Informed Consent in Body Dysmorphic Disorder

Tony E. Francis, MD, JD


February 22, 2012

In This Article

Informed Consent in BDD

In recent years, articles have appeared warning of a potential problem with informed consent in patients with BDD undergoing plastic surgery and dermatological procedures. The theme of these articles is that patients with BDD may not be able to give a truly informed consent when contemplating cosmetic procedures. It has been shown that patients with BDD are more likely to seek cosmetic procedures, especially those of a trivial nature, and that they are more likely to be dissatisfied or angry with the surgeon after the procedure. Is this a real problem?

The source of the concern comes from a single case that occurred in New York in 2000-2001. In Lynn G. v. Hugo, the following facts were developed:

Lynn G. visited Dr. Norman Hugo, a plastic surgeon, approximately 50 times over a 6-year period to discuss various cosmetic procedures. During that time, she underwent a series of elective surgeries, including eyelid surgery, facial liposuctions, eyebrow tattooing, and wrinkle and skin growth removals. Satisfied with these results, she elected to undergo liposuction on February 9, 1993, to correct, among other things, her "pouch-like stomach." Prior to the operation, Dr. Hugo discussed the procedure with Lynn and advised her of the risks, including scarring. Acknowledging these risks, she signed a consent form and, in her own handwriting, indicated "I understand" on her hospital chart.

When the liposuction failed to produce the result she had anticipated, Lynn underwent a full abdominoplasty ( "tummy tuck") to tighten her abdomen. Prior to the surgery, Dr. Hugo informed her of the risks associated with an abdominoplasty, including "ugly scars." Once again, Lynn acknowledged, in writing, her understanding of the risks and signed a consent form. Following her surgery on November 9, 1993, Lynn complained of an unsightly scar on her abdomen.

Lynn G. and her husband commenced a medical malpractice action against defendant Dr. Hugo, alleging lack of informed consent and medical malpractice. The plaintiff claimed that she lacked capacity to consent to the procedures because she had been diagnosed with BDD, a preoccupation with slight or imaginary physical imperfections that causes considerable distress or functional impairment.[1] The plaintiffs maintained that her numerous "unnecessary" surgeries, together with defendant Dr. Hugo's knowledge of her use of antidepressant medication, should have alerted him to her condition, and that the defendant was negligent in not referring her to a psychiatrist before performing the surgeries. Lynn G. also claimed that her consent was not "informed" because the defendant failed to advise her of less invasive alternatives to a full abdominoplasty. Finally, the plaintiff alleged that Dr. Hugo was negligent in combining significant truncal liposuction and a full abdominoplasty. Lynn G. submitted affidavits from a plastic surgeon and a psychiatrist alleging substandard care.

Dr. Hugo furnished an affidavit from a plastic surgeon who reviewed the medical records and deposition testimony and opined that the defendant adequately informed the plaintiff of all risks and alternatives and did not deviate from acceptable medical practice by not referring her to a psychiatrist. He noted that nothing in the plaintiff's medical history indicated that she suffered from BDD, nor was her use of antidepressant medication sufficient to alert the defendant to this condition. With respect to the plaintiff's claim that the defendant negligently combined liposuction with a full abdominoplasty, the expert concluded that the defendant properly spaced the 2 procedures 9 months apart to allow adequate time for healing.

The court ruled that the plaintiff's affidavits failed to create a question of material fact. Furthermore, there was no evidence that the plaintiff had been diagnosed with BDD at the time of the surgery or that she was incompetent to make an informed decision.

After much litigation, the case was dismissed by the Court of Appeals of New York in 2001. In other words, there was no case, so it was dismissed.

To date, no other cases with this cause of action have been published, so the legal risk at this time appears minimal.


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