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Despite the myriad benefits accompanying these trends,
there is certainly the potential for complications, including
thermal injury and skin discoloration, as noted in our analy-
sis. Allegations of inadequate informed consent were raised
in 50% of cases included (17 cases) (Figure 3). Nearly 60% of
these cases (10 cases) were resolved with a payment, com-
pared with the 29% payment rate in cases without this issue,
andmedianpayments trendedhigherwith the presence of this
factor ($246 000vs $150 000), although this trenddidnot reach
statistical significance (
P
= .17) (Table 2). Alleged deficits in in-
formed consent have been consistently found in a variety of
medicolegal analyses.
21,45,55-57
This is particularly important
for cosmetic procedures, in which informed consent allega-
tions can stem from a patient’s expectations not being met
rather than a physician’s simply not mentioning a potential
risk.
44
Consequently, in a comprehensive discussion of risks,
benefits, and alternatives, physicians and patients should ex-
plore specific goals of a procedure, as well as what plan to fol-
low if expectations are not met. Although including the spe-
cific injuries detailed in this analysis (Figure 3) is certainly
Table 3. Cases Resolved With a Plaintiff Verdict
Patient
Age,
y/
Sex
a
Award,
$ Defendant Indication Laser
Qualifi-
cation Burn Pigment
Postop-
erative
Unnec-
essary Consent Additional Work Perm Comments
52/F 977 000 Derm Aging CO
2
Yes
Third
degree
Yes
No
No
Yes
Yes
No No Perioral scarring
F
150 000 Unspeci-
fied
Hair
Unspeci-
fied
No
First
degree
Yes
No
No
No
No
Yes Yes Positive erythema
F
2300 OB
Aging Titan
No
Third
degree
No
No
No
Yes
No
No Yes Involvement of
cheeks, forehead
35/F 20 000 GS
Vascular CO
2
No
No No
No
Yes
Yes
No
No Yes “Should have” used
argon laser
F
391 000 Plastic
Scar
CO
2
No
No No
No
No
Yes
No
No No Lost tip of nose
71/F 1 265 000 Oculo-
plastic
Aging CO
2
No
No No
No
Yes
Yes
No
No Yes Skin breakdown
needing HBO
F
80 000 Derm Vascular Unspeci-
fied
No
No No
No
No
Yes
No
Yes Yes Ulcers that scarred
83/M 200 000 O/A
VC
Unspeci-
fied
No
No No
No
No
No
No
No No See Table 2
M 1 665 000 Oto
Rhinologic Unspeci-
fied
No
No No
No
No
Yes
No
Yes Yes See Table 2
M 850 000 Oto
OSA
Unspeci-
fied
No
No No
Yes
Yes
Yes
No
Yes Yes See Table 2
38/F 100 000 Dentist
Dental
b
Unspeci-
fied
Yes
No No
No
Yes
Yes
Yes
Yes No Loss of bone; death
of 7 teeth
Abbreviations: Additional, required additional surgery; CO
2
, carbon dioxide;
consent, alleged deficits in informed consent; defendant, defendant specialty;
Derm, dermatologist; GS, general surgeon; hair, hair removal; HBO, hyperbaric
oxygen therapy; indication, indication for procedure; O/A, otolaryngologist and
anesthesiologist codefendants; OB, obstetrician-gynecologist; oculoplastic,
oculoplastic surgeon; OSA, obstructive sleep apnea surgery; Oto,
otolaryngologist; perm, permanent injury; pigment, dyspigmentation; plastic,
plastic surgeon; postoperative, postoperative negligence; qualification,
defendant allegedly not qualified to perform procedure; rhinologic, rhinologic
procedure; unnecessary, unnecessary or inappropriate procedure; vascular,
removal of vascular anomaly; VC, vocal cord procedure; work,
employment/income affected.
a
Ages were not available for many patients.
b
Laser gingivectomy.
Table 4. Allegations in Cases Involving Removal of Vascular Lesions
Patient
Age,
y/Sex
a
Defendant
Award
(S/P), $
Postop-
erative
Unnec-
essary
Consent Additional Perm Comments
35/F
Not specified 20 000 (P) No
Yes
Yes
No
Yes
CO
2
laser to remove PWS on neck/jaw; scarring;
plaintiff claimed defendant should have used argon laser
8/M Derm
…
b
No
Yes
Yes
No
Yes
Candella laser for PWS on face, neck, and arm;
hyperpigmentation; “inappropriate” candidate because
patient was African American
F
Derm
80 000 (P) No
No
Yes
No
Yes
Telangiectasias on face removed; resulting nonhealing
ulcer
F
General
surgeon
…
b
Yes
No
No
No
No
Postoperative application of aloe, to which patient had
known allergy; facial swelling; physician not in room
during procedure; procedure for veins on cheek
Abbreviations: Additional, required additional surgery; CO
2
, carbon dioxide;
consent, alleged deficits in informed consent; Derm, dermatologist; P, plaintiff
decision; perm, permanent injury; postoperative, postoperative negligence;
PWS, port-wine stain; S/P, settlement or plaintiff decision; unnecessary,
unnecessary or inappropriate procedure.
a
Ages were not available for some patients.
b
Defendant decision.
Lasers and Malpractice
Original Investigation
Research
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