SUMMARY Many clients enquiring about plastic surgery malpractice actions are disappointed about a result that is technically satisfactory. Cigarette smoking during the weeks before and after plastic surgery gives predictably inferior results. Negligent error in plastic surgery is organisational or preparatory more frequently than faulty technique.
CLIENT FACTORS
Unrealistic Expectations
Many clients enquiring about plastic surgery malpractice actions are disappointed about a result that is technically satisfactory.
The plastic surgeon has a responsibility to assess and address the realism with which his patient approaches cosmetic surgery 1.
Most surgeons assume that the patient understands that healing entails the formation of scar tissue, and they fail explicitly to discuss this aspect 2.
In reality, the qualities of healing are genetically determined and to a large degree unpredictable.
Nowhere is this unpredictability more evident than in nasal cosmetic surgery.
If the client was poorly prepared for a less than ideal result, the large emotional investment may trigger a medical malpractice enquiry despite a good outcome.
Portfolios of better than average results may be useful for marketing cosmetic surgery services, but they also feed the fantasies and disappointments of those seeking surgical solutions to psychological difficulties.
Practice PointMany would-be medical malpractice litigants following plastic surgery had, and still have, unrealistic expectations |
A useful rule of thumb1 for plaintiff malpractice lawyers is that high patient concern before surgery for minor deformity often results in a very unhappy client who has no viable claim.
Smoking
Cigarette smoking during the weeks before and after plastic
surgery gives predictably inferior results.
Smoking is by far the most important avoidable risk factor for poor healing after plastic and cosmetic surgery 3.
In a particular variety of breast reconstruction, poor cosmetic outcome was significantly more common among current smokers than among non-smokers 4.
Of practical significance, quitting for at least a month before surgery caused the healing to be indistinguishable from that of non-smokers.
Practice PointCigarette smoking is the commonest cause of objectively poor outcome after cosmetic surgery |
Some authors3 have gone so far as to require patients to sign a separate statement confirming that they have not smoked for 4 weeks pre-operatively - and suggest the surgeon check for nicotine in urine if in doubt about his patient's truthfulness.
Requiring that patients quit smoking for 1 month before, and while recovering from, elective plastic surgery does not reflect Canadian community standards.
However, failing effectively to disclose the well-researched and well-documented adverse effect of cigarette smoking on healing could be the basis for a viable action based on lack of informed consent.
SURGICAL ISSUES
Negligent error in plastic surgery is organisational
or preparatory more frequently than faulty technique.
Practice PointConsider the planning rather than the execution of the plastic surgery as a likely source of substandard care |
The defendant surgeon should be asked to provide copies of the clinical-quality preoperative and postoperative photographs, for more objective assessment of the effects of surgery.
Informed Consent
Though plastic and cosmetic surgeons are generally more attuned to the need for adequate disclosure than are some other surgical sub-specialists, certain aspects of informed consent are worth addressing.
There may be over-reliance on written materials, that are all too often peppered with medicalese.
Nurses and other paramedical personnel are over-represented among plastic surgery malpractice clients. A significant factor is the universal medical temptation to break rules and cut corners with health professional patients, on grounds that they are more knowledgeable.
Because cosmetic surgery is such a sensitive area, surgeons may not be able to fulfil disclosure requirements without the services of an independent medical interpreter (not a member of the patient's family).
In the highly competitive field of plastic and cosmetic surgery, specialists do not always take out the time for adequate training before offering a new procedure.
Determining the shortcomings in training at Examination for Discovery may overcome the largest obstacle to early settlement of the case.
Although combining two or more minor facial procedures, for instance, may be acceptable and appropriate, scheduling a sequence of major procedures lasting many hours may prove indefensible, particularly if undertaken in a private office without the ready availability of full life-support facilities 5.
Not allowing for the effects of gravity has led to viable cause of action arising after, for instance, blepharoplasty (eyelid reconstruction)5.
If the surgeon evaluates only with the client lying on her back, then operates on her in the same position, not only may the result be cosmetically unacceptable, but the cornea may be left exposed to potential injury (exposure keratitis).
Even more devastating following blepharoplasty is the occurrence of bleeding because of sudden exertion in the hour or two after surgery, at a time when the local anesthetic is wearing off and the blood vessels are opening up.
If the client is not still under observation, so that the blood clot can be immediately removed, blindness may result.
Copyright © 2009 Electronic Handbook of Legal Medicine