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Please fill out the following questionnaire to learn whether you are a good candidate for the “Dermabrasion + Thin Skin Grafting Surgery” or not. The treatment fee and the other details will be posted you after this step. Please write your e-mail address correctly and check your incoming and spam mail boxes for our reply e-mail. If you do not receive any reply e-mail in 24 hours, then you can contact Prof. Dr. Cengiz Açıkel by e-mail ( ) or WhatsApp (+90 5337703727).

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Are You a Good Candidate for Self-Harm Scars Removal Surgery?

Prof. Dr. Cengiz Açıkel will reply by e-mail in 24 hours after your submission of this form.

First and Last Name.
Phone (Optional)Please write your phone number correctly.
Have you got Covid-19 disease?
If YES, please write the date of your Covid-19 diagnosis
Have you got any Covid-19 vaccination?
If YES, please write the name of your vaccine and the dates of your vaccination
Do you have any psychiatric disorder?
If yes; what is the diagnosis?
Please indicate whether you have any chronic illness such as anemia, hypertension, tiroid disease, diabetes etc.
Weight (in kilograms)
Height (in centimeters)
Please use this converter if needed: Weight Height Converter
Are you allergic to anything?
If YES, please define the type of allergy:
Have you had any surgery before?
If YES, Name and date of your previous surgery (surgeries)
Have you used izotretinoin pills for acne treatment in the last 1 year?
Do you take any medication?
If YES, please give the name of medication:
Do you have possibility of pregnancy?
You should get necessary precautions to prevent pregnancy between your last period and surgery date.
Please upload the photos of your scars that you want to be treated.jpg, png, gif max file size 3 MB. Select up to 5 photos.
How long have you had the scars?
Anything You Want to Ask to Prof. Dr. Cengiz AçıkelOptional
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