No warning of ectropion

Failure to warn a patient of the possible complication of ectropion following blepharoplasty led to a successful claim

A 54-year old woman consulted a plastic surgeon, an MDU member, seeking surgical intervention to improve the appearance of wrinkles beneath her eyes. The surgeon discussed possible alternatives, including minimally invasive methods of improving the appearance, and the patient left to consider her options further.

She arranged to see the plastic surgeon again a few months later and following further discussion opted to undergo bilateral blepharoplasty. She was warned of the risks of surgery, including anaesthetic risk, bleeding, infection, and that there would be some scars. The surgeon also advised of the risk of developing post-operative chemosis and asymmetry.

No asymmetry was evident following surgery, and everything appeared satisfactory. When the patient attended for removal of sutures a week later, it was noted that there was bilateral ectropion and chemosis. She was advised on how to manage this with conservative measures, including massage and moisturising. Arrangements were made to review her progress.

There was significant improvement at review two weeks later, but only on the left side. Unfortunately the right-sided ectropion and chemosis persisted. She was given steroid eye drops and asked to return for review in three weeks.

The appearance of the patient's eyes did not improve, however, and therefore arrangements were made to carry out a lower eyelid release. Unfortunately, the desired improvement was not achieved. The patient sought a second opinion, and underwent corrective surgery with a different surgeon, involving a skin graft.

A claim was then brought against our member. The allegations included that the consultant had breached his duty of care by excising excessive skin, leading to tension below the right eye which caused an ectropion to develop. It was also alleged that this would have been evident immediately at the end of surgery and on post-operative review. When corrected surgically, a skin graft should have been undertaken.

Solicitors and an expert plastic surgeon were instructed, and it was noted that in the pre-operative discussions there had been no specific mention of the possibility of developing an ectropion, and that further corrective surgery had been required. It was felt that, on balance, too much tissue had been excised at the initial operation, leading to complications. While it is recognised that such complications can occur with non-negligent surgery, in this case the specific risk of developing an ectropion was not something the patient had been explicitly warned of.

Unfortunately, it was felt likely that our member would be found to be in breach of duty, and therefore a decision was made to settle this case.

Following negotiations, the claim was settled for £20,000 damages, and costs at £80,000. The costs were claimed under a conditional fee agreement, which included a 100% success fee. The MDU successfully challenged the initial costs bill of well over £100,000, reducing it by over 25%.

Dr Catherine Thompson
Senior medical claims handler

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