Plastic Surgeon Dr. Russell F. Sassani
Expert in Plastic and Cosmetic Surgery

Call Now for a Cosmetic or Elective Consultation

(954)585-3800

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Virtual Consultation REQUEST

In the event of no shows or failure to give 24 hour notice of cancellation, there will be a $40 charge.

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Full Name*

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Birthday*

Height*

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What procedure are you interested in?

Do you have any medical problems? Please list them.

Have you had any previous surgeries? Please List them.

What medications do you take on a daily basis?

Do you smoke?

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No

If yes, how much and for how many years?

Are you interested in having multiple procedures done at the same time?

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How do you plan to pay for the procedure?

How many children have you had?

Do you plan on having children in the future?

Yes

No

If yes, when?

Have you had any problems with your breasts (such as cysts, lumps, abnormal discharge, skin changes, etc)?

Yes

No

If yes, please list:

Have any close relatives had breast cancer?

Yes

No

The last mammogram I had was:

What type of implants are you interested in?

What bra size do you currently wear?

What cup size do you want to be after surgery (approximate)?

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Doctor Russell F. Sassani is an expert in cosmetic surgery of the face, plastic surgery of the breast, body contouring surgery, fat grafting with concentrated stem cells, and laser skin resurfacing.

Contact Us

4161 N.W. 5th St., Suite 100
Plantation, Florida 33317

Phone: (954)324-2329
Fax: (954)585-6100

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