Analysis of Factors Associated With Malpractice Litigation in Rhinoplasty

Abstract

Rhinoplasty, the third most common cosmetic surgical procedure in the United States, represents the second most litigated facial plastic surgery procedure. Previous examinations of litigation specific to rhinoplasty are limited. The objective of this study was to comprehensively evaluate rhinoplasty malpractice litigation over the past 30 years and to investigate the financial burden of medical malpractice litigation associated with rhinoplasty, as well as factors that contribute to litigation and negative defendant outcomes. Jury verdict and payment reports related to rhinoplasty malpractice litigations over the past 30 years (1988-2018) were obtained using the WestlawNext and Nexis Uni subscription-based legal databases. The term “malpractice” was searched in combination with “rhinoplasty” and various names associated with the procedure. Cases included in the analysis were reviewed for outcomes, verdict payments, defendant specialty, and allegations raised in proceedings. Of the 46 cases identified, 12 (26%) were resolved with a plaintiff verdict payment. The median payment awarded was $127 500 (standard deviation, $96 590.63). The surgeon specialties found for 35 cases included otolaryngology (17 [49%]), plastic surgery (13 [37%]), facial plastic surgery (3 [9%]), and oral/maxillofacial surgery (OMFS; 2 [6%]). A greater proportion of cases involving otolaryngologists were resolved with payment compared with cases involving plastic surgeons (4 [24%] vs 1 [8%]), though this difference did not reach statistical significance ( P = .26). The most common allegations raised among the 46 cases were poor cosmesis (20 [43%]), intraoperative negligence (18 [39%]), inadequate informed consent (13 [28%]), and nasal function deficits (13 [28%]). Cases had a higher likelihood of being resolved in payment when allegations of cosmetic deformity (7%, 95% confidence interval [CI], −17.55 to 31.91) and nasal function deficit (17%, 95% CI, −9.29 to 45.32) were present, nevertheless these findings did not reach statistical significance ( P = .60 and P = .24, respectively). Rhinoplasty malpractice litigation resulting in payments can create substantial financial burden for the defendant. Common factors cited by plaintiffs for pursuing rhinoplasty malpractice litigation included cosmetic deformity, intraoperative negligence, lack of informed consent, and nasal function deficit. Cosmetic deformity and nasal function deficit allegations tended to result in negative defendant outcomes, though these findings are inconclusive. Our findings reinforce the importance of physician-patient communication, including conducting a comprehensive informed consent process, to limit or avoid postsurgical allegations.

Patients’ understanding of “informed consent” in plastic surgery

“…In contrast, American studies have observed that the use of supplementary, written, audiovisual, and other materials increase satisfaction after the procedure and may limit litigation 19,20 . In another study, 75% of the plastic surgeons interviewed were defendants in at least one malpractice lawsuit, and most of the investigated cases involved complaints of unsatisfactory results, excessive scarring, or lack of ICT 20 .…”