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New Patient Documents

Welcome to Ditesheim Cosmetic Surgery!

To help you prepare for your appointment more easily, Dr. Ditesheim has made our new patient forms available here for you. Please complete and print your forms bring them with you to your consultation.

These forms require Adobe Reader for proper viewing. Feel free to call us with any questions you may have before your consultation. We look forward to meeting you soon!

You may also fax (704) 542-8696, scan and email, or attach your forms in email to [email protected].

Schedule a Virtual Consultation*

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Gynecomastia

$7,950-$18,790

All pricing shown is an estimation. Final quote will be received during consultation.
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Additional Information:

Examples of Procedures

  • Complete breast tissue removal: $7,950
  • Treatment with scarless skin tightening (Renuvion): $11,700
  • Treatment for very high weight pt (>250lb) including extensive liposuction, nipple repositioning: $18,790

Our Pricing Includes

  • All pre-op, surgical, and post-op appointments.
  • Anesthesia, surgeon, and operating room fees
  • Individualized Patient Care Coordinator to guide you through your journey
Need Financing? Apply with one of our three financial options.
M-Lend Financial logo representing patient financing options for cosmetic and plastic surgery treatments.
CareCredit logo representing flexible payment and financing options for cosmetic and plastic surgery procedures.
Alphaeon Credit logo representing patient financing options for cosmetic and plastic surgery procedures.

Tummy Tuck

$7,500-$25,450

All pricing shown is an estimation. Final quote will be received during consultation.
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Additional Information:

Examples of Procedures

  • Mini-tuck (skin excision awake): $7,500
  • Tummy Lipo with skin tightening (Renuvion): $12, 900
  • Tummy Tuck with whole body shaping: $25,450

Our Pricing Includes

  • All pre-op, surgical, and post-op appointments.
  • Anesthesia, surgeon, and operating room fees
  • Individualized Patient Care Coordinator to guide you through your journey
Need Financing? Apply with one of our three financial options.
M-Lend Financial logo representing patient financing options for cosmetic and plastic surgery treatments.
CareCredit logo representing flexible payment and financing options for cosmetic and plastic surgery procedures.
Alphaeon Credit logo representing patient financing options for cosmetic and plastic surgery procedures.

Breast Reduction

$8,800-$18,790

All pricing shown is an estimation. Final quote will be received during consultation.
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Additional Information:

Examples of Procedures

  • No-scar breast reduction (lipo): $8,800
  • Asymmetry correction w/breast reduction: $17,125
  • Implant removed, breast reduction and lift: $18,790

Our Pricing Includes

  • All pre-op, surgical, and post-op appointments.
  • Anesthesia, surgeon, and operating room fees
  • Individualized Patient Care Coordinator to guide you through your journey
Need Financing? Apply with one of our three financial options.
M-Lend Financial logo representing patient financing options for cosmetic and plastic surgery treatments.
CareCredit logo representing flexible payment and financing options for cosmetic and plastic surgery procedures.
Alphaeon Credit logo representing patient financing options for cosmetic and plastic surgery procedures.

Liposuction

$6,000-$20,455

All pricing shown is an estimation. Final quote will be received during consultation.
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Additional Information:

Examples of Procedures

  • Tummy & Waistline Lipo: $12,130
  • Arm Lipo w/Renuvion: $10,500
  • Lipo 360: $17, 125

Our Pricing Includes

  • All pre-op, surgical, and post-op appointments.
  • Anesthesia, surgeon, and operating room fees
  • Individualized Patient Care Coordinator to guide you through your journey
Need Financing? Apply with one of our three financial options.
M-Lend Financial logo representing patient financing options for cosmetic and plastic surgery treatments.
CareCredit logo representing flexible payment and financing options for cosmetic and plastic surgery procedures.
Alphaeon Credit logo representing patient financing options for cosmetic and plastic surgery procedures.

Lipedema

$7,900-$20,455

All pricing shown is an estimation. Final quote will be received during consultation.
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Additional Information:

Examples of Procedures

  • Liporeduction of arms (awake): $7,900
  • Liporeduction of Circumferential knees and legs: $18,790
  • Liporeduction of Arms and Forearms and Arm lift: $20,455

Our Pricing Includes

  • All pre-op, surgical, and post-op appointments.
  • Anesthesia, surgeon, and operating room fees
  • Individualized Patient Care Coordinator to guide you through your journey
Need Financing? Apply with one of our three financial options.
M-Lend Financial logo representing patient financing options for cosmetic and plastic surgery treatments.
CareCredit logo representing flexible payment and financing options for cosmetic and plastic surgery procedures.
Alphaeon Credit logo representing patient financing options for cosmetic and plastic surgery procedures.

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Implant Exchange

$6,000-$19,050

All pricing shown is an estimation. Final quote will be received during consultation.
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Additional Information:

Examples of Procedures

  • Secondary Breast Surgery (implant Removal or Exchange)
  • Remove breast implants and Breast lift: $15,460
  • Remove breast implants, breast fat grafting and breast lift: $19,050

Our Pricing Includes

  • All pre-op, surgical, and post-op appointments.
  • Anesthesia, surgeon, and operating room fees
  • Individualized Patient Care Coordinator to guide you through your journey
Need Financing? Apply with one of our three financial options.
M-Lend Financial logo representing patient financing options for cosmetic and plastic surgery treatments.
CareCredit logo representing flexible payment and financing options for cosmetic and plastic surgery procedures.
Alphaeon Credit logo representing patient financing options for cosmetic and plastic surgery procedures.

Breast Lift

$8,800-$18,390

All pricing shown is an estimation. Final quote will be received during consultation.
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Additional Information:

Examples of Procedures

  • Donut breast lift (periareolar): $8,800
  • Lollipop Breast Lift (minimal scar): $15,460
  • Breast lift with breast augmentation (silicone implants): $18,390

Our Pricing Includes

  • All pre-op, surgical, and post-op appointments.
  • Anesthesia, surgeon, and operating room fees
  • Individualized Patient Care Coordinator to guide you through your journey
Need Financing? Apply with one of our three financial options.
M-Lend Financial logo representing patient financing options for cosmetic and plastic surgery treatments.
CareCredit logo representing flexible payment and financing options for cosmetic and plastic surgery procedures.
Alphaeon Credit logo representing patient financing options for cosmetic and plastic surgery procedures.

Mommy Makeover

$13,130-$31,460

All pricing shown is an estimation. Final quote will be received during consultation.
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Additional Information:

Examples of Procedures

  • Tummy lipo and breast augmentation: $13,130
  • Tummy and love handle lipo and lollipop breast lift: $25,890
  • Augmentation w/ saline implants, lollipop breast lift, tummy tuck w/ waist lipo & overnight suite: $31, 460

Our Pricing Includes

  • All pre-op, surgical, and post-op appointments.
  • Anesthesia, surgeon, and operating room fees
  • Individualized Patient Care Coordinator to guide you through your journey
Need Financing? Apply with one of our three financial options.
M-Lend Financial logo representing patient financing options for cosmetic and plastic surgery treatments.
CareCredit logo representing flexible payment and financing options for cosmetic and plastic surgery procedures.
Alphaeon Credit logo representing patient financing options for cosmetic and plastic surgery procedures.