Should a Patient with Botched Surgical Results, Be Required to Pay for a Revision Surgeon?

Question

should a patient with botched plastic eye and brow lift be required to repay the surgeon for a revision?

Eric Pugash, MD · Answer

This is a great question and one that should be answered BEFORE taking a patient to the operating room for the first time.

	Each surgeon develops his or her policy regarding surgical revisions, and this should be communicated to patients at the very beginning. 

	Plastic surgeons crave approval - we love to have happy patients. However, no one bats 1.000, and occasionally we end up with someone who isn't satisfied after their procedure.

	My policy is this: if the result isn't what the patient would have liked, and I feel I can bring them closer to their goal with a second procedure, then I do the surgery without charging a professional fee. However, the patient is responsible for clinic and anesthesia fees. My office staff strive to make this as cost-effective as possible for the patient, so that theirs is the smallest possible cost. In my experience people have been very accepting of this practice.

	Of course if you end up seeing a different surgeon, that practitioner is under no obligation to offer reduced fees.

	Good luck!

Brent Moelleken, MD · Answer

Most surgeons cover their own fees and ask patients to pay actual costs, such as operating room expenses, in the case of revisions.  However every surgeon has their own policy, and these policies are usually in writing.

	The question is was the surgery "botched" and actually performed below the standard of care?

	Or were the patient's expectations simply not met?

	Was there an asymmetry in the eyes or brows that prevented the surgical result from appearing symmetrical?

	If the surgery were truly botched, a patient should not typically go back to that surgeon.

	If however the patient suffered a complication that is known to occur with this surgery, this can happen to any surgeon.

Kenneth D. Steinsapir, MD · Answer

For better or worse, a great deal of cosmetic surgery is subjective.  For this reason, it is impossible to offer a money back guarantee or any type of guarantee for that matter.  What you consider a botch, may in fact be a standard surgical result that simply does not meet your expectation.  You may have a benefit but wish to have more of a result.  You may have a complication that is expected and discussed in your surgical consent.  An adverse outcome does not mean that your surgeon did anything wrong in the performance of surgery.  Of course this is very different than a routine consumer purchase where we are accustom, and often promised, that the toaster, plasma tv, or cell phone we purchase will perform as advertised or the manufacture or retailer will make good on the item.

	Take home lesson, your potential cosmetic surgery is not like a routine consumer purchase.  I know of no surgeons who extend personal satisfaction guarantees for surgery.  You undertake a significant personal risk having a cosmetic surgery.  Please pay close attention to what is told to you by your surgeon and their staff.  Carefully read and understand what your surgical consent.  If you have questions, have those questions addressed.  If you are not comfortable having the surgery based on what is described in your surgical consent and the informed consent process, please don't have the surgery.  There is no such thing as a risk free surgery, things can and do happen that disappoint us or even disable us as a result of any surgery including cosmetic surgery.  This is going to happen at some small rate unavoidably.  You assume this risk when having a cosmetic surgery.  Often your surgeon will be motivated to help correct issues and may even assume some or all of the expense of revising a surgery. The problems come when you and your surgeon do not agree on the nature of the problem or there is a break down in the relationship.

	As Dr Rand correctly points out, in many cases, it is in your best interest to find the right surgeon to address your post-surgical concerns and this may not be the original surgeon.  Unfortunately many individuals in this situation find they do not have the financial resources to repair or revise a cosmetic surgery that they are not happy with.  It is worth noting that it is not unusual that the fix is even more expensive and surgically intensive than the original surgery.  You may be posting because you are in this dilemma.  Proceed cautiously and seek qualified second opinions before deciding how to proceed.

David Q. Santos, MD · Answer

Each individual plastic surgeon has his/her protocol in their office.  Common protocols include not charging for a second procedure.  Many offices and plastic surgeons require a facility fee.  Less often full price is charged.

	When it comes to the need for a revision procedure, which is a little bit different than &ldquo;botched surgery&rdquo;, repeat procedures are common.  A certain percentage of patients who have a rhinoplasty or facelift surgery for instance, require touch-up or revision procedure.  This can be in the range of 10 to 15% of patients sometimes.  Due to the fact that this is not too uncommon, this possibility should be discussed prior to the procedure. 

	In the instance of a &ldquo;botched&rdquo; surgical procedure, a good trusted second party is needed to assist with defining the real true problems.  A trustworthy second opinion would help to define whether there truly is a permanent complication or whether there is simply something else such as not getting the results that one desires, or a wound or swelling that should get better with time, etc.  Going back to the primary surgeon, getting his/her opinion followed by a second opinion will best assess whether there is a true problem that needs fixing.

	Commonly good ethical physicians will provide assistance for correcting surgical related complications at minimal or no charge.  But there is no requirement to do so.  Your best answer is to try to do the best you can with the primary physician/surgeon to see if he/she will provide correction of a true surgical complication at a reduced fee.

Rafael C. Cabrera, MD · Answer

I hate the word "botched". if you are unhappy and your surgeon does not agree with you, get a second opinion. if the second surgeon feels a revision is in order then either pay him/her or return to the original surgeon and ask him/her to do the procedure or pay for revision if its something he/she does not do.  If he feels the result is potentially a malpractice lawsuit, he will gladly pay for the revision. if he thinks the result is subpar but not meeting the standard of malpractice he will probably offer to do the revision at a cost predetermined by the contract you signed originally. remember he actually wants you happy. 

	I personally have never been sued (15 years of practice) but  I will do revisions based on contract when I believe it is possible to do better. Rarely, i will offer to do a revision and the pt will go elswhere, at their expense. the rare times an attorney has contacted me I have reviewed the case and determined that no malpractice was performed and told them to do what they see fit. again I have never been sued or paid a setlement.  Why? because an unhappy pt with a bad result is not malpractice. however, it is bad for business so i recommend you return to the surgeon and work something out. usually the best option for all parties involved.  

	I hope this helps. also stop using the word botched. it makes you sound unrealistic and may keep good surgeons from considering you for revisional surgery.

Gregory Branham, MD · Answer

The most important thing to remember is to get the answer to that question prior to surgery.  In general, if there is an issue, it is best to discuss that with your surgeon as soon as you become aware of it.  Most surgeons want you to have the best result and they want you to be happy with your outcome.  To that end, I will revise my owncosmetic patients in the first year usually without charging a professional fee.  Facility costs and anesthesia costs are paid by the patient.  If the patient wants a different procedure then the costs are not discounted. 

	You also must decide if you feel that the surgery was really "botched" and whether you want to return to the original surgeon.  In that case, you cannot expect the new revision surgeon to discount the fees.  In fact most surgeons charge more for revision cases as they are more difficult and risky.

Maurice M. Khosh, MD · Answer

There are no standards in regards to who is responsible for the surgical cost of revision surgery. Some surgeons perform revisions for free while others charge the patient. You should raise your concerns with your surgeon in an open and non-confrontational manner. I am sure that your surgeon, as most plastic surgeons, would want to have a happy patient, and want to minimize the cost aspect of revision surgery as long as you you have legitimate issues with the outcome.

Richard P. Rand, MD, FACS (retired) · Answer

First of all, is the result really "botched" or just not perfect or just not meeting your expectations? All of these play into potential fees for revisions and each surgeon has their own policy on this and there are no industry standards. Secondly, if you truly believe the surgeon botched the result, why would you let them have another try? Thirdly, if you go to a new surgeon, all fees will be new and the first surgeon won't be paying the second surgeon to do your revision.

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