At one point in every physician’s life, it is likely that they will be faced with either an unhappy patient or adverse events as a result of treatment — or both. However, by ensuring that effective informed consent is taken, and that the patient is fully informed of the potential risks — both common and rare — the chances of being on the receiving end of bad reviews or even legal action can be significantly reduced. For physicians who perform aesthetic procedures, this is paramount.

‘When you’re talking to a patient in neurosurgery, for example, the patient is typically ill, so he/she will have a completely different set of expectations,’ said Jeffrey Segal, MD, JD, CEO and Founder of Medical Justice.

‘With cosmetic surgery you’re taking a healthy patient and essentially making them sick to make them better. So it’s imperative to explain to the patient that a cosmetic surgery is like any surgery and there are risks involved. If you short-circuit that discussion, then the patient’s expectations haven’t been managed, and that can create a whole host of issues.’

Dr Segal recommends that a full discussion of risk — including death — should be addressed: ‘It’s the correct thing, it’s the fair thing, and from a litigation standpoint, it’s absolutely necessary.’

Informed consent, it should be remembered, is a process and not simply the signing of a document. It is the understanding that you have given the patient a reasonable list of the risks, benefits and options, and that the patient has been able to understand what you have told them, giving them an opportunity to ask and have questions answered to his/her satisfaction.

Mark Jewell, MD, an aesthetic plastic surgeon based in Eugene, Oregon, agrees: ‘It’s an educational process. Part of this is spending time with the patient so that he/she understands that the decision being made is reasonable — we have a prudent patient, a prudent surgeon, and a prudent plan. If you talk about expectations after treatment then it looks like you’re making excuses.’

Dealing with the unhappy patient

Unfortunately, following the correct procedures for education and informed consent doesn’t always prevent the patient from being unhappy with their treatment.

‘This is not an uncommon occurrence, particularly in elective situations where the patient has paid cash out of pocket and they are a consumer. As consumers, we all have high expectations and expect those expectations to be met,’ said Dr Segal.

‘The good news is that for the vast majority of patients, if the doctor listens and tries to remedy the issue, you will have turned a negative into a positive.’

Dr Jewell agrees: ‘Part of this area is education; if the patient is so fixated on a perfect outcome from the beginning, then they need to have their expectations aligned with the reality of what we, as surgeons, can do. And for the most part that works pretty well.’

If the patient comes back to you unhappy with the outcome of treatment, and you believe that you can revise your work and make them happier, then Dr Segal recommends physicians do so. ‘Many aesthetic surgeons will offer to do a revision procedure where they waive the professional fee, and some will actually waive all fees.’

Luckily, the majority of patients will be happy with the results of treatment, but Dr Segal recommends that you include any revision offers in your policy documents, as then you will be setting the stage for patient satisfaction and eliminating the majority of conflicts.

Of course, some patients will never be happy — whether its for revision or not — and at that stage you may wish to consider a refund. However, Dr Segal recommends that if this is done, it will be addressed via the mutual understanding that there will never be any litigation or a campaign of negative reviews on the internet. For this, a well crafted release is needed.


The aesthetic business is often about helping people to feel good about themselves — improving the self-esteem and confidence of patients. As a result, physicians are perhaps at greater risk of an unhappy patient and potential legal ramifications than any other medical specialty. Fortunately, there are a number of steps that you can take to minimize this risk — consulting an expert for advice and ensuring that you take all necessary steps for informed consent are just two starting points. This article gives only a summary version of what you should be doing, but consider Dr Segal’s advice: ‘I often say that failure to have a plan is a plan for failure.’