How to determine what face procedure you may be a candidate for?
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Consultation Request for Dr. Roskies

Thank you for your interest in a consultation with Dr. Roskies. Please fill out the fields below. Following submission, Dr. Roskies will review your medical history and photos, and provide a complimentary assessment. Our Surgical Consultant will reach out to you directly once the form is completed.

Please note, the current price for a Deep Plane Face and Neck Lift starts at $55,000, and the current price for a Rhinoplasty starts at $25,000. Both are not inclusive of other ancillary procedures that may be recommended. Your surgical plan and pricing will be finalized during your consultation with Dr. Roskies.

Procedure(s) of Interest

What previous treatments have you had performed on your face/neck/body? Choose all that apply.

Patient Attestation I hereby confirm that I have read and understood all of the information provided above. I certify that all answers and personal health information I have disclosed in this form are true, complete, and accurate to the best of my knowledge. I understand that withholding or providing false information may affect the care I receive and could result in the cancellation or delay of treatment. I agree to inform the clinic of any changes to my health status or medications before any future procedures or treatments.

We appreciate you taking the time to share this information. Dr. Roskies and his team put a great deal of care and attention to detail into every consultation and procedure. We're thankful for your interest and look forward to speaking with you soon.

To finalize your form, please upload clear digital photos of your face and neck for Dr. Roskies and his team to review. These high-quality photos are essential for accurate remote assessments. For best results, please have someone take your pictures in a room with good natural light and a neutral background. Stand a few feet away from the camera, pull your hair back, and ensure the camera lens is at eye level with your chin parallel to the floor. Make sure both your face and neck are visible in the frame. Thank you!

*PDF or JPG Files only (Total File Size must be under 20mb)

Please note, communications through our website or via email are not encrypted and are not necessarily secure. By submitting this form, you are granting Dr. Mike Roskies and his team have permission to review your photos. These photos will only be used in-house for consultation purposes.*

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