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Surgical facelift

Form

Surgical facelift

    Personal data
    Face photos
    Front without smile
    Front with smile
    Right profile, without smile
    Left profile, without smile
    Left half-profile
    Right half-profile
    Procedure
    Will this be your first facial plastic surgery? YesNo
    Additional information
    Have you ever had a surgical face lift? YesNo
    Have fillers been used in any areas of your face? YesNo
    Have you ever been treated psychiatrically? YesNo
    Are you currently taking any psychotropic medications? Which ones?
    In the last 6 months, have you had cosmetic or medical aesthetic procedures that broke the skin continuity (tattoo, piercing, laser)? YesNo