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20 January 2014
A consultant plastic surgeon, an MDU member, saw a 40-year old female patient who requested cheek augmentation surgery. The patient had already undergone several plastic surgery procedures, including the insertion of malar implants, but she remained dissatisfied with her appearance.
The plastic surgeon agreed that it would be possible to undertake surgery to augment the cheeks and mandible using a different type of implant than had been used previously. The operation was carried out using new malar prostheses and angle of mandible implants.
Upon review, the right angle of the mandible was slightly more prominent than the left but it was thought that this would settle with time. Several months later the patient attended a different plastic surgeon for a second opinion as she was still unhappy with her appearance. The second plastic surgeon thought the implants might have been slightly rotated.
The patient then attended our member again complaining of ongoing asymmetry. The prostheses were palpated and it did not appear that there was any displacement. It was thought that the asymmetry was probably due to scar tissue. The consultant gave the patient several options as to the next steps and she opted for further surgery.
During surgery, the consultant found that the implants were in the correct position but there was a mass of scar tissue around the right implant which was causing the asymmetry. A small ridge was shaved off the implant before it was replaced. Later, the patient was still complaining of swelling and the member thought it may be appropriate to inject a steroid into the scar to try and settle it.
The patient subsequently suffered an infection and it was agreed that both implants should be removed to allow the infection to clear.
Over the next few months the patient continued to suffer from an infection and three months after the procedure to remove the prostheses it was noted that a fragment of the implant had been left in situ and was extruding from the lower molar region. This was easily removed with forceps.
The consultant subsequently received a letter from a solicitor alleging that the implant had been malpositioned, resulting in asymmetry, and that the infection had not been diagnosed or treated quickly enough. It was also alleged that the injection of the steroid was contra-indicated in the presence of infection and that there was a failure to remove all of the implant.
The consultant gave the patient several options as to the next steps and she opted for further surgery.
The MDU obtained a report from an independent plastic surgeon who noted that the implant had been found not to be malpositioned during the revision surgery, and any asymmetry was in fact a result of scar tissue surrounding the implant. He was of the opinion that as soon as the infection had been recognised, appropriate treatment had been implemented and surgery to remove the implants had been carried out.
While it was agreed that had an infection been present this would have been a contra-indication to a steroid injection, at the time of the injection there had been no indication that an infection had been present. On the basis of the expert opinion, these allegations were denied.
It was accepted that a fragment of the implant had been left in situ, and it was likely that this fragment had delayed successful treatment of the infection by several months and a procedure had been required to remove it. On the basis of this allegation alone the patient's claim was settled for £4,000 in damages.
Lead claims handler
This guidance was correct at publication 20/01/2014. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.
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