Bilateral Lower Face Lift – Poor Outcome

Facts

The Claimant underwent a bilateral lower face lift at The Hospital Medical Group (First Defendant) in Birmingham on 12.7.06. The surgery was performed by Mr Adriano Seno (Second Defendant).

Three days later on 15.7.06, the Claimant was concerned to see that the left side of her face had started to turn black and that the skin surface was very different to the right hand side. She telephoned the First Defendant's emergency line and was advised that this was normal and that she would wait until her routine appointment on 18.7.06 for the removal of her stitches.

On 18.7.06, the Claimant was seen by Mr Renato Zaccheddu (Third Defendant), who advised her to keep out of the sun, that everything was alright and that she should make an appointment to see Mr Seno in two week's time. There were difficulties in arranging an appointment and the Claimant eventually saw Mr Seno, the Second Defendant, three weeks later on 7.9.06.

The Second Defendant stated that the skin had necrosed and that it would be at least 6 months before anything could be done. The Claimant then experienced further difficulties in arranging an appointment. She did see the Second Defendant again, but by this time had lost confidence in him and was referred to the Third Defendant on 31.8.07, over a year after the operation; he advised a 12 month wait.

The Claimant then saw another plastic surgeon, who advised her that nothing could be done by way of corrective surgery and that the post operative care had not been adequate.

Liability

There was a failure on the part of the Second Defendant to raise a flap, which had adequate vascularity during the operation on 12.7.06. There was a failure by the First and Second Defendants on 13.7.06, to remove the Claimant's bandages to inspect the wound fully. If this had taken place remedies could have been undertaken, which would have left the Claimant with minimal scarring.

There was a failure by the First Defendant on 15.7.06, to advise the Claimant that she should immediately attend one of their clinics for examination by a surgeon. If the wound had been inspected remedies could have been undertaken, which would have left the Claimant with minimal scarring. There was a further failure by the First Defendant to institute a system for the immediate clinical follow up of patients telephoning in with problems.

There was a failure by the First and Third Defendant on 18.7.06, to appreciate the extent of the Claimant's deterioration. Even on 18.7.06, operative treatment would have saved another 30% or so of scarring from developing.

Although all three Defendants were at fault in relation to breach of duty and causation. Primary liability lay with the Second Defendant as the Claimant's operating surgeon, who was ultimately responsible for her care both before, during and after the operation.

Breach of duty, causation and quantum remained in dispute throughout this case.

Quantum

The Claimant was left with scarring of the left cheek as a result of the likely failure of a skin flap by reason of insufficient vascularisation and a failure to treat a haematoma in the left cheek in an appropriate and timely manner.

The extensive scarring of the Claimant's left cheek extended to behind her left ear in the mastoid area with additional significant scarring behind the right ear. The scarring was numb. The Claimant felt obliged to wear heavy camouflage make-up in the form of a filler akin to stage make-up and then a double layer of foundation finished with a setting powder. The Claimant had suffered loss of confidence, compounded by fears of the camouflage make-up melting in the heat, or her hair blowing away from her face and showing the scars. She suffered from depression.

A series of photographic evidence was obtained showing the Claimant's face pre-op on 12.7.06, post-op, 6 days later on 18.7.06, 6 months post op on 18.12.06, 3 years post op on 7.4.09 and 4 years post op on 1.10.10.

Evidence

Breach of duty and causation and condition and prognosis medical evidence was obtained from Mr Henderson (Consultant Plastic Surgeon). Further evidence was obtained from a Consultant Psychiatrist and from a skin camouflage expert.

The medical expert advised that in relation to prognosis there was not enough laxity of skin to be able to make any worthwhile improvement in the amount of scar tissue visible and that the Claimant would have to wait at least 5 years or more before there would be any prospect of improving the appearance of her face. His recommendation was to preferably leave any scar revision surgery for as long as possible. Instead he recommended improving the result in the meantime with camouflage make-up. He did not think that the scarring would worsen.

A psychiatric report was obtained from Professor Benjamin Green (Consultant Psychiatrist). The psychiatric expert diagnosed a chronic mild adjustment disorder. Chronic in that it had lasted more or less since the surgery, but there was evidence of fluctuation in her mood and that she suffered particularly “black days”. The psychiatric expert confirmed that the primary cause of her chronic mild adjustment disorder was undoubtedly the scarring.

The prognosis was guarded and he felt there was always likely to be some level of low mood, which could be improved with cognitive behavioural therapy and in the future if any corrective surgery was able to ameliorate the condition. He did, however, consider that the Claimant would be vulnerable to further episodes of depression in the future because of the result of the scarring on her self esteem.

A skin camouflage report was obtained from Miss Melanie Speakman, a member of the British Association of Skin Camouflage. The skin camouflage expert noted “she has two scars extending from the lower temporal regions to the angle of the mandible and posterior aspect of the ears bilaterally. Both sides are pitted and raised in some areas. They are also shiny in appearance. When she is hot or blushes, these areas appear more blanched and in cold weather become more blue toned, which makes them more obvious. The scars are much more obvious and reddened in appearance in person than on the photographs. She did not expect the appearance to improve.

The camouflage expert confirmed that the scarred areas would never tan normally as the tissue was permanently altered, which meant that the Claimant would also require the use of SPF creams when in the sun. The Claimant was recommended various camouflage make-up products and instructed on their application and removal. She was advised on scar massage. Different shades of camouflage cream would be required for summer and winter due to skin pigmentation changes and costings were given for the cost per item of each product and annual cost of replacement. The camouflage makeup when applied gave a good result, particularly in relation to even skin tone.

General Damages

With regard to the actual scarring the Claimant fell within the JSB Guidelines bracket for 7(b) facial disfigurement (a) females (ii) less severe scarring £20,000.00 to £31,750.00 – where the disfigurement is substantial and where there is a significant psychological reaction.

General damages were estimated at £30,000.00.

Special Damages

Special damages totalled approximately £22,500.00. This figure was made up of a small amount of travel expenses, some past and future anticipated care and assistance, past costs in relation to camouflage make-up, future cognitive behavioural therapy, future camouflage make-up and corrective surgery.

Solicitor's Comments - Procedural Difficulties

This was a very difficult claim procedurally due to there being three Defendants, two of which were Italian. It eventually became apparent that the primary Defendant would be Mr Adriano Seno, the operating surgeon. After the difficulties regarding service of proceedings on the Second and Third Defendants were overcome, we then unfortunately had to deal with the Second Defendant's Italian insurers, Gruppo Zurich Italia.

Time, effort and money was wasted in pursuing the claim with this insurance company who poorly represented their client. The Second Defendant was contacted by ourselves on a number of occasions and advised to instruct UK Solicitors. Proceedings were issued and an application made for judgment against the Second Defendant. This action prompted the instruction of UK Solicitors following which it became possible to start sensible negotiations.

Settlement was eventually agreed on 13.5.11 for £52,500.00. Settlement was agreed with the Second Defendants on the basis that the Claimant assigned her cause of action against the First and Third Defendants to the Second Defendant, who would then be entitled to pursue the First and Third Defendant in the place of the Claimant. The Claimant further agreed to provide the Second Defendant with copies of all her expert reports.