Medical Malpractice Claims After Nonsurgical Cosmetic Procedures

Abstract

BACKGROUND: Nonsurgical procedures account for >40% of the 15 billion dollars spent on cosmetic procedures nationally each year. These procedures are being performed by physicians across a multitude of both surgical and nonsurgical specialties, and by physician extenders. Although nonsurgical procedures are often viewed as a low-risk alternative to cosmetic surgery, they are not without their own complications. Consequently, physicians assume the risk of malpractice litigation when performing or supervising such procedures. There is a paucity of literature regarding malpractice claims associated with nonsurgical cosmetic procedures. The goal of this study is to use multiple national legal databases to characterize such malpractice claims. METHODS: Retrospective analyses of both the Westlaw legal database and VerdictSearch legal database were performed on all legal cases from 1985 to present that resulted in a verdict or settlement related to nonsurgical cosmetic procedures. The 10 most common nonsurgical cosmetic procedures were included in the search query. Malpractice cases were reviewed individually to ensure that they were directly related to nonsurgical cosmetic procedures and then the databases cross-referenced to eliminate any duplicates. The final combined database was then analyzed based on the procedure, primary malpractice claim, defendant qualifications and specialty, the case outcome, and the amount of award in case of plaintiff decision/settlement. RESULTS: A total of 68 individual cases were collected and analyzed. The most common procedure was laser resurfacing (n = 20), followed by chemical peel (n = 17) and laser hair removal (n = 16). Despite being the most and second most common procedures performed over the last 2 decades, botulinum toxin injection and dermal filler injection only accounted for 1 and 8 malpractice claims, respectively. The most common cause for litigation for laser resurfacing (90%), chemical peel (94%), and laser hair removal (94%) was burns/scarring due to alleged inappropriate administration, whereas the most common cause for litigation after dermal filler injection was nodule/cyst formation (50%). Thirty-eight percent of all cases resulted in a decision in favor of the plaintiff (against the physician) and 6% of cases were settled out of court. The remaining resulted in favor of the defending physician. The average award after a decision in favor of the plaintiff was for $440,323.27 ± $419,404.77. The average settlement was for $393,625.00 ± $240,355.77. The majority of providers with identified specialties were board-certified plastic surgeons (n = 20), followed by dermatologists (n = 14) and ophthalmologist/oculoplastic surgeons (n = 6). There was a disproportionate number of general practitioners (internists, family practitioners, and pediatricians) (n = 7) given the small volume of cosmetic procedures they perform relative to other specialties. There was no significant difference between the procedure, the cause for litigation or the defendant specialty, and the outcome of the lawsuit or the final monetary award. CONCLUSIONS: Medical malpractice litigation is a significant cost burden to physicians across all specialties, including those performing nonsurgical cosmetic procedures in the office. Given the rapidly increasing popularity of nonsurgical procedures, it is important that plastic surgeons are aware of the medicolegal landscape to avoid potential malpractice claims associated with such procedures.