37 year old undergoes bilateral medial thigh lift with excision of excess skin in February 2025. She previously had bariatric surgery and went from 353lb to 257lb. She reported having a significant ongoing rash between her thighs which she tried treating topically without success. BMI at the time of procedure was 40.
Patient is consented for bilateral excision, excessive skin and subcutaneous tissue; medial leg with liposuction and bilateral excision, excessive skin and subcutaneous tissue; medial thigh. Surgeon draws proposed excisions preoperatively to which the patient agrees. A photo of proposed excisions taken by patient is attached.
Following surgery, patient was very upset that the incisions were not what she agreed to. It was her understanding that the incisions would be vertical and on the inner thighs. Postop photos are attached. Patient confronted the surgeon regarding the incisions in her first postop follow up visit. The surgeon noted that he had clearly outlined the area to be excised and the location of the incisions preoperatively. He further noted that he had explained to the patient that she was asymmetric. Finally, he charted that he informed the patient preoperatively that she had excess tissue and that he may have to stage the thigh lift and just limit the excision to the areas outlined. This discussion is not noted in the chart preoperatively. Patient then asked to be seen by another surgeon at the practice.
Patient is seen by the second surgeon at the same practice two months later. Patient explained that she believed the incisions would be vertical and symmetrical. She further explained that she understood that the excision of skin would be more extensive. The surgeon on exam explained that there was no further resection that could have been performed without risking being unable to close and having an open wound. Patient was further informed that she needed to lose a significant amount of weight in order to resect more. Surgeon explained that thigh lifts can often require more than one surgery. However, she would not do any further surgery with liposuction until the BMI was under 30.
Photos postop are attached.
Also, the second photo shows the planned incision markings preoperatively. Zoom in on the photo and focus on the right thigh. There appears to be a marking that is horizontal and somewhat across the front of the thigh. Question: Does this marking reasonably coincide with what was ultimately done for this patient?
Questions: Was it a deviation of the standard of care to proceed with this surgery given the patient's BMI? Did the surgeon actually make incisions in the area that was proposed to the patient as reflected in the photos? If not, was it a breach of the standard of care?
Files:
No questions yet!
Do you believe there might have been medical error?
Incisions are supposed to be placed in the groin and medial (inner) thigh and sometimes infragluteal creases - not horizontally in the middle of the thigh. I do not see a photo showing planned horizontal incision in middle of thigh. Ok to operate on higher BMI patients insofar as medical clearance was obtained and patient was advised of higher risk due to higher BMI.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Surgeon made the incisions which are the focus of the complaint.
What makes you a good expert for this case?
Board certified, fellowship-trained plastic surgeon with prior experience as expert witness at trial
How often do you encounter cases similar to this one in your practice?
5-10 times per year - sometimes more depending on case volume
Do you believe there might have been medical error?
Of the issues proposed in the case summary, the placement of the scars is not a medical error. While the ideal and most common scars are in the groin crease and/or vertically up and down the medial thigh, this patient required different positions in order to safely remove the most amount of tissue which is not a medical error. It would be a medical error not to inform the patient of the scar placement. Furthermore, there is no standard of care for maximum BMI to perform this surgery and no medical error occurred. While a higher BMI does incur a higher risk of complications, the more important issue is the thickness of the fat layer in the resected area. This patient suffered no complications as a result of her high BMI and thick fat layer suggesting to me the surgeon was skilled and experienced in patients with this BMI and fat thickness. The summary also implies that the drawings on the patient coincide with scar placement which they absolutely do not and once again no medical error occured.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
The only possible medical error I see could be the lack of informed consent on scar placement.
What makes you a good expert for this case?
My practice is primarily body contouring.
How often do you encounter cases similar to this one in your practice?
I encounter cases similiar to this in my practice every day.
Do you believe there might have been medical error?
The markings/ incisions are quite assymetric and do not represent standard of care markings for medial or vertical thigh lift markings.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
The markings led to a very assymetric result
What makes you a good expert for this case?
I do this surgery in massive weight loss patients
How often do you encounter cases similar to this one in your practice?
I don’t do this bmi but I do conduct this surgery.
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