Definition and Scope of Plastic Surgery
Plastic surgery is a broad surgical specialty focused on the restoration, reconstruction, or alteration of the human body’s form and function. It encompasses reconstructive surgery, which provides medically necessary repairs of body parts affected by trauma, disease, or congenital defects, as well as cosmetic (aesthetic) surgery, which is elective surgery performed to enhance appearance. The term “plastic” derives from the Greek plastikos, meaning to mold or give form, reflecting the specialty’s goal of reshaping tissues. For medical malpractice attorneys, understanding the full clinical scope of plastic surgery – including its procedures, anatomy, and technologies – is essential for evaluating standard of care issues and potential negligence. This article provides an in-depth look at the clinical aspects of plastic surgery and examines the legal implications of malpractice in this specialty, including common claims, standard of care considerations, expert testimony, credentialing standards, and recent case law examples.
Reconstructive Plastic Surgery
Reconstructive plastic surgery aims to restore normal form and function to tissues damaged by injuries, illnesses, or birth defects. Unlike cosmetic procedures that are purely elective, reconstructive procedures are often medically necessary to improve a patient’s quality of life or physical capabilities. Plastic surgeons routinely repair traumatic injuries such as complex lacerations and facial fractures from accidents, perform burn wound coverage with skin grafts or flaps, reattach severed fingers or limbs using microsurgery, and reconstruct deformities caused by cancer surgeries (for example, breast reconstruction after mastectomy). They also correct congenital abnormalities like cleft lip and palate, helping patients achieve more normal appearance and function from an early age. In these contexts, plastic surgeons draw on extensive knowledge of anatomy – including skin, soft tissue, nerves, and blood vessels – and use specialized techniques (e.g., microsurgical free tissue transfer, tissue expansion, bone grafting) to rebuild structures.
The clinical scope of reconstructive surgery is vast. Common examples include:
Craniofacial reconstruction: Repairing facial bone fractures, skull defects, or deformities (often needed after car accidents or other trauma).
Hand surgery: Fixing tendon injuries, nerve lacerations, or fractures in the hand; plastic surgeons are trained in delicate hand surgery and nerve repair.
Burn reconstruction: Applying skin grafts or performing flap surgeries to cover burn wounds and improve mobility or appearance after severe burns.
Breast reconstruction: Rebuilding a breast after mastectomy using implants or autologous tissue flaps (e.g., TRAM or DIEP flaps), restoring contour for breast cancer survivors.
Scar revision and contracture release: Improving thick scars or tight scar bands that restrict movement (often done after traumatic injuries or burns).
Post-traumatic limb salvage: Covering exposed bones or repairing soft-tissue defects on limbs after serious injuries (sometimes using muscle flaps to prevent amputation).
Reconstructive procedures often occur in urgent or complex medical situations, which can impact legal analysis of care. For instance, a plastic surgeon on call for emergencies may need to act quickly to save a patient’s tissue or life. Due to the severity of injury or infection risk inherent in trauma cases, adverse outcomes can happen despite proper technique. However, standard of care still demands exercise of the skill and diligence expected of a reasonably competent plastic surgeon under similar circumstances. If a reconstructive procedure is performed negligently – for example, a surgeon fails to diagnose and treat compartment syndrome in a crushed limb leading to unnecessary amputation or uses an improper technique that causes a flap to fail – a malpractice claim may arise. In general, courts recognize that a bad outcome alone (especially in high-risk reconstructive cases) is not proof of malpractice; the key question is whether the surgeon’s actions met the accepted standard of care given the clinical situation. Still, reconstructive surgery claims do occur, particularly when an error or omission by the surgical team worsens the patient’s condition beyond the underlying injury from the accident or disease.
Cosmetic Plastic Surgery
Cosmetic plastic surgery consists of elective procedures intended to improve appearance, targeting physical features that patients wish to change. Common cosmetic surgeries include breast augmentation or reduction, liposuction and other body-contouring procedures (tummy tucks, thigh lifts), facial cosmetic operations such as rhinoplasty (nose reshaping), rhytidectomy (facelift), and blepharoplasty (eyelid lift), as well as many minimally invasive treatments (e.g., Botox® injections, dermal fillers, laser resurfacing). Unlike reconstructive surgery, cosmetic procedures are typically performed on healthy patients who expect aesthetic improvement rather than medical restoration. This creates a unique scenario in which patient expectations are extremely high, and even minor imperfections or complications can lead to dissatisfaction. From a legal perspective, this means cosmetic surgeons must be especially meticulous in patient selection, informed consent, and execution of the procedure, because an unhappy patient may pursue a claim if outcomes fall short of what was promised or expected.
Statistically, a large portion of plastic surgery malpractice litigation involves cosmetic procedures. Studies of malpractice cases have found that the most commonly litigated procedures in plastic surgery are breast surgeries, liposuction, and other body contouring surgeries. In one analysis of cases from 2009–2015, breast-related cosmetic surgeries accounted for about 34% of the claims, liposuction for 18%, and abdominoplasty or similar body-contouring for 14%. These proportions reflect the popularity of these procedures as well as their propensity to generate claims. Breast augmentation in particular is one of the most frequently performed cosmetic surgeries and can involve significant risks such as infection, implant complications, or undesired aesthetic results. Liposuction and tummy tucks carry risks including organ perforation, bleeding, blood clots, and contour deformities. Facial cosmetic procedures (facelifts, eyelid surgeries, nose reshaping) are also well represented in malpractice claims, often due to issues like nerve injury (e.g., facial nerve damage causing paralysis), sensory loss, scarring, or dissatisfaction with cosmetic outcome.
One especially high-risk cosmetic procedure is gluteal fat grafting, commonly known as the Brazilian Butt Lift (BBL). This procedure involves liposuction with fat injected into the buttocks for augmentation. Alarmingly, gluteal fat grafting has the highest mortality rate of any aesthetic surgery – estimated as high as 1 in 3,000 cases – due to the risk of fat embolism if fat is inadvertently injected into large veins. Numerous malpractice claims have arisen from BBL complications, including patient deaths. For example, in a 2020 case in Maryland, a woman underwent liposuction and a BBL and later developed a necrotizing soft tissue infection (necrotizing fasciitis). The infection was allegedly not recognized or treated in a timely manner by the clinic’s staff, leading to the patient’s near death, extensive surgical debridements, and permanent disfigurement of her abdomen and thighs. In 2023, a jury found that the surgeon, clinic, and staff breached the standard of care in that case, awarding a substantial verdict (though state caps reduced the payout). This example underscores how a post-operative complication in a cosmetic procedure, if mishandled, can become a catastrophic injury and a strong basis for a malpractice claim.
In cosmetic surgery, patient selection and informed consent are paramount. Many malpractice claims in aesthetic surgery are not due to blatant surgical errors but rather stem from inadequate screening or counseling of the patient before surgery. Surgeons must evaluate whether a patient’s goals are realistic and whether any psychological factors (such as body dysmorphic disorder) are present that could lead to dissatisfaction regardless of the surgical result. They also have a duty to disclose all significant risks, benefits, and alternatives to the patient. The informed consent discussion for cosmetic procedures tends to be even more detailed and stringent than for medically necessary surgery. Patients should be informed that perfection is not guaranteed and that certain complications (scarring, asymmetry, need for revision surgery, etc.) are possible even with proper care. If a surgeon provides information that overstates potential results or minimizes possible risks, and the outcome is unsatisfactory, a patient may assert that they did not fully consent to the result. Conversely, thorough informed consent can provide a legal safeguard because a bad result alone does not establish malpractice – there must be proof that the surgeon deviated from the standard of care. This principle is particularly relevant in cosmetic cases because dissatisfaction might occur despite technically competent care.
It is also important to recognize that in the U.S. not all practitioners performing cosmetic surgery are board-certified plastic surgeons. There is a phenomenon of physicians from other specialties (or even non-physician providers) venturing into performing cosmetic procedures because they are lucrative; of course, they are sometimes outside the scope of their formal training. For instance, dermatologists, OB/GYNs, or even pediatricians have performed cosmetic surgeries such as liposuction or breast augmentations. These out-of-specialty practices have prompted warnings from professional organizations about a “cosmetic surgery Wild West.” From a malpractice standpoint, a doctor performing procedures outside his or her core competence can be held to the same standard of care as one who is trained as a plastic surgeon. In other words, if a physician without plastic surgery training performs a tummy tuck, the law will judge them by what a prudent board-certified plastic surgeon would have done in that situation. Performing major cosmetic surgery without appropriate credentials or training can itself be evidence of negligence if complications arise. Indeed, cases have emerged involving unqualified providers: for example, a highly publicized 2020 incident in California involved a patient’s death during liposuction performed in an office by a pediatrician with no formal surgical training. Such tragic outcomes highlight the importance of proper credentials and adherence to accepted surgical safety protocols (including having qualified anesthesia personnel and accredited facilities for surgery). To perform cosmetic procedures in their operating rooms, hospitals typically require surgeons to be credentialed in plastic surgery, but office-based surgeries and clinics vary in oversight. This area has also led to negligent credentialing claims against facilities that allowed an unqualified practitioner to operate, though these claims are complex and vary by state.
Standards of Care and Surgeon Qualifications
In any medical malpractice case, the plaintiff must establish the applicable standard of care and show that the defendant breached it. The standard of care in plastic surgery is generally defined as the level of skill, expertise, and care practiced by a reasonably competent plastic surgeon under similar circumstances. It is not a written statute but rather derived from professional guidelines, common practices, and expert testimony. For plastic surgeons, some benchmarks for the standard of care can be found in guidelines published by organizations like the American Society of Plastic Surgeons (ASPS) or the American College of Surgeons. For example, in response to the high risks of BBL procedures, the ASPS issued specific recommendations (such as injecting fat only in the subcutaneous layer, not into muscle) to reduce fatal complications. Deviation from such well-publicized safety guidelines could be used in court to argue a breach of standard of care. Similarly, not managing a known complication appropriately – such as failing to timely diagnose an infection or hematoma after surgery – would likely be deemed a breach by most plastic surgery experts.
A unique challenge in plastic surgery is that outcomes can be subjective. Unlike a clear-cut error (e.g., operating on the wrong limb), the question of whether a cosmetic outcome is acceptable can be a matter of opinion. Thus, standard of care in cosmetic cases often revolves around whether the surgeon’s methods and decision-making were appropriate, rather than the aesthetic result alone. For instance, consider a rhinoplasty that leaves the patient unhappy with their nose shape. If the surgeon’s surgical technique and post-op management were in line with what competent surgeons would do (and known risks were disclosed), there may be no negligence even if the result is not ideal. However, if the surgeon used an improper technique that is outdated or overly aggressive – say, removing excessive nasal cartilage causing collapse – that could breach the standard of care. Likewise, poor preoperative planning (such as operating on a patient who is not a good candidate) could be a breach if it falls below what a careful surgeon would do. In one malpractice case, a surgeon performed multiple facial cosmetic procedures on a patient with a history of body dysmorphic disorder and unrealistic expectations; the court focused on whether proceeding with surgery was a deviation given the red flags. These nuanced determinations require expert testimony to establish what a prudent surgeon would have done.
Surgeon qualifications and credentialing standards play an important role in both patient safety and legal considerations. In the United States, the gold standard credential for a plastic surgeon is certification by the American Board of Plastic Surgery (ABPS), which is recognized by the American Board of Medical Specialties. ABPS board certification requires completion of an approved plastic surgery residency (often 6+ years of training after medical school, including comprehensive training in both reconstructive and cosmetic procedures) and passing rigorous written and oral examinations. Board-certified plastic surgeons also commit to continuing education and ethical standards. While board certification is not legally required to practice (any physician with a state license could theoretically perform cosmetic surgery), lack of certification can be a red flag in malpractice cases. If a doctor without proper training causes harm, plaintiff attorneys will often highlight that the practitioner did not have board certification or hospital privileges in plastic surgery – suggesting they fell outside the standard of care, per se. Even among board-certified plastic surgeons, there are subspecialties (such as hand surgery or craniofacial surgery), and having appropriate experience in the procedure at issue is crucial when evaluating a case.
Hospitals and accredited surgery centers have credentialing processes to ensure surgeons are qualified for each procedure they perform. For example, a hospital will typically only grant privileges for microsurgery or craniofacial surgery to a surgeon who can demonstrate training and experience in those areas. Failure of a facility to properly credential a surgeon (allowing an unqualified physician to do a complex plastic surgery) could lead to institutional liability. From the malpractice attorney’s perspective, checking the surgeon’s credentials, training background, and whether they operated within the scope of their privileges is an important part of case evaluation. A trend in cosmetic surgery is that many procedures happen in private clinics or office-based surgical suites, which may not be subject to the same oversight as hospitals. This can sometimes result in substandard environments or staff (for instance, no certified anesthesiologist on site, or inadequate emergency equipment), which in turn can breach the standard of care if an emergency arises and cannot be managed. Attorneys should be alert to such context in cases of office cosmetic procedure injuries.
Common Malpractice Claims in Plastic Surgery
Plastic surgery malpractice claims arise from a variety of alleged mistakes or poor outcomes. Some common categories of claims include:
Surgical Errors and Poor Technique: These are allegations that the surgeon performed the procedure improperly. This could mean a technical mistake (e.g., resulting in nerve damage during a facelift, improperly placed breast implants causing deformity, excessive tissue removal, or lack of symmetry after a breast reduction). In many claims, an undesirable outcome that is actually a known complication gets framed as “improper performance” if the patient feels it resulted from the surgeon’s technique. For instance, a patient might allege a tummy tuck was done incorrectly if they develop a large noticeable scar or uneven contour, even if the surgeon followed an accepted technique. However, again, a bad outcome does not mean there was malpractice. Claims of gross negligence are also seen – for example, operating on the wrong site or leaving surgical instruments inside the patient (rare in plastic surgery, but possible).
Lack of Informed Consent: These are claims that the surgeon did not adequately disclose the risks, alternatives, or potential outcomes of the procedure. In cosmetic surgery especially, informed consent is a frequent battleground. A patient who is unhappy with the result may say, “Had I known I could end up with these scars or that I might need a second revision surgery, I would not have gone through with it.” If documentation or testimony shows the surgeon failed to review such risks, the patient may establish a breach of the standard of care for informed consent. However, if the surgeon did discuss those risks (and ideally had the patient sign detailed consent forms, such as those provided by ASPS), it bolsters the defense that the patient was appropriately informed. In some jurisdictions, lack of informed consent is pled as a separate cause of action, while in others it falls under general negligence. Either way, demonstrating a robust consent process is key for the defense.
Improper Patient Selection or Contraindications: These claims argue that the surgeon should not have operated in the first place or should have chosen a different procedure. For example, operating on someone with clear health contraindications (like performing an extensive facelift on a patient with severe cardiac issues who is not cleared for lengthy surgery), or doing a cosmetic procedure on a patient with unrealistic expectations or untreated psychological issues. If an adverse event occurs, plaintiffs may claim the surgeon was negligent in recommending or proceeding with surgery given the patient’s condition. Case reviews have noted that inadequate patient assessment preoperatively is a contributing factor in many lawsuits. A real-world example involved a patient who continued smoking against medical advice but was still given a facelift; she then suffered skin necrosis (a known risk heightened by smoking) and sued alleging the surgeon should not have cleared her for the procedure under those conditions.
Postoperative Care Negligence: These claims focus on failures in monitoring and follow-up care. A plastic surgeon’s responsibility does not end when the operation is over; proper post-op management is critical. Common scenarios include: failure to recognize and treat an infection in a timely manner leading to sepsis or tissue loss; failure to address a hematoma or bleeding after surgery leading to shock or the need for additional surgeries; and not responding to patient complaints of severe pain or symptoms that indicated a complication. An example is the case of a Chicago woman, who underwent liposuction in 2019. During recovery, she suffered internal bleeding that went unrecognized. Evidence showed the doctor did not evaluate her after surgery and “essentially abandoned her in the recovery room,” resulting in hours of untreated hemorrhage and ultimately her death. In 2024, a jury awarded her family $66 million, finding that the surgeon’s postoperative negligence was the cause of this preventable fatal outcome. This illustrates how a lapse in standard post-op protocols (such as monitoring vital signs, checking on the patient, and having emergency response capability) can lead to devastating consequences and substantial liability. Other post-op claims involve issues like not giving proper wound care instructions or discharging a patient too soon without recognizing complications.
Anesthesia or Sedation Errors: Many plastic surgeries, especially cosmetic ones, are performed under general anesthesia or heavy IV sedation. Errors in anesthesia (such as improper intubation, overdose of anesthetics, lack of monitoring leading to oxygen deprivation or cardiac arrest) can lead to brain damage or death. Often these claims implicate the anesthesiologist or nurse anesthetist as well as the surgeon or facility. In outpatient cosmetic surgery clinics, there is sometimes controversy if sedation is administered by the surgeon or an unsupervised nurse (to cut costs), which can breach standard safety practice. Severe anesthesia accidents in a plastic surgery context are fortunately infrequent, but when they occur, they form a strong basis for malpractice suits.
Lack of Credentialing/Out-of-Scope Practice: As discussed, if a procedure was performed by someone not properly trained or outside a proper facility, plaintiffs may claim the provider breached the standard of care by doing a surgery they were not qualified to do. For example, a general practitioner performing a complex cosmetic surgery could be held negligent for undertaking it without the appropriate credentials. Similarly, performing surgery in an unaccredited office surgery suite lacking proper equipment can be viewed as a breach. While not a traditional “cause of action” on its own, these circumstances often accompany the above claims and can aggravate the perception of negligence (sometimes leading to punitive damages if egregious, such as a fake “surgeon” with no training causing harm).
Emotional or Psychological Injury Claims: Plastic surgery patients sometimes sue not just for physical injury but for emotional distress and psychological harm, especially when the outcome is disfigurement. In fact, one analysis found that disfigurement was the most common alleged injury in plastic surgery claims (40% of cases studied), and emotional/psychological trauma was also frequently cited. Patients who undergo cosmetic surgery often have a high emotional investment in the result; if the result is a significant disfigurement or need for additional corrective surgeries, they may claim severe emotional distress. These damages are in addition to physical pain and suffering. It has been observed that cases involving claims of pain and emotional distress have a higher likelihood of resulting in plaintiff verdicts compared to cases without such elements. This suggests juries may be sympathetic to the life impact of a botched plastic surgery beyond the visible scars.
It is worth noting that most malpractice claims against plastic surgeons do not result in payment. Many are either dismissed, settled for modest amounts, or won by the defense at trial. According to one insurance study of claims closed from 2015–2018, only about 26% of claims against plastic surgeons led to any indemnity payment to the plaintiff. Similarly, a review of jury verdicts found that about 70% of verdicts in plastic surgery cases favored the surgeon (defendant). This reflects the fact that not every adverse outcome is due to negligence, and surgeons often successfully defend cases by showing they met the standard of care or that the complication was an accepted risk. However, the flip side is that when plaintiffs do win, the awards can be large, especially for catastrophic injuries or death. Plastic surgery cases can evoke strong emotions – for example, if a young patient is disfigured by a cosmetic procedure gone wrong and the jury finds negligence, they may award high damages for loss of quality of life, emotional suffering, and corrective treatment costs. The large verdicts in the cases of the Maryland BBL infection and the Illinois liposuction death cited above (even if later reduced by caps or appeals) demonstrate this potential.
Expert Testimony in Plastic Surgery Malpractice
Because plastic surgery involves specialized techniques and nuanced judgment calls, expert testimony is usually the cornerstone of malpractice litigation in this field. Both plaintiffs and defendants will retain plastic surgery experts to review the case, explain the medical issues to the jury, and opine whether the care provided fell below the standard of care. An expert must establish what a competent plastic surgeon would have done under similar circumstances. For example, a plaintiff’s expert might testify that “no prudent plastic surgeon would have injected that amount of fat superficially during a BBL, given the known safety guidelines,” thereby framing the defendant’s actions as a breach. The defense expert, conversely, might highlight that the complication was a known risk and the surgeon’s approach was one used by many careful surgeons, thus within standard practice.
Importantly, most jurisdictions require that a medical expert in a malpractice case be qualified as the defendant to testify on the standard of care. Some states have even codified this into law. For instance, Michigan law mandates that an expert witness in a malpractice case spend the majority of their professional time in the same specialty and be board certified in the same specialty as the defendant. This “same specialty” rule means that if a board-certified plastic surgeon is being sued, the plaintiff generally must present an expert who is also a board-certified plastic surgeon (not, say, a general surgeon or dermatologist). The intent is to ensure the expert truly understands the field’s standards and to prevent “professional witnesses” from unrelated fields offering opinions. In a Michigan case, Selliman v. Colton, involving a facial plastic surgery, the court assessed whether the plaintiff’s expert because the expert spent 90% of his time practicing in another specialty (otolaryngology) and only 10% in facial plastic surgery – met the statutory requirement of matching the defendant’s specialty. Many other states have similar rules or at least strong preferences for same-specialty experts. For malpractice attorneys, this means when bringing a case against a plastic surgeon, one should secure an expert who is a plastic surgeon with current clinical experience. Likewise, defense counsel will seek out experienced plastic surgeons (often with academic credentials or leadership in the field) to support that the care was appropriate.
Having a well-credentialed expert is not only a legal necessity in many areas but also a strategic advantage. Research indicates that the party whose expert is a plastic surgeon tends to be more successful in litigation. Juries give considerable weight to the credibility and authority of experts. If, for example, a plaintiff uses a non-plastic surgeon as an expert and the defense uses a renowned board-certified plastic surgeon, the jury will likely find the defense expert more persuasive on technical points. Professional societies like ASPS also maintain ethical guidelines for expert witnesses, stressing that they should provide honest, evidence-based opinions. A history of providing dubious testimony can undermine an expert’s credibility and even lead to professional censure. There have been instances where plastic surgeons faced disciplinary action by medical boards or professional associations for giving misleading or false testimony (essentially acting as “hired guns”). Thus, reputable experts strive to stick to the facts and widely accepted standards in their testimony.
Expert witnesses also educate the court on causation – i.e., linking the alleged deviation to the injury. In plastic surgery cases, causation can be complex. For example, if a patient suffers tissue necrosis after a procedure, was it caused by surgeon error (like cutting too much blood supply) or by patient factors (such as smoking or poor circulation) or just an unlucky complication? Experts debate these points. In reconstructive cases, an expert might have to distinguish harm caused by the original trauma versus harm due to surgical mishandling. Clear expert analysis is crucial because the plaintiff must prove not only that the care was substandard but that this lapse caused the bad outcome.
Additionally, experts may speak to what reasonable outcomes and risks are. In cosmetic cases, a defense expert often will testify that the outcome, while not what the patient hoped for, is within the range of normal results and that the surgeon did everything per standard of care. Or an expert could highlight that the patient’s own actions (like not following post-op instructions) contributed to the poor outcome. For instance, if a patient fails to keep wounds clean or resumes smoking against advice and then has a complication, the defense may argue that as the cause. (Notably, in a Maryland case involving the BBL infection, the defense attempted to assert contributory negligence, though the judge did not allow it and the jury still found for the patient.)
In summary, expert testimony in plastic surgery cases must establish the standard of care, evaluate the surgeon’s conduct against that standard, and clarify the causation of the injury. Given the highly technical and specialized nature of plastic surgical procedures, the experts often determine the outcome of the trial.
Case Law Examples and Legal Precedents
To ground these concepts, it is useful to look at a few recent cases involving plastic surgery malpractice. These cases illustrate how courts handle allegations of negligence in this specialty and what factors influence their decisions:
Gross v. Stuart, 833 S.E.2d 834 (Va. 2019) – Cosmetic Eyelid Surgery Resulting in Blindness. In this case, a patient underwent an elective upper blepharoplasty (upper eyelid lift) and suffered a serious complication: permanent injury to the levator muscle of the right upper eyelid, leaving her functionally blind in that eye. She sued the plastic surgeon for negligently performing the procedure. A Virginia jury found the surgeon liable and awarded the patient $800,000 in compensatory damages. On appeal, the Supreme Court of Virginia affirmed the verdict, rejecting the defense’s arguments of trial error. Notably, a point of contention was the cross examination of the defense’s medical expert about prior disciplinary actions; the court allowed this, which speaks to expert credibility issues in trial. The Gross case underscores that if a cosmetic surgery causes a significant injury (blindness) and the plaintiff can show the surgeon’s technique fell short (for example, damaging an ocular muscle which a careful surgeon would avoid), liability can result. It also highlights the importance of expert witnesses, as both sides relied on expert testimony regarding the standard of care for blepharoplasty.
Gardner v. Jackson, 344 So.3d 1026 (Miss. Ct. App. 2022) – Breast Surgery Complications and the Need for Expert Testimony. This Mississippi case involved a patient who had a complicated history of breast surgeries and then underwent a combined breast augmentation and mastopexy (lift) with a different plastic surgeon. Postoperatively, she developed infections in both breasts which became so severe that both implants and large portions of breast tissue had to be removed. The patient sued the surgeon, alleging that he improperly performed the surgery (in particular, the technique of using an “inferior pedicle” breast flap instead of the prior surgeon’s “superior pedicle” technique, which she argued led to poor blood supply). However, at trial her case faltered because of insufficient expert evidence. Her expert did not clearly articulate the national standard of care or how it was breached, and under Mississippi law, that proof is required. The court granted a directed verdict for the defense, and the Court of Appeals affirmed, agreeing that the plaintiff’s evidence failed to establish the standard of care and breach with requisite clarity. This case demonstrates that even when a patient has a devastating outcome (losing both breasts), a malpractice claim cannot succeed without solid expert testimony on what the surgeon did wrong. It also reflects the principle that surgical judgment (choice of technique) will be given deference unless peers testify it was a clear error.
Kunda v. Premier Surgical (Md. Cir. Ct. 2023) – Liposuction and Brazilian Butt Lift Leading to Necrotizing Fasciitis. This case (discussed earlier) involved a woman who developed a life-threatening necrotizing fasciitis infection after a liposuction and Brazilian Butt Lift procedure in an outpatient center. Evidence in the trial showed that a physician assistant saw the patient in follow ups but failed to recognize clear signs of infection (fever, complaints of pain) and did not inform the surgeon in time. The infection progressed until the patient was found in septic shock and had to undergo emergency surgeries and prolonged hospitalization, resulting in permanent tissue loss and disability. The Maryland jury found that every defendant – the surgeon, the PA, and the surgical center – breached the standard of care in how they managed the patient. Although the jury awarded over $35 million, state caps on noneconomic damages reduced the actual collectible amount to around $5.8 million. The legal significance of this case lies in its focus on postoperative care and team communication failures. It shows that liability in plastic surgery can extend beyond the primary surgeon to assisting staff or clinics if they fail in their duties. It also illustrates the application of comparative negligence defenses – the defense tried to argue the patient’s own delays or actions contributed, but the court disallowed that argument in this instance – an interesting procedural point. This case received media attention given the size of the verdict and the egregious nature of the oversight, reinforcing that juries will hold providers accountable for not responding to complications in time.
Corcoles v. Sayeg (Ill. Cir. Cook Cty. 2024) – Fatal Hemorrhage After Office Liposuction. This case involved the death of a 39-year-old patient, Idalia Corcoles, who underwent liposuction at a Chicago clinic (an office-based surgery facility). During surgery, she suffered an internal injury that led to internal bleeding. The surgeon failed to monitor or recognize the bleeding postoperatively – he did not personally check on her, and she was essentially left in recovery until it was too late. The patient was found unresponsive and later died of the hemorrhage. In late 2024, a Cook County jury returned a verdict of $56 million in damages (around $66 million with interest) against the surgeon – reportedly one of the largest medical malpractice verdicts in Illinois to date. This outcome highlights a few legal points: the standard of care in outpatient cosmetic surgeries requires careful post-op observation and emergency preparedness, just as in a hospital. Abandoning a patient or having inadequate supervision in recovery is a clear breach. The case also raises the issue of whether the clinic was equipped to handle complications; while the verdict was against the doctor, it was noted that such a large award would trigger an investigation by the state medical authorities. For attorneys, the Corcoles case is a stark reminder of how juries respond to avoidable deaths in cosmetic surgery – with significant awards – and the importance of scrutinizing the setting (office versus hospital) and care protocols used by the surgeon.
These cases, all from the last five to 10 years, show the spectrum of plastic surgery malpractice issues: surgical technique errors (Gross), judgment calls on technique (Gardner), post-op management failures (Kunda, Corcoles), and the pivotal role of expert testimony (Gardner). They also demonstrate that while many plastic surgery cases favor defendants, when clear negligence is proven, courts will uphold patient victories and substantial damages. Another theme is that multidisciplinary care and communication are important – e.g., involvement of physician assistants or other staff can complicate the liability picture. In any plastic surgery malpractice scenario, recent case precedents and jury trends in the relevant jurisdiction can guide how to approach the claim, whether representing the plaintiff or the defendant.
Legal Implications and Risk Management
From a risk management perspective (highly relevant to malpractice attorneys advising clients or evaluating cases), several key takeaways emerge about plastic surgery:
Importance of Documentation: Plastic surgeons should maintain meticulous operative reports, consent forms, and follow-up notes. In court, detailed documentation of informed consent (listing the discussed risks and patient’s understanding) and postoperative instructions can make the difference in defending a claim. If it is not documented, a jury might believe it was not done. For attorneys reviewing a case, missing or vague documentation is often a red flag that can be exploited in litigation.
Managing Patient Expectations: Unrealistic patient expectations are a common root of cosmetic surgery lawsuits. Surgeons are advised to thoroughly discuss what outcomes are achievable and perhaps even turn away patients who have unattainable goals or pressure for perfection. When cases do go to litigation, one strategy for the defense is to show the patient was adequately counseled about realistic outcomes (sometimes using the patient’s own preoperative photographs or presurgery notes about discussions). For plaintiffs, showing that the surgeon glossed over the risks or oversold the results can build a narrative of negligence or even recklessness.
Standard of Care Protocols: The existence of published safety protocols (such as the ASPS advisories on safe BBL technique, or guidelines on VTE prophylaxis in abdominoplasty, etc.) give concrete standards that experts and lawyers will cite. Surgeons deviating from these without a compelling reason put themselves at risk. Conversely, adherence to such guidelines can be a strong defense. Lawyers on both sides should familiarize themselves with any applicable standard protocols in the procedure at issue.
Continued Training and Credentialing: Plastic surgery techniques evolve (for example, new laser treatments or implant materials). Surgeons must stay current, and hospitals must ensure competency. An attorney examining a case involving a newer technology will ask: Did the surgeon have adequate training on this device or technique? There have been malpractice claims when a surgeon used a new cosmetic device (say a laser or an ultrasound-assisted liposuction machine) without proper training, causing injury (like burns or nerve damage). That can be framed as a breach of standard of care – not being properly trained or not following manufacturer’s protocols.
Malpractice Insurance and Litigation Trends: As of the last decade, around 13% of plastic surgeons face a malpractice claim each year, one of the higher rates among specialties (similar to orthopedic and general surgeons). Many cases, however, do not go to trial; roughly 93% of claims might be resolved by dismissal or settlement. This suggests that while lawsuits are a risk, the specialty has a strong defense record. Attorneys might consider this when advising clients on settlement – plaintiffs should be made aware that surgeons win a majority of fully litigated cases, but defendants should also weigh the unpredictability of jury sympathy in egregious cases.
Case Law Developments: New case law continues to refine how legal principles apply to plastic surgery. For example, issues like enforceability of waivers or arbitration clauses that some cosmetic surgery clinics use, or the impact of state noneconomic damage caps on largely aesthetic injury cases, are all considerations. Lawyers must stay updated on relevant decisions in their jurisdiction. Additionally, some states have been scrutinizing office-based surgery standards through legislation, which could influence future negligence claims (e.g., requiring certain accreditation for offices that do high-risk cosmetic surgery).
In conclusion, the field of plastic surgery presents a complex interplay between clinical innovation and legal accountability. For medical malpractice attorneys, a solid grasp of the specialty’s scope – from reconstructive microsurgery to cosmetic makeovers – is necessary to assess what should (or should not) happen in each case. By understanding common procedures and their risks, the prevailing standard of care, and how experts and courts view plastic surgery cases, attorneys can more effectively litigate and defend these claims. Plastic surgeons can reduce liability by adhering to high standards of practice: careful patient selection, thorough informed consent, excellence in surgical technique, diligent post-op care, and staying within the bounds of their training and credentials. While not every unfortunate outcome is due to malpractice, when negligence does occur in plastic surgery, the consequences for patients can be life-altering – and the legal system provides recourse to address those injuries within the framework of medical negligence law.
Plastic surgery is a unique medical specialty that straddles the line between essential reconstructive care and elective aesthetic enhancement. Its practitioners are held to well-defined standards of care that factor in both the functional and cosmetic stakes of their interventions. For attorneys dealing with plastic surgery malpractice, cases will often hinge on expert-driven evaluations of surgical decisions and management of complications. With high patient expectations and delicate procedures, plastic surgery generates a significant share of malpractice claims, though surgeons successfully defend many by demonstrating adherence to the standard of care. Ultimately, careful documentation, communication, and credentialing are key practices that protect both patients and surgeons. By staying informed on the latest clinical techniques and legal precedents in plastic surgery, medical malpractice attorneys can ensure that they effectively represent their clients – whether pursuing justice for an injured patient or defending a surgeon who met the standard of care under challenging circumstances. The definition and scope of plastic surgery, therefore, is not only a medical description but also a framework for understanding the responsibilities and potential liabilities that come with this surgical art and science.
[^1]: Standard of Care Note: A poor outcome by itself does not prove negligence. Courts require showing the provider’s conduct fell below what a competent practitioner would have done. This is especially pertinent in cosmetic surgery cases where dissatisfaction alone is insufficient for liability.
Sources:
Cooper University Health Care – What Is Plastic Surgery?
The Doctors Company – Plastic Surgery Closed Claims Study
Sarmiento S, Wen C, Cheah MA, Lee S, Rosson GD. Malpractice Litigation in Plastic Surgery: Can We Identify Patterns? Aesthet Surg J. 2020 May 16;40(6):NP394-NP401. doi: 10.1093/asj/sjz258. PMID: 31563936.
Therattil PJ, Chung S, Sood A, Granick MS, Lee ES. An Analysis of Malpractice Litigation and Expert Witnesses in Plastic Surgery. Eplasty. 2017 Sep 28;17:e30. PMID: 29062461; PMCID: PMC5638964.
AMA Litigation Center – Expert witness must practice same specialty (Michigan) https://www.ama-assn.org/practice-management/sustainability/expert-witnesses-must-practice-same-specialty-defendant
Gross v. Stuart, 833 S.E.2d 834 (Va. 2019)
Gardner v. Jackson, 344 So.3d 1026 (Miss. App. 2022)
Jury awards $35M… after cosmetic surgery (Maryland The Daily Record, March 28, 2025) https://thedailyrecord.com/2025/03/28/jury-awards-35m-med-mal-verdict-to-woman-who-went-into-coma-after-cosmetic-surgery/
Chicago woman’s family awarded $66M… (CBS News, December 21, 2024) https://www.cbsnews.com/chicago/news/idalia-corcoles-lawsuit-verdict-66-million-plastic-surgery-internal-bleeding/
Michigan Bar Journal – Legal and Ethical Considerations Informed Consent https://www.michbar.org/file/barjournal/article/documents/pdf4article957.pdf https://www.michbar.org/file/barjournal/article/documents/pdf4article957.pdf