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Dr. Belyansky often does prefer to see at least one scan before agreeing to removal. First go-round I did mail a CD. The last time (since I am considering another surgery to tighten things up and remove a lipoma) and since I live 2.5 hours away, I actually drove up and got the scan there in the morning and had an appt with him in the afternoon. Everything done at his hospital seems much cheaper than having it done anywhere else, too, including the actual surgery.
So yes, I am out of state but within driving distance. The first appt will often have him saying “I would caution against it unless you’re very serious about this or very bothered by it or disabled, because it’s a major and risky surgery. Let’s talk again in a few months.” And then the second appt he’ll usually say “Ok, I see you’re serious. I will remove it if you want.” And at that point they can get you on the schedule, which is usually a couple months. But I am guessing if you really push and tell him you’re going to get removal one way or another, with him or without him, he may immediately agree to do it.
Also, I went home the day of my surgery. I had removal done on only one side.