y / N
Do you have any medical allergies? Y / N list please:__________________________
Please list any medications you take regularly: __________________________________
Signed________________________________________________
The information you have provided is essential in our comprehensive evaluation of your goals. ~Andrea Basile, MD
Patient Questionnaire C - Web Consultation
We are happy to begin our evaluation and discussions via the internet. This is especially helpful for patients who do not live in Naples, and wish to explore their options before arriving, in the hopes of arranging a procedure while here.
Please begin the web consultation by using either Form A- CONSULTATION AND MEDICAL QUESTIONNAIRE or Form B-NEW MediSpa PATIENT REGISTRATION depending on whether your interests involve a possible Surgical procedure or an Injectable solution like BOTOX or Filler.
In a few sentences, please explain what is bothering you, and wish to have corrected. Be specific please.
____________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
When are considering having this procedure?_________________________________
Are you a resident of Naples or will be visiting then?___________________________
If traveling , how much time do you have available for your stay?_________________
Please provide us with photographs of you relevant body part:
FACIAL SURGERY Interests:
1. Head shot sincluding top of hair to top of shoulders--from the front; both profiles; both 3/4 views.
2. Close up shot of specific area of interest (lips, nose, crease, eyelids, etc.) which best demonstrates your concerns.
BOTOX :
1. Head shot from front, from hairline to chin in four expressions:
a) at rest; b) scowling; c) squinting; d) surpise (brow lifting)
2. Close up of temple and eyes from both sides, while squinting
BREASTS:
1. Torso shot including tops pf shoulders to bottom ribs. Please use Five views: front, profile, both 3/4 views
BODY:
1. Wide view of body part in question, from 2 or 3 different angles, including some area just above and below the area of focus. (For example, if we are going to look at the outer thigh, the photo should include the hips and flanks above, and the knee below.)
Which email address would you like to correspond through?___________________________________________________
Please attach these photos along witht he questionnaires to one or multiple emails and send to: I nfo_BASILEPlasticSurgery.com
We look forward to communicating with you!
Causes We Care About
The following local charitable organizations, schools, and support groups are some of the benevolent organizations we have chosen to support.
We hope that you, too, will look upon them with interest and open hearts.
Avow Hospice of Naples
Neighborhood Health Clinic
Bosom Buddies
Seacrest Country Day School
Humane Society of Naples
Domestic Animal Services
Spanish Wells Care Foundation
Foundation for the Developmentally Disabled
Plastic Surgery Statistics
LINKS for your benefit
Medical Sites
American Board of Plastic Surgery
American Society of Plastic Surgery
American Society of Aesthetic Plastic Surgery
Florida Board of Medicine
Collier County Medical Society
Florida Society of Plastic Surgery
Breast Implant Information
Miscellaneous
Beware the Bite Campaign
Breast Implants - Mentor
Breast Cancer Resources
Breast Implants - Allergan
Breast Cancer Society
FDA
History of Plastic Surgery
Local Sites
Naples Beauty
FOX News
Naples Chamber of Commerce
Naples Community Hospital
Naples Daily News
Naples Day Surgery North
Physician's Day Surgery
Hooters Calendar
Hooters of Naples & Ft. Myers
WINK-TV
Lifestyle Family Fitness
