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Kearney AM, Gart MS, Brandt KE, Gosain AK. Lessons from American Board of Plastic Surgery Maintenance of Certification Tracer Data: A 16-Year Review of Clinical Practice Patterns and Evidence-Based Medicine in Cleft Palate Repair. Plast Reconstr Surg 2020; 146:371-379. [PMID: 32740590 DOI: 10.1097/prs.0000000000007018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND As a component of the Maintenance of Certification process from 2003 to 2019, the American Board of Plastic Surgery tracked 20 common plastic surgery operations. By evaluating the data collected over 16 years, the authors are able to examine the practice patterns of pediatric/craniofacial surgeons in the United States. METHODS Cumulative tracer data for cleft palate repair was reviewed as of April of 2014 and September of 2019. Evidence-based medicine articles were reviewed. Results were tabulated in three categories: pearls, or topics that were covered in both the tracer data and evidence-based medicine articles; topics that were covered by evidence-based medicine articles but not collected in the tracer data; and topics that were covered in tracer data but not addressed in evidence-based medicine articles. RESULTS Two thousand eight hundred fifty cases had been entered as of September of 2019. With respect to pearls, pushback, von Langenbeck, and Furlow repairs all declined in use, whereas intravelar veloplasty increased. For items not in the tracer, the quality of studies relating to analgesia is among the highest of all areas of study regarding cleft palate repair. In terms of variables collected by the tracer but not studied, in 2019, 41 percent of patients received more than 1 day of antibiotics. CONCLUSIONS This article provides a review of cleft palate tracer data and summarizes the research in the field. Review of the tracer data enables cleft surgeons to compare their outcomes to national norms and provides an opportunity for them to consider modifications that may enhance their practice.
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Affiliation(s)
- Aaron M Kearney
- From the Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine; OrthoCarolina; and the American Board of Plastic Surgery
| | - Michael S Gart
- From the Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine; OrthoCarolina; and the American Board of Plastic Surgery
| | - Keith E Brandt
- From the Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine; OrthoCarolina; and the American Board of Plastic Surgery
| | - Arun K Gosain
- From the Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine; OrthoCarolina; and the American Board of Plastic Surgery
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Affiliation(s)
| | - Allison C Hu
- University of California, Irvine School of Medicine, Irvine, Calif
| | - Zeshaan N Maan
- Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, Calif
| | - Michael S Hu
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
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Lee DH, Woo JH, Hong SE. Judicial Precedent-Based Clinical Practice Guidelines of Propofol in Sedative Esthetic Surgery. Aesthetic Plast Surg 2018; 42:891-898. [PMID: 29610953 DOI: 10.1007/s00266-018-1122-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 03/11/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Propofol is has been widely used for sedation in the field of esthetic surgery because of its favorable pharmacokinetic profile. Propofol sedation-induced side effects are rare. However, when present, they can be serious. The number of malpractice claims associated with propofol sedation has increased in recent years. This study aims to show which procedures lead to the most claims in the field of esthetic surgery through a review of Korean precedents. METHODS Thirteen precedent cases of propofol sedation in the field of esthetic surgery were collected between 2000 and 2016. We analyzed the type of procedure, administration route, anesthesia provider, complications, timing of damaging events, average indemnification, plaintiff's (patients) winning rate, ratio and the reason of limitation of liability and the key factors affecting the judgement in these cases. RESULTS Most plaintiffs were women, and in most cases (11/13, 73.3%), the times of the damaging events were in maintenance and the anesthesia provider was the surgeon. The most common complication related to propofol sedation was hypoxic brain damage. Among the 13 cases, 12 were won by the plaintiff. The mean claim settlement was 339,455,814 KRW (USD 301,792.15). The key factors affecting the judgement were administration method and staff, monitoring method, preparation of emergency kit, response to emergencies, transfer to a higher-level hospital, detailed medical recording about event and informed consent. CONCLUSION The number of claims owing to propofol sedation after esthetic surgery is increasing. Close monitoring during the operation, immediate reaction to an event and thorough medical records were main key factors that influenced the judgement. Preoperative explanation about the possibility of complications was important. The findings will help surgeons achieve high patient satisfaction and reduce liability concerns. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Duk Hee Lee
- Department of Emergency Medicine, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Joo Hyun Woo
- Department of Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Seung Eun Hong
- Department of Plastic Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea.
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Leow LJ. Navigating the disparate Australian regulatory minefield of cosmetic therapy. Aust Fam Physician 2017; 46:697-698. [PMID: 28892603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Sweis IE, Spitz J, Barry DR, Cohen M. A Review of Body Dysmorphic Disorder in Aesthetic Surgery Patients and the Legal Implications. Aesthetic Plast Surg 2017; 41:949-954. [PMID: 28204935 DOI: 10.1007/s00266-017-0819-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/03/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is an often under-recognized yet severe psychiatric illness. There is limited guidance for plastic surgeons in the USA in how to recognize and manage patients with BDD and protect themselves from potential litigation and harm. Therefore, in collaboration with legal counsel, we remind our profession of the serious nature of patients with BDD, provide warning signs for recognizing BDD, and critically evaluate the validity of informed consent and the legal ramifications of operating on such patients in the USA. METHODS A literature review was performed to clearly define the psychopathology of BDD and identify cases of patients with BDD who underwent cosmetic surgery resulting in potential threats to the surgeon. An additional search of the legal literature was performed in collaboration with legal counsel to identify key cases of patients with BDD attempting litigation following cosmetic surgery procedures. RESULTS The diagnostic criteria and psychopathology of BDD are presented. Warning signs are highlighted to alert the plastic surgeon to patients at high risk for BDD. Strategies for legal protection include a pre-procedure checklist for patients that are suspected of having a BDD diagnosis. CONCLUSION Body dysmorphic disorder is prevalent in the cosmetic surgery population. Patients with BDD often have a poor outcome following aesthetic surgery, which can result in a dangerous or even deadly situation for the surgeon. We aim to remind aesthetic plastic surgeons of the psychopathology, severity, and specific risks associated with operating on patients with BDD while suggesting specific protective strategies. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Iliana E Sweis
- Division of Plastic, Reconstructive, and Cosmetic Surgery, Department of Surgery, University of Illinois Hospital and Health Science System at Chicago, 820 S. Wood Street, Suite 515 Clinical Science North Building (M/C 958), Chicago, IL, 60612, USA
| | - Jamie Spitz
- Division of Plastic, Reconstructive, and Cosmetic Surgery, Department of Surgery, University of Illinois Hospital and Health Science System at Chicago, 820 S. Wood Street, Suite 515 Clinical Science North Building (M/C 958), Chicago, IL, 60612, USA.
| | | | - Mimis Cohen
- Division of Plastic, Reconstructive, and Cosmetic Surgery, Department of Surgery, University of Illinois Hospital and Health Science System at Chicago, 820 S. Wood Street, Suite 515 Clinical Science North Building (M/C 958), Chicago, IL, 60612, USA
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Edsander-Nord Å. [Protect patient safety in aesthetic treatments]. Lakartidningen 2016; 113:EC7T. [PMID: 27845821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Lidman D. [The beauty inquiry transforms our patients into consumers]. Lakartidningen 2016; 113:D34Z. [PMID: 27187711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Park BY, Pak JH, Hong SE, Kang SR. The Legal Doctrine on 'Limitation of Liability' in the Precedent Analysis on Plastic Surgery Medical Malpractice Lawsuits. J Korean Med Sci 2015; 30:1718-22. [PMID: 26713045 PMCID: PMC4689814 DOI: 10.3346/jkms.2015.30.12.1718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 09/14/2015] [Indexed: 11/20/2022] Open
Abstract
This study intended to review the precedents on plastic surgery medical malpractice lawsuits in lower-court trials, classify the reasons of 'limitation of liability' by type, and suggest a standard in the acknowledgement of limitation of liability ratio. The 30 lower-court's rulings on the cases bearing the medical negligence of the defendants acknowledged the liability ratio of the defendants between 30% and 100%. Ten cases ruled that the defendants were wholly responsible for the negligence or malpractice, while 20 cases acknowledged the limitation of liability principle. In the determination of damage compensation amount, the court considered the cause of the victim side, which contributed in the occurrence of the damage. The court also believed that it is against the idea of fairness to have the assailant pay the whole compensation, even there is no victim-side cause such as previous illness or physical constitution of the patient, and applies the legal doctrine on limitation of liability, which is an independent damage compensation adjustment system. Most of the rulings also limited the ratio of responsibility to certain extent. When considering that the legal doctrine on limitation of liability which supports concrete validity for the fair sharing of damage, the tangible classification of causes of limitation of liability suggested in this study would be a useful tool in forecasting the ruling of a plastic surgery medical malpractice lawsuit.
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Affiliation(s)
- Bo Young Park
- Department of Plastic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Ji-Hyun Pak
- Department of Plastic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Seung-Eun Hong
- Department of Plastic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - So Ra Kang
- Department of Plastic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
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Torjesen I. Surgeons urged to prepare for changes in cosmetic surgery regulation. BMJ 2015; 351:h5991. [PMID: 26545805 DOI: 10.1136/bmj.h5991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Among all the sectors of UK healthcare, cosmetic surgery poses some of the biggest challenges for nurses, with the most significant issue being professional indemnity.
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Kennedy A. Slice them up or slice them out? Legal liability for operating on the troublesome patient in cosmetic surgery. J Law Med 2015; 23:137-155. [PMID: 26554204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The practice of cosmetic surgery is constructed as psychologically beneficial. This therapeutic promise transforms cosmetic surgery into proper medical treatment. However, there is emerging evidence that a significant percentage of cosmetic surgery patients suffer from the condition of Body Dysmorphic Disorder (BDD), which is characterised by excessive preoccupation with imagined or minor defects in appearance. BDD is uniformly identified as a strong contra-indication for cosmetic surgery. Articles in scholarly journals on cosmetic surgery identify the "red flag" indicators to assist in screening out problem patients. However, a close examination of the most common indicators reveals that most are ineffective in identifying BDD in prospective patients. This article also considers the legal liability of cosmetic surgeons who operate on patients with BDD, and concludes that there is little likelihood of liability in trespass or negligence under current Australia law.
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Lidman D, Stark B. [Esthetic plastic surgery is usually health care]. Lakartidningen 2014; 111:2169. [PMID: 25650449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Dyer C. High Court quashes tribunal decision to ban cosmetic surgeon from practising. BMJ 2014; 349:g5848. [PMID: 25258373 DOI: 10.1136/bmj.g5848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dyer C. Cosmetic surgeon is struck off for putting commercial interests ahead of his patients. BMJ 2014; 349:g5236. [PMID: 25139542 DOI: 10.1136/bmj.g5236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
The recent PIP scandal that affected patients worldwide, and received extensive media coverage, led to concerns being felt by patients about the 'risks' of cosmetic surgery. Theories about regulation and risk refer to societies such as those in the West becoming more risk averse. Regulation, in turn, has come to be seen as an instrument to solve a problem for a community seen to be or which perceives itself to be at risk. The political and electoral risk acknowledged by government if it ignores that concern, or at least media coverage of it, can lead to regulation, or the tightening up of regulation, as a response. This article looks at current proposals for legislation in the UK following the PIP silicone implant scandal as an example of the risk-regulation premise. Are cosmetic surgery patients in the UK now going to see stricter regulation of the cosmetic surgery industry? The article argues that the UK and France have both reacted to healthcare scandals and the ensuing societal conception of risk by drawing up more thorough legislation on cosmetic surgery than previously existed. France enacted the Kouchner law in 2002 and the UK government published the Keogh Report in April 2013. A comparison is made of these to establish whether the UK can learn from the French legislation when it comes to drafting actual regulation in the future, perhaps in 2014. Finally, some arguments are made about whether risk aversion may make better law.
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Affiliation(s)
- Melanie Latham
- Manchester Law School, Manchester Metropolitan University, Manchester, UK
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de Fontaine S. [Ethics in aesthetic surgery]. Rev Med Brux 2013; 34:287-290. [PMID: 24195242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The use of aesthetic medicine and surgery is increasingly popular, and becomes a true phenomenon of society. Many women and men are asking for such treatments. A large proportion of the population carry the idea that this branch of medicine is a true consumer product. The acts of aesthetic medicine and surgery are not without consequences. They produce important changes in the human body, and carry risks of complications that must be taken into account. The overrated media interest of this subject produce commercial drifts that act against the general health of the patients. The invasive acts of medical aesthetics must be placed in a precise legal and ethical framework to protect the patients. A project of a new Belgian law is on the way, awaiting for publication in "Le Moniteur": this law (proposed by Senator Dominique Tilmans) clarifies the competences required for performing non-surgical aesthetic treatments and specific aesthetic invasive treatments. Other projects of law are being studied, and will concern publicity, information of the public, and rules of private clinics where aesthetic invasive acts are performed. Recent international news have shown, with the PIP breast prosthesis scandal, that surveillance of the medical aesthetic field is mandatory. To provide a better protection of patients, the legislator has decided legislate over the subject.
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Affiliation(s)
- S de Fontaine
- Service de Chirurgie plastique, Hôpital Erasme, Bruxelles.
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Cammarano P, Schweder M. Legislative brief: New Jersey legislatures address: ambulatory surgery centers. MD Advis 2013; 6:30-33. [PMID: 24037437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Affiliation(s)
- Sally Taber
- Independent Healthcare Advisory Services, London WC1A 1DU.
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20
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Affiliation(s)
- Fazel Fatah
- Westbourne Centre, Edgbaston, Birmingham B15 3SJ.
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[Improving the safety of medical devices]. Rev Infirm 2012;:4. [PMID: 23092071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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McHale JV. Regulating cosmetic surgery: a scalpel where it is needed. Br J Nurs 2012; 21:190-191. [PMID: 22584662 DOI: 10.12968/bjon.2012.21.3.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This paper considers the recent controversies around the regulation of cosmetic surgery procedures. The author suggests that any review considering reform of the law in this area should not only look at issues concerning the safety of the procedures and competence of the practitioners, but should also address the question of which procedures should be allowed. In particular, the author advocates that there should be a review as to the whether cosmetic procedures should be made available to those under the age of 18 years. The paper also discusses analogous legislation in Queensland, Australia and explores whether this could be a useful model for legislative reform.
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Marchesi A, Marchesi M, Fasulo FC, Morini O, Vaienti L. Mammaplasties and medicolegal issues: 50 cases of litigation in aesthetic surgery of the breast. Aesthetic Plast Surg 2012; 36:122-7. [PMID: 21725718 DOI: 10.1007/s00266-011-9768-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 06/07/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Aesthetic surgery procedures are increasing all over the world, and so are related medicolegal questions and litigation cases. Aesthetic mammaplasties represent a very important part of this field and consequently many cases of error appear. Most of these errors lead to litigation from which plastic surgeons rarely can be exonerated. The aim of this article was to evaluate different errors ascribed to the plastic surgeon, the rate of cases in which professional responsibility has been identified, and the type of guilt imputed. METHODS Each case is based on the evaluation of both documentation used by the judge and the relationships of two specialists involved in the assessment of the presumed error. In every case, problems complained about by the patient and the eventually related error of the surgeon were analyzed. Moreover, the eventual identification of professional responsibility, the quantified damage, and its possible reduction by another corrective operation were considered. RESULTS The cases studied (N=50) were divided into 34 cases of augmentation mammaplasty, 11 cases of reduction mammaplasty, and 5 cases of mastopexy. Most of the problems complained about by patients were in the preoperative and intraoperative phases. In only 10% of the cases was the informed consent contested and an expected reduction of the damage was individuated in less than half of cases. CONCLUSIONS The evaluation of aesthetic damage is a tricky question due to different aspects such as the psychological component or the frequent lack of adequate photographic documentation of the patient before the operation. Moreover, whenever possible reduction of the damage is proposed, the patient's willingness to undergo another operation, with all its related costs and benefits, must be considered.
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Affiliation(s)
- A Marchesi
- Department of Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan, 20097, San Donato Milanese, MI, Italy.
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Noterman J. [Publicity, ethics and medical deontology]. Rev Med Brux 2011; 32:540-543. [PMID: 22279855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Compatibility between publicity and deontology is an old problem. Since a few months, TV shows, press interviews or newspapers have aroused interest. Some judgements from the European Court and the National Council of the medical Order and lawmakers were expressed. An "inventory of fixtures" seems to be now necessary.
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Lyu SY, Liao CK, Chang KP, Tsai ST, Lee MB, Tsai FC. Analysis of medical litigation among patients with medical disputes in cosmetic surgery in Taiwan. Aesthetic Plast Surg 2011; 35:764-72. [PMID: 21416296 DOI: 10.1007/s00266-011-9684-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 02/11/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study aimed to investigate the key factors in medical disputes (arguments) among female patients after cosmetic surgery in Taiwan and to explore the correlates of medical litigation. METHODS A total of 6,888 patients (3,210 patients from two hospitals and 3,678 patients from two clinics) received cosmetic surgery from January 2001 to December 2009. The inclusion criteria specified female patients with a medical dispute. Chi-square testing and multiple logistic regression analysis were used to analyze the data. RESULTS Of the 43 patients who had a medical dispute (hospitals, 0.53%; clinics, 0.73%), 9 plaintiffs eventually filed suit against their plastic surgeons. Such an outcome exhibited a decreasing annual trend. The hospitals and clinics did not differ significantly in terms of patient profiles. The Chi-square test showed that most patients with a medical dispute (p < 0.05) were older than 30 years, were divorced or married, had received operations under general anesthesia, had no economic stress, had a history of medical litigation, and eventually did not sue the surgeons. The test results also showed that the surgeon's seniority and experience significantly influenced the possibility of medical dispute and nonlitigation. Multiple logistical regression analysis further showed that the patients who did decide to enter into litigation had two main related factors: marital stress (odds ratio [OR], 10.67; 95% confidence interval [CI], 1.20-94.73) and an education level below junior college (OR, 9.33; 95% CI, 1.01-86.36). CONCLUSION The study findings suggest that the key characteristics of patients and surgeons should be taken into consideration not only in the search for ways to enhance pre- and postoperative communication but also as useful information for expert testimony in the inquisitorial law system.
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Affiliation(s)
- Shu-Yu Lyu
- School of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031, Taiwan.
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Food and Drug Administration, HHS. Medical devices; general and plastic surgery devices; classification of the focused ultrasound stimulator system for aesthetic use. Final rule. Fed Regist 2011; 76:43119-21. [PMID: 21774154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The Food and Drug Administration (FDA) is classifying the focused ultrasound stimulator system for aesthetic use into class II (special controls). The special control(s) that will apply to the device is the guidance document entitled "Class II Special Controls Guidance Document: Focused Ultrasound Stimulator System for Aesthetic Use." The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.
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Kitipornchai L, Then SN. Cosmetic surgery on children - professional and legal obligations in Australia. Aust Fam Physician 2011; 40:513-516. [PMID: 21743859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Public awareness and concern about cosmetic surgery on children is increasing. Nationally and internationally questions have been raised by the media and government bodies about the appropriateness of children undergoing cosmetic surgery. Considering the rates of cosmetic surgery in comparable Western societies, it seems likely that the number of physicians in Australia who will deal with a request for cosmetic surgery for a child will continue to increase. This is a sensitive issue and it is essential that physicians understand the professional and legal obligations that arise when cosmetic surgery is proposed for a child. OBJECTIVE This article reviews the current professional and legal obligations that physicians have to competent and incompetent children for whom cosmetic surgery has been requested. DISCUSSION A case study is used to highlight the factors that Australian primary care physicians must consider before referring and conducting cosmetic surgery on children.
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Affiliation(s)
- Leon Kitipornchai
- Department of ENT Head and Neck Surgery, Ipswich Hospital, Australia.
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McKinney M. Medical spas face new scrutiny. New regulations sought for some common cosmetic procedures. Mod Healthc 2010; 40:26-27. [PMID: 21344730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Abstract
The use of photography is an integral part of any plastic surgery practice. Photographs are part of the patient's medical record and thus are covered by both federal and state privacy laws. Liability issues may arise when patients are photographed without their knowledge and consent. With proper written consent, practices may use "before" and "after" photographs of patients. However, some states have specific requirements as to the manner in which these photographs are taken and what claims may appear as text with the photographs. This article seeks to discuss legal issues associated with the use of photography in plastic surgery practices, and provides sample agreements to serve as a basis for addressing these issues.
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Affiliation(s)
- Jeffrey Segal
- Medical Justice, 2007 Yanceyville Street, PO Box 49669, Greensboro, NC 27419, USA.
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Scott K. Under the knife: an analysis of the Medical Council of New Zealand's Statement on Cosmetic Procedures. J Law Med 2009; 16:625-652. [PMID: 19297871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The lack of regulation in the field of appearance medicine has long been a cause for concern in New Zealand. As an industry, it has fallen outside the protective ambit of the regulatory framework that governs all other areas of medicine. This article examines the Medical Council of New Zealand's attempt to address some of the concerns that have existed by producing a Statement on Cosmetic Procedures. The author concludes that this statement goes a long way towards better ensuring consumer safety and wellbeing in this area. It also offers valuable guidance to practitioners in the areas of advertising and promotion, obtaining consent and providing care. The author does, however, propose and discuss several possible changes that could be made to improve the statement that has been produced.
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Cockburn T, Madden B. Legislative intervention in Queensland to restrict access to solariums and cosmetic procedures by children and young persons. J Law Med 2009; 16:653-665. [PMID: 19297872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Breaking new ground, Queensland has enacted laws restricting access to cosmetic surgery by those under 18 years of age. Legislation in other Australian jurisdictions is narrower in scope, focusing on niche areas such as solarium use, tattoos and body piercing. Even in those niche areas there are inconsistencies of approach and now the unique Queensland cosmetic surgery restrictions further raise the prospects of "medical tourism" and highlight the difficulties of differing legislation throughout Australia. All implementations, however, face the same challenge: to balance protection of vulnerable children, respect for a young person's autonomy and due regard to parental consent.
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Baeyens A, Goffin T. European Court of Justice. ECJ 2008/10--Corporación Dermoestética SA v. to Me Group Advertising Media, 17 July 2008 (C-500/06). Eur J Health Law 2008; 15:347-351. [PMID: 19024873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- An Baeyens
- European Commission, DG Internal Market and Sciences
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Centers for Disease Control and Prevention (CDC). Acute renal failure associated with cosmetic soft-tissue filler injections--North Carolina, 2007. MMWR Morb Mortal Wkly Rep 2008; 57:453-6. [PMID: 18451755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Soft-tissue fillers are substances injected to augment or enhance the appearance of lips, breasts, buttocks, or other soft tissues. Previous reports have linked the administration of soft-tissue fillers, usually liquid silicone, by unlicensed practitioners to severe adverse events, including death. On December 27, 2007, the North Carolina Division of Public Health (NCDPH) was notified of three cases of renal failure occurring among women who had received cosmetic soft-tissue filler injections at a facility in North Carolina (facility A). This report summarizes the clinical findings for these cases and describes the subsequent public health investigation. All injections were administered by a practitioner with no medical training or supervision (practitioner A). Investigators were not able to identify the substances injected. Although records indicated that the injections contained liquid silicone, this substance has not been associated previously with renal failure. These findings underscore the risks posed by cosmetic injections administered by unlicensed practitioners. Public health officials should be alert for adverse events associated with these injections and take all necessary actions to prevent additional injuries.
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Najarian S. Rhode Island leads in regulating office-based cosmetic surgery. Med Health R I 2008; 91:153-154. [PMID: 18549046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Shaun Najarian
- Rhode Island Department of Health, Office of Medical Licensure and Discipline, USA
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McGuire MF. Aesthetic reconstructive surgery: patient access to essential care requires expanded definitions. Aesthet Surg J 2008; 28:217-8. [PMID: 19083531 DOI: 10.1016/j.asj.2008.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Nachshoni T, Kotler M. Legal and medical aspects of body dysmorphic disorder. Med Law 2007; 26:721-735. [PMID: 18284113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Body Dysmorphic Disorder (BDD), a preoccupation with an imagined defect in physical appearance has a rich clinical history, but officially appeared with diagnostic criteria only in the DSM-III-R classification system. Prevalence of BDD in plastic and cosmetic dermatology ranges between 7-15% due to the obsession with imagined imperfections. The emotional "defect" causes dissatisfaction with nonpsychiatric medical procedures, and often recourse into legal action. We present a case study of BDD developing after cosmetic surgery and debate whether this is an actual possibility and the legal consequences of this possibility. We question whether surgery was a traumatic event and its relationship to the patient's premorbid "eggshell personality". The difficulty in determining causation of psychiatric disorders for the purpose of deciding issues of compensation is discussed. A practical algorithm is offered in order to avoid litigation and to maintain the legitimate medical ideal of "first do no harm".
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Parker R. Cosmetic surgery in Australia: a risky business? J Law Med 2007; 15:14-8. [PMID: 17902485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Cosmetic surgery is increasing in popularity in Australia and New Zealand, as it is across other Western countries. However, there is no systematic mechanism for gathering data about cosmetic surgery, nor about the outcomes of that surgery. This column argues that the business of cosmetic surgery in Australia has questionable marketing standards, is conducted with little scrutiny or accountability and offers patients imperfect knowledge about cosmetic procedures. It also argues that while medical practitioners debate among themselves over who should carry out cosmetic procedures, little attention has been paid to questionable advertising in the industry and even less to highlighting the real risks of undergoing cosmetic surgery. While consumers are led to believe that cosmetic surgery is accessible, affordable and safe, they are sheltered from the reality of invasive and risky surgery and from the ability to clearly discern that all cosmetic procedures carry risk. While doctors continue to undertake advertising and engage in a territorial war, they fail to address the really important issues in cosmetic surgery. These are: providing real evidence about what happens in the industry, developing stringent regulations under which the industry should operate and ensuring that all patients considering cosmetic surgery are fully informed as to the risks of that surgery.
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Reiter D. Sailing the straits of approval: the nature of FDA approval and its implications for surgeons. Facial Plast Surg Clin North Am 2007; 15:247-50, vii-viii. [PMID: 17544941 DOI: 10.1016/j.fsc.2007.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Use of Food and Drug Administration-approved medications and products for other than the approved indications is common in facial plastic surgery and violates no laws. Addressing practical concerns about such use strengthens the doctor-patient relationship and can minimize the risk of successful allegations of negligence in the event of untoward outcomes. The facial plastic surgeon can find support and assistance with off-label use in two general areas. Abundant scientific literature focuses on off-label use and addresses its practical, scientific, legal, moral, and ethical issues. The Food and Drug Administration also addresses off-label use in its own publications. It offers guidelines for physicians that, if followed, facilitate incorporation of off-label use into practice with minimal risk and maximum potential for therapeutic success.
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Affiliation(s)
- David Reiter
- Department of Otolaryngology-Head & Neck Surgery, Jefferson Medical College, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA.
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Abstract
Facial plastic surgery, by its nature, is a field that constantly is seeking new and innovative ways of treating patients. This innovation often involves novel techniques and tools. The US Food and Drug Administration is charged with regulating drugs and medical devices to ensure that the public is treated in safe and effective ways. It does not, however, regulate the practice of medicine. Physicians are able to use drugs and devices off-label but are required to follow certain guidelines. This article describes the physician's legal responsibilities and limitations in off-label drug or device use.
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Affiliation(s)
- Anthony P Sclafani
- Division of Facial Plastic Surgery, Department of Otolaryngology-Head & Neck Surgery, The New York Eye & Ear Infirmary, New York, NY 10003, USA.
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Fogli A. La chirurgie esthétique face au droit. ANN CHIR PLAST ESTH 2007; 52:234-7. [PMID: 17632885 DOI: 10.1016/j.anplas.2007.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- A Fogli
- Clinique Château-Berger, Marseille, France.
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Abstract
The field of aesthetic facial surgery is dynamic and may be driven by new technology and market trends. It is important that we respond to these pressures as small business persons, but only in the context of our obligations to our state regulatory boards, the Hippocratic Oath, and our patients' best interests. Regulations with regard to the scope of practice of aesthetic medicine and the corporate practice of medicine have the greatest potential to affect facial plastic surgeons. This article provides basic information regarding these medicolegal issues and resources to examine physician compliance. There may be an opportunity for the American Academy of Facial Plastic and Reconstructive Surgery to provide its membership with basic guidelines for scope of practice and corporate practice of medicine in an effort to optimize patient care.
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Affiliation(s)
- Stephen P Smith
- Facial Plastic and Reconstructive Surgery, Williams Center for Excellence, 1072 Troy Schenectady Road, Latham, NY 12110, USA.
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Abstract
Dermal fillers represent one of the most commonly used noninvasive cosmetic treatments. They are often used in an off-label manner. Most off-label use is not only legal, but represents an appropriate physician standard of care. This article will first describe the meaning of on- and off-label. Then the article will explore manufacturer promotion of off-label use of both drugs and devices. Finally, the legal ramifications of off-label dermal filler use will be discussed.
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Affiliation(s)
- David J Goldberg
- Skin Laser and Surgery Specialists of NY/NJ, 115 East 57th Street, Suite 710, New York, NY 10022, USA.
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Abstract
Cosmetic laser surgery is a continuously evolving field of medicine. According to the American Society for Dermatologic Surgery, over 100 million laser and light source cosmetic procedures were performed by its members. Procedures including hair removal, nonablative treatments, as well as removal of pigmented lesions, tattoos, and unwanted vascular lesions have revolutionized this field. With an increasing number of physicians and nonphysicians performing these procedures, and with the availability of increasingly powerful laser technologies, the potential for problems and their legal consequences continue to increase. This chapter will deal with the concept of negligence and the potential for a resultant medical malpractice that may arise in such a setting. An understanding of the basic principles of a cause of action in medical malpractice will likely protect a physician from losing such a case in a court of law.
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Affiliation(s)
- David J Goldberg
- Mount Sinai School of Medicine, Fordham University School of Law, New York, NY, USA.
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