Are surgeons held accountable?

Question

I understand a face lift isn’t always perfect, but when there are legitimate issues such as my ears look diff and I still have eye lid issues, raised scars behind ears &chin, face is not symmetrical, lightly touching my skin makes a nerve tingle all the way to the eye.doesnt the Dr have a responsibility to correct it? It seems like the only way to get a Dr to correct it or reimburse you is a lawsuit? Even then you’d have to be deformed to win. Is there no recourse? Thank you

Semih Yildiz, MD, FEPOBRAS · Answer

I am sorry you are dealing with this. In cosmetic surgery, a surgeon does have a responsibility to evaluate postoperative concerns, explain what is within the normal healing range, identify complications, and discuss reasonable treatment options. However, an imperfect or disappointing result is not automatically malpractice, and revision policies vary from practice to practice.

For the specific issues you mention, raised scars may respond to silicone, steroid injections, laser, or scar revision. Nerve tingling can sometimes improve over many months, but it should be examined, especially if it is persistent or worsening. Ear changes, asymmetry, and eyelid concerns need an in-person evaluation because they may require anything from time and scar care to a formal revision.

A practical next step is to request a dedicated follow-up appointment, bring a written list of concerns, and ask what they believe is normal healing versus correctable. If you do not feel heard, get an independent second opinion from a board-certified facial plastic or plastic surgeon experienced in facelift revision. For non-medical recourse, patients may contact the surgery center, hospital patient advocate, state medical board, or seek legal advice, but medically the first step is a careful examination and a clear revision plan.

John Michael Thomassen, MD · Answer

Of course surgeons are responsible for your care and should see you through the entire recovery process.  It is important for patients to be honest in expressing their concerns so the surgeon's are aware.  If you feel you are not given the attention your issues deserve, just communicate this with them and I am sure the issues will be addressed.  Of course it is important to go to a board certified plastic surgeon whose certification ensures the highest level of professionalism and ethical standards.

Mitchell Hagen, MD · Answer

Hi and sorry you are dealing with all of this! This sounds very stressful and I am sure it has impacted your life in ways you never thought imaginable. We do not have pictures and I do not know how far from surgery you are, but I can give you my general perspective on this issue. When I see patients that are not satisfied with their previous surgeon, I recommend they go back to see them for two reasons. The first is so the surgeon knows you are not pleased and it gives them a chance to either treat or correct the areas of concern. The second reason is so they can understand what they might have done to cause these issues so they can prevent them for future patients. However, it appears that you have already discussed this with your surgeon and it did not go well. That being said, I also understand that some patients may not feel comfortable returning to their previous surgeon. The unfortunate reality is there is a large variability in expertise and experience. I would seek out a surgeon that focuses exclusively on facial rejuvenation procedures and has experience with revision cases. Unfortunately, every surgeon occasionally has a complication. Even if a surgeon could perform a "perfect" surgery, there can be some wound healing issues. This is why follow up care is so important so some of these issues can be dealt with while your body is healing. Many issues can be resolved simply with steroid injections (scars) or sometimes with small revision procedures (correcting an ear lobe). Typically, a more invasive correction such as a revision facelift surgery requires waiting a year from the prior surgery. You really want a surgeon that will stick with you. Ultimately, the colleagues and friends that I have in the field want nothing more than for their patients to be happy and would stop at nothing for that outcome. It puts a pit in my stomach to hear stories like this. I'm so sorry you are dealing with this and I wish you luck with these tough decisions ahead!

Connie Hiers, MD, FACS · Answer

I would suggest sitting down with your surgeon and discussing all your concerns and options. You did not submit photos of before and after nor mentioned the time since surgery. However, most surgeons want to give their patients the best results and understand revisions may be needed.  A lawsuit may make things much more difficult for you, and also leaving bad surgeon reviews.  Once sued, your surgeon will not want to touch you, and others may also be less willing.  Go back and discuss your concerns with your surgeon.

Thomas Spalla, MD · Answer

As you noted yourself, surgery isn't always perfect. That being said, you may have some legitimate concerns depending on the outcomes. 
I have never met a surgeon that doesn't care about their patients' outcomes and satisfaction. There may be some horror stories out there that you read about online, but that has never been my experience. 
As surgeons, we carry a great responsibility on our shoulders, and our minds are constantly in a state of worry for our patients during, and after, surgery.
The first thing I would recommend you do is meet with your surgeon and calmly express each of your concerns. Prioritize what is troubling you the most and go from there. Rather than just name all the issues, just start one by one and go through each issue with your surgeon. See what they have to say about the outcome, expectations, and potential solutions. Then, move onto the next issue.

If reoperation is necessary, the contract you signed with your surgeon generally lays out the office policy for dealing with this situation. That being said, exceptions may be made.

If you truly feel that you cannot, or should not, work with this surgeon, seek a second or third opinion from similar surgeons.

Lastly, be patient, outcomes continue to evolve over months to even up to a year. I don't know how far out you are from surgery to potentially reassure you that the outcomes may not stay the way they are at this point.

Mats Hagstrom, MD (license on probation) · Answer

In a nutshell, the surgeon is responsible for your overall well-being after surgery, including taking care of complications or potentially offering revisions when indicated.
On the other hand, patients are responsible for choosing providers and providers very substantially in regards to skill, experience, personal philosophy and how they practice medicine.
 This is very much caveat emptor situation a.k.a. buyer beware.
Somethings after surgery may happen that are not related to the skill and experience of the provider and some will be.
Likewise, some issues may not have an easy fix, and there is no revision surgery indicated even if the patient has problems or concerns.
Your situation is complex and you bring up a lot of issues.
Without seeing completes set of proper before and after pictures, we can’t begin to make an assessment.
 I always recommended. Patient have multiple in person consultations before selecting providers or considering scheduling surgery.
It is the patient’s responsibility to vet the provider.
This means you should have a good understanding of that provider ability to perform the procedure well on a consistent basis.
I recommend patient do that by asking each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients with similar facial characteristics to your own.
highly experienced surgeons should have access to hundreds or preferably thousands of before and after pictures to choose from.
It’s also a good idea to ask surgeons what the revision policy is, what their most common indication for doing revision surgeries, and what their revision rate is.
You should also ask yourself if you’re unhappy with the outcome of the procedure from your current provider do you really want that provider doing your revision work?Threatening surgeons usually doesn’t end up working very well and mounting a lawsuit is extremely emotionally draining on both parties, and enormous waste of money for attorney fees and cosmetic surgery cases unless something egregious happened. The doctors usually win.
You can certainly try to negotiate to get a partial refund, which is probably the best you can help for.
Again Threatening providers is usually not going to get doctors to want to cooperate, but your best source of leverage may be the doctors reputation using social media. Start by saying you were hoping to leave positive reviews then go through all the things that left you disappointed.
If you’re provider showed you specific before and after pictures during your consultation, can ask them to compare your results to the pictures they showed you Implying that your provider failed to promise results consistent with what they had described.
Some providers are smart enough to negotiate with unhappy patients to work out something that is fair or at least extend an all branch.
For example, it’s unlikely your surgeon will pay the fee for another doctor to do revision work.
It may be possible to get part of your surgeons fee back if you negotiate well and your provider has the insight to realize that keeping you happy is to their advantage.
When providers refund money, they often ask patients to sign a release of liability. That usually includes an agreement that patient will not write negative things about the doctor.
Some malpractice insurance companies, recommend or insist that surgeons do this every time they give patients some a refund.
Be professional, try not to get emotional and negotiate like this is a business deal.
A partial refund is better than no refund.
If you want your doctor to do revision work, then you should simply bring that up. Before asking for a revision, you want to get confirmation that revision surgery is appropriate and that your surgeon isn’t going to make things worse.
Revision work can be more technically difficult than the primary procedure so recognize that sometimes revisions don’t make things better and they can in fact make things worse.
Each person will form scars that are unique to their own genetic makeup.
Some people simply scar worse than others.
In regards to facial symmetry, you had facial symmetry before the procedure.
All people have a facial asymmetry.
Most people have a substantial amount of asymmetry and are often unaware of this before surgery.
Some people will have changes in skin sensation and that is not something the surgeon can control.
Best,
Mats Hagstrom MD

Are surgeons held accountable?

Answers (6)

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