By William Byron Barber II, M.D.

Q. I had liposuction on my abdomen and flanks about a year ago and I do not see very much improvement.  I have not gained any weight since my surgery, so I wonder whether enough fat was removed.  I have discussed this with my plastic surgeon on several occasions and he seems to get that I am not happy.  I want to ask for my money back but I do not know whether that is appropriate.  Do doctors ever refund money if a patient is not satisfied?

A. You have asked a very good question and one that probably should have been discussed with your plastic surgeon before your liposuction rather than after.  I am going to tell you what my guidelines are for patient refunds, which by no means represents a universal policy followed by other plastic surgeons.  The question that I ask myself if a patient is not happy with his/her result is whether the patient is being reasonable regarding his/her expectations.  If, for example, I perform a facelift on a 65 year old patient and the patient reports that I did not make her look 50 and therefore is unhappy and wants her money back, I believe that is an unreasonable expectation and therefore the patient is not entitled to a refund.  In this case, I will do whatever I can to make the patient feel better about her results and may even offer her a touch up procedure to try to come closer to her expectations, but it is not likely that I will refund my fees.  After all, I cannot make someone look a particular age, but I can almost always make someone look as good as she can for the age that she is.  Managing expectations in plastic surgery is extremely important, and in this situation, there was a failure of the patient to understand the limitations of facelift surgery. 

Another example that is more similar to your case is someone who has had liposuction, gained a significant amount of weight following the procedure and cannot understand why his/her results are not better.  In this situation, I will not offer a refund of the surgical fees since there have been changes (additional weight) that affects the liposuction results. My advice to this patient is to return to her pre-op weight and then reevaluate the results.

If a patient truly has not had a good result from a surgical procedure, then I ask myself what is the fair thing to do if I were in the patients shoes.  An example of someone who might be entitled to getting some or all of the surgical fees returned, or at least a touch up procedure at a reduced fee, might be a patient who, say for example, has had an eyelid lift with little or no improvement in the appearance of the eyes.  In this situation I almost always will first offer the patient an opportunity to undergo a touch up procedure at either a significantly reduced fee, or at no professional fee.  You might ask why there should be any fee, and the answer to that is that there are anesthesia fees and operating room fees that are incurred with redo surgery that the surgeon cannot control.  In the case that I describe above involving an unhappy eyelid lift patient, I would do her surgery at no professional fee (my fee), but there typically will be fees for anesthesia and the use of the operating room.  If the patient has lost confidence in my abilities and decides she does not want me to do surgery on her again, then I will be apt to return my professional fee to the patient.  When I am confronted with this type of issue, which I am on rare occasions, as all plastic surgeons are, I simply follow the golden rule.  I will treat the patient’s request in the same manner that I would want someone to treat my request if I were the patient.  My goal with every patient is to inform her about realistic expectations, strive to achieve the desired results, and to the extent possible end up with a satisfied patient.  I wish this goal were achievable 100% of the time.  Sometimes patients are not happy and in these situations, I will always try to do what is right.  Sometimes that is to return the money, and sometimes it is not.  Having a discussion with your plastic surgeon is in order, if only to make the surgeon aware of your dissatisfaction.