Ethics and aims of cosmetic surgery: a contribution from an analysis of claims after minor damage.
OBJECTIVE
Cosmetic surgery raises the ethical problem of the balance of risks and benefits of an operation the benefit of which is psychological and difficult to evaluate. The aim of this study is to improve the understanding of the factors that influence an unsatisfactory outcome. In this context, we have analyzed complaints from patients the alleged damage to whom proved to be ultimately non-existent or minimal.


METHODS
Review of the case notes of 20 patients who had sought damages through the French judicial system for minimal or non-existent alleged damage. Data were collected in 1999.


RESULTS
We found fifteen complaints of insufficient results, two for cause and effect relations with pathologies without any connection, and three for lack of information. 5 patients received compensation, the rest having been ruled out of court. The gender ratio (17 F/3 M), the average age (38 years old), the distribution of the operations and the socio-professional categories reflect the characteristics of a standard cosmetic surgery population. The average period of time between an operation and a complaint was 4.3 years (SD = 4.2). Among the medical histories we found two cases of depression, one treatment "for the nerves", one suicide attempt, and two cases of alcoholism without possible interpretation in the framework of this study. In six cases, the surgeon's qualification was not appropriate to the type of operation. The unprofessional conduct of colleagues had an influence on the effect of the procedure as an independent factor.


CONCLUSIONS
These results call for more responsibility from professionals and encourage the undertaking of prospective complementary studies in order to evaluate more precisely the balance of risks and benefits.
Meningaud
J P
JP
Department of Medical Ethics and Public Health, Necker University Hospital Paris, France.
Servant
J M
JM
Herve
C
C
Bertrand
J C
JC
D000328:Adult; D002983:Clinical Competence / Q000331:legislation & jurisprudence / Q000592:standards; D004992:Ethics, Medical; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D008875:Middle Aged; D017060:Patient Satisfaction / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D013518:Surgery, Plastic / Q000009:adverse effects* / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome