Litigation in Aesthetic Plastic Surgery (1982-2022): Verdicts and Indemnity Across Five Procedures.

[BACKGROUND] Malpractice litigation remains a source of professional and financial risk in aesthetic surgery. Prior Westlaw/LexisNexis studies typically focus on single procedures. We assessed aesthetic surgery malpractice across five common procedures and compared verdicts and indemnity between body and facial domains.

[METHODS] Retrospective review of Westlaw Edge for U.S. malpractice cases adjudicated 1982-2022 involving abdominoplasty, breast augmentation, breast reduction, blepharoplasty, and facelift. Variables included procedure, allegations, injuries, verdict, and payout. Outcomes were categorized as defense versus non-defense (plaintiff verdict or settlement). Awards are reported in unadjusted U.S. dollars. χ and Mann-Whitney U tests compared verdict distributions and indemnity.

[RESULTS] 534 lawsuits met inclusion (408 body; 126 facial). Non-defense outcomes were 33.6% in body vs 38.1% in facial cases (χ = 1.74, p = 0.19). Among paid cases, median (IQR) award was $155,000 ($52,000-$586,371) for body and $337,500 ($118,750-$650,000) for face (Mann-Whitney U, p = 0.04). By procedure, non-defense proportions were 46.9% facelift, 39.5% breast augmentation, 32.5% blepharoplasty, 32.0% breast reduction, and 23.3% abdominoplasty. Lack of informed consent was associated with higher odds of a non-defense outcome on unadjusted comparison (p = 0.03). Major injury/death was associated with larger awards (median~$780,000 vs $210,000; p < 0.01).

[CONCLUSIONS] Over four decades, defense verdicts predominated, yet facial procedures carried greater indemnity than body procedures among paid cases. Findings support expectation forward informed consent, reliable postoperative communication, and risk stratification for combination body procedures as practical targets to reduce medicolegal exposure while improving patient understanding.

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