Laser hair removal gone awry – a medical student’s plight. The risks are real.
Related posts:
- Talking hair
- Cosmetic surgery for two
- Bargain cosmetic surgery
- Death after cosmetic surgery
- Cosmetic surgery for teens and tweens
- Do TV shows influence cosmetic surgery?
- Horrific addiction to cosmetic surgery
KevinMD.com on Facebook
{ 20 comments }
It doesn’t make you ‘litigious’ if you file a lawsuit against a doctor when actual malpractice occurred. There is a lot of animosity on this board towards attorneys and patients that file frivolous suits against doctors, but I don’t think even the harshest critic on this site would advocate ignoring actual malpractice when it occurs. This dermatologist had insurance to cover mistakes just like this one. If I were this patient, I would name the offending dermatologist in my blog. Maybe after hearing from some of your readers she would be inclined to readdress the situation.
This student is one who should know better.
The outcome was one of the range of possibilies that could have occured dispite technically normal performance of the procedure.
In no manner has she even posited that there was any deviation from normal good practices by her dermatologist in the performance of the procedure. She is merely dissatisfied with the result, one that she knew was possible and was willing to gamble upon in order to achieve her desired result.
cdclled
Both you and the blogger cite malpractice, yet neither bothers to explain what they think was done outside the reasonable standard of care.
Malpractice is not merely the wish for a better cosmetic result. It requres the doc to perform below the standard of care.
Malpractice is not merely the wish for a better cosmetic result. It requres the doc to perform below the standard of care.
I agree with you on this. I assumed a medical error was made because of the behavior of the physician. I have never met a physician that pays out of pocket for follow up care for a patient in cases of a bad outcome. If you aren’t satisfied with a cosmetic procedure and the doctor did everything right, most docs are not going to volunteer to pay any future expenses you incur like this one did.
Another reason I was inclined to think the doc did something wrong was that she apologized profusely afterwards. When you start your clerkships in your third year of medical school, you learn that apologizing for a bad outcome to a patient is essentially legal suicide. It shouldn’t be like that, but it is. If no malpractice occurred, however, then I agree with the previous poster that no case should be filed.
We don’t really know if there was malpractice or not. The doctor could’ve easily made a mistake with settings, for example.
Many sites list scarring as one of the risks, but they all mention that it is extremely rare and that if you go to a competent doctor you minimize the chances of this happening. I researched this a little bit before I had hair removal, and all horror stories I saw were from people who gone to technicians or dentists who took a few courses. This is really the very first one from a dermatologist.
Also, as cdclled said, this doctor is either extremely altruistic or indeed made a mistake.
I am an internist and I perform cosmetic laser procedures, including laser hair removal, like that described in this story.
It’s easy to see how a burn like this might happen, but it should not happen. Reasonable care with settings and handling of the laser handpiece should really prevent problems like this.
The physician factors that may have contributed:
1. Laser settings (Joues/Cm2, pulse length)
2. Inadequate cooling – most lasers use some sort of concurrent cooling to protect the skin. Was it on?
3. Overtreating the same region of skin – were too many pulses applied to the injured location?
4. Was the presence of photosensitizing agents investigated? (tetracyclines, diuretics, recent alpha-hydroxy acids, recent tanning – natural or artificial, photosensitive medical conditions)
Patient factors that may have contributed:
1. Failing to disclose the use of photosensitizing agents, tanning, or medical conditions
2. Failing to disclose a propensity to develop keloids (a relative contra-inidcation to laser hair removal)
The shame of this story is that the physician DID take responsibility, without having to be sued, and so forth, but then stopped taking the responsibility when the threat of a lawsuit was removed. The bright side of this story is that it demonstrates to the doubters that physicians DO take responsibility, it just doesn’t make the headlines and you never hear about it, until there is something to complain about. Shame on this dermatologist for not following through – had the demands become unreasonable at any time she could have argued about them – none of the demands described in the story seem to be unreasonable.
This is a story about a surgical complication.
The blog says nothing about the presence of substandard care. Certainly that is possible, but it is possible that this patient had a sub-optimal outcome despite use of best practices without deviating from acceptable standards. The fact that the doctor made efforts to mitigate further problems for this patient by covering outside consultations and reconstruction may indicate only concern for the welfare of this patient and a wish that the patient have the best possible outcome. The physician removed as many financial barriers as possible so that her patient could have timely treatment. Could there have been self-interest in avoiding litigation and retaining patient goodwill by doing that? Certainly. But that does not lessen the potential benefit to this patient all the same. And it does not imply that the dermatologist did anything wrong.
I also am trained in these procedures, and I have seen and cared for patients who have had complications. It is possible to follow all accepted standards of care in patient selection and treatment and still have surgical complications. That is a statistical certainty. And the woman who posted this story ought to have understood that, especially as she is a physician.
Using retouched and glamourized high school yearbook photographs as a basis for preoperative comparison to her postoperative clinical photos is manifestly dishonest and manipulative. First, it lacks proximity to the time of the patient’s surgery. Second, where is the moustache high school photo?
Airbrushed or photoshopped away perhaps, which makes the use of this photo a deception. Lots of people look good in their high school photos, some never look as good again. If she wants to show what she really looked like before her laser treatment, then show the preoperative clinical photo. But she didn’t do that. Why?
And why doesn’t she want to name the doctor? Consider the possibility that she might be mistaken, that she had a complication but is not a victim of malpractice. Calling something malpractice when it is not invites counter claims for libel.
Since this is my story, I thought I should address a couple of things mentioned here in the comments.
First of all, I’m not a physician – I’m a medical student (2nd year). And I WASN’T a medical student at the time of the procedure, or I would have researched the risks myself – I was 18 years old, barely an undergraduate in my first semester of college, and I stupidly trusted my doctor, who told me that my skin may be a little pink after the procedure, but it should fade that evening. Of course the fine print said “scarring, death, etc.” as it always does. But every release form warns of the worst, doesn’t it?
As for my high school photo – I just happened to have that on my computer, which is why I used it as a comparison. It was one year before my surgery, and you can’t see the upper lip hair because it was taken at the end of August and I had a tan. The photo was not meant to be “manipulative”. It wasn’t excessively airbrushed either – that’s what I looked like.
And I didn’t fail to disclose the use of photosensitizing agents, tanning, or medical conditions; nor did I failing to disclose a propensity to develop keloids. I had no idea I had such a propensity – things that I’ve read since say that keloid scarring is most often seen in African-Americans.
What upsets me is not that I was burnt (which probably was faulty laser settings, due to the fact that the procedure hurt BADLY. And I have hereditary pancreatitis, so I know pain. This laser HURT. I almost asked her not to do the other side!) I was upset that my doctor seems to have taken advantage of my naivete. When I got the letter from her lawyer, I cried. I felt so, so stupid for believing her, for feeling that she had my best interests at heart. That hurt worse than the burn, truthfully – leaving a different kind of scar, you know?
I hope everyone here isn’t judging me too harshly, and I do appreciate Kevin for picking up my blog entry.
Also, the “risks” that Kevin’s post mention as being “real” – are these risks to the doctor or the patient? I first read it as risks to the cosmetic surgery patient, but it may have meant that it’s risky to be a cosmetic surgery doctor – because of people like me who have the audacity to be the recipient of a procedure gone awry.
Of course the risks are to the patient. And of course risks are real, or why would anyone waste time talking about them.
As for covering subsequent surgeries, I have seen doctors willing to do revisions without charge where the patient is not happy with the initial outcome. It is commonplace in cosmetic practice to do this. For non-cosmetic surgeries, practices often do not do this. It is a good thing to do, and it maintains goodwill. I have also seen colleagues who have paid for revision work done by other doctors where that has been the preference of the patient. That can also be a smart thing to do.
This story involves an initial treatment with complications resulting in scarring and disfigurement. Deviation from acceptable care standards is not certain from the offered information. There were subsequent surgeries done by other doctors, a scar revision, then dermal fillers, and another revision all presumably in the interest of improving the cosmetic outcome of the initial procedure. Those procedures themselves carry risk, I am sure you appreciate.
I suppose one might ask how long a doctor who did the initial laser treatment could be expected to pick up the tab for repairs? Until the patient is satisfied enough and doesn’t want more surgery? Until other treating surgeons say to stop?
A lifetime? How much is enough? There is no answer, really. I am sure the treating doctor has already spent many more times the fee earned by the original procedure in trying to make this problem as right as it could be made (sure, trying also to avoid a suit and bad publicity) and yes, the consequences are borne disproportionately, the doctor sees the consequences only when she meets with her accountant; the patient gets reminded every time she looks in the mirror. Four years is a long time though, when it comes to cosmetic outcomes and revisions of revisions done not by the initial treating surgeon, but by second and third surgeons. And while no one wants to go around feeling marked by misfortune, there probably should be a point where the initial treating physician ought to be able to stop voluntarily paying for additional surgery. I do not think drawing the line at four years’ time was unreasonable. When you bought your initial procedure, you paid for surgical care for a surgery that had known risks. There is a professional, ethical and legal responsibility to provide for your postoperative care, which the dermatologist seems to have done, even going well beyond that. But that is not an unlimited obligation.
“Of course the fine print said “scarring, death, etc.” as it always does. But every release form warns of the worst, doesn’t it?”
Is miss Kim scamming us again? First it was a photo of dubious ‘before’ veracity, and now she is quoting the consent document “scarring, death, etc.” Did it really say what you have in quotes or are you paraphrasing. I cannot believe any written consent would have an ‘etc.’ in it.
Yes, scary things are written into the consent document. That is not because you are supposed to ignore them with the flippant giggle of a petulant teen, it is because you are to heed them. When we say death can happen, it doesn’t mean a little bit dead, or something like dead but not quite, it means real dead.
And again, you have not remotely supported an ascertation of malpractice with any rational theory other than to remark that the physician was just a little too nice following an untoward event. Just what is the take home message for physicians? When the patient is hurt turn a cold shoulder? I was never more ignorant about being a physician than when I was a young medical student. I don’t expect Kim to understand that one can retain a shred of compassion with untoward events where most just cower. Would you really rather have had this doc be a cold bastard to you all those years ago just so you could have a case pending in court? Very likely you had a decent human being taking care of you then. Would you now go to a doc who had posted in the reception desk a sign that said ‘Patients with complications need not return’?
I have a few questions both to Kim and the doctors who do laser hair removal. As someone who had laser hair removal in the past and who plans to do it again because of a few hairs that popped up after a couple years or so.
Doesn’t the fact that procedure hurt badly a reasonable indicator that there was some error in the settings? This article states that excessive pain should be brought immediately to the attention of technician so that the settings can be adjusted. Kim, did you bring up your eccessive pain right away? Surely, if this was the case doctor had to adjust settings immediately?
I know that I had hardly any discomfort from laser hair removal, and that without any kind of numbing cream. My doctor used GentleLase.
The previous post was brought to you by the makers of GentleLase.
I’m not going to respond to the person who refers to me as a scammer, with the demeaning moniker “Miss Kim”. That’s just ridiculous – I would expect a more intelligent and reasonable discussion from the readers here. But regarding this:
“And while no one wants to go around feeling marked by misfortune, there probably should be a point where the initial treating physician ought to be able to stop voluntarily paying for additional surgery.”
The thing that confuses me, though, is that she made the initial appointment for me to meet with the surgeon in Pittsburgh (before the statue of limitations) to schedule a surgery to bring my left upper lip down to make it more symmetrical – and gave me all indications that she would continue to cover my care until I looked as normal as possible. Or as close to what I looked like before the laser treatment, anyway. (This is always what she promised me, incidentally – I didn’t demand the plastic surgeon visits, the cortisone injections, etc. – they were her idea. She offered them immediately, when she saw my giant swollen face.) But then, when the four-year statue had passed (between my consultation with the surgeon and the actual surgery) her lawyer sent the letter and she refused to pay. And by that time, there was absolutely no legal action to be taken (I just wanted the $1400 surgery covered – it wasn’t easy for my family to afford. I wasn’t looking to make millions.) That’s what makes me think there’s something wrong there.
Y’all, I was just trying to tell my story – chronicle it on my blog so that I would always remember the details. I didn’t expect to draw this much vitriol from some people – especially if those of you who are so critical of me are physicians, who are supposed to be caring healers. I was 18 years old, I believed my doctor, I ended up horribly burnt with a scar. I don’t see how that’s my fault.
“Is miss Kim scamming us again?”
Anon 7:46:
I think you are confused about the situation. Who are you upset with? You are treating Kim as a litigious patient that is scamming the system, even though she never filed a lawsuit against the doctor and she won’t even divulge the doctor’s identity in order to protect the doctor’s reputation.
The truth of the matter is that many patients would have filed a lawsuit in this case even if malpractice had not occurred. The average defense cost in a malpractice trial is in the neighborhood of $15,000 (much greater than $1400 operation) and it would have been in the insurance company’s best interest to settle out of court. She took the high road and did not go after the doctor. Why are you upset with her?
The previous post was brought to you by the makers of GentleLase.
I am the anon who mentioned it. I wish I haven’t mentioned the name of the laser. I truly don’t know much about other types of laser and I have no connection to the company. For all I know it was not the type of laser but the skill of my doctor.
This story drives home several important messages. One is that laser procedures are SURGERY and complications DO occur. I have seen other patients with disfiguring facial scars from laser procedures, and have developed an avid disdain for elective cosmetic procedures.
All one may conclude from the story is that a bad outcome occurred, comprising a known risk of laser surgery. It appears to me that the dermatologist mentioned sold her soul in this circumstance. I couldn’t sleep at night, especially if it had been my fault. Taking care of the problem was definitely the right thing to do, being deceitful was not.
I would probably buy a billboard near the dermatologist’s office to better educate the public on the risks of such procedures, featuring my before and after mugshot, just like the dermatologist has in her office showing only her most successful outcomes.
HOW LONG DOES IT TAKE TO READ THE BLOG i POSTED ON dEC-06-2006 IN REGARDS TO MEDICAL MALPRACTICE THAT WAS SPURRED BY KIM’S STORY-
I TOLD OF MY STORY WITH MEDICAL MEDIOCIRTY- YET i CANNOT FIND IT ANYWHERE– PLEASE IF YOU FIND IT SEND IT BACK TO ME AT:
AQUAMAN182D@EARTHLINK.NET
A great site pertaining to worse case scenario plastic surgery results
What happened to this woman illustrates two major points. First, there are severe complications for even the simplest surgery, and therefore everybody should be wary of getting any procedure they don’t absolutely need. Second, there’s no limit to the lengths fellow physicians will go to protect their own and their profession. The medical mafia is alive and well in this country, and it’s sad that even in an obvious case where the physician apologized and agreed to pay for corrective surgery, that someone would jump on here and try to defend this so called “doctor.” People who try to protect poor practitioners are only making it more likely for patients to avoid elective procedures altogether. If the climate out there is such that even a blatant case of malpractice is defended as an outcome that is simply unsatisfactory to the patient and not really a genuine medical error, the only conclusion to make is that conspiracy is alive and well in medicine. Why should anyone take the chance of being scarred for life if there is no recourse for correcting mistakes and calling those who mauled you to account when things go wrong? Deny, deny, deny. That’s the new way. Kim’s story represents a huge problem in the medical industry. Doctors these days care more about themselves and lining their pockets than they do about their patients. It is getting harder and harder to find the few who buck that trend. Hopefully she will become one of the elite who strive for better than the status quo.
I know this woman. I am a doctor. I can’t believe that after seeing the pictures, untouched, of an 18 year old woman with facial disfigurement, that anyone has the right to critique the patient! Yes, all procedures have risks – this case of substandard care was artificially absolved as follow-up care for a major burn with keloid scarring was remediated. However, the patient did trust that the ethically correct move was being made in this regard and the physician mocked her by dropping all guilt as soon as “time for a lawsuit is up!” This is an outrage and a sadness to a profession. Knowing the patient’s character and decency, I assure you that the blog is meant as a warning, not as a critique among all physicians. It is also meant as a testament to the standard of care of which SHE chooses to practice after medical school.
Comments on this entry are closed.