Advanced Plastic Surgery Institute

To Whom It May Concern:I’m responding to a refund request by patient NJ ID#: *** Due to HIPAA laws I am somewhat limited on the information I may provide without the patient’s permission but I will respond to as much information as she has divulgedAs the patient stated in 11/she underwent a liposuction procedure with fat transfer by myself as the surgeonOf the total cost of the procedure $was paid to the Surgery Center of *** *or the facility fees and $was paid to me for the anesthesiologist to whom I then paid directlyShe was seen for follow up throughout her recovery and overall expressed satisfaction over her results other than two areas of the seven treated which she claimed were unevenAll liposuction patients can have some irregularity or contour deformity as stated in her consent forms the patient signedSometimes this is due to scar tissue forming which a plastic surgeon cannot controlBecause of this we advise patients to wait months to a year then a revision liposuction could be attempted but still without guarantee it will improveThe patient stated in her complaint that I confirmed it was not swelling however there is no way to tell if this is scar tissue that will resolve on it’s own, persistent swelling, or even loose skin that appears like leftover fatty tissueA future revision surgery was offered to her on 3/20/at no charge but still advising she wait another few months for surgeryHowever, at this time the patient revealed she was now pregnantPregnancy can have significant changes to a body including weight changes that can clearly alter results from recent liposuctionWeight gain will typically extenuate these deformitiesI have no control over this as a surgeon. With regards to her overall dissatisfaction this was never expressed during her follow up appointments other than the two stated areas aboveEvery liposuction patient has unevenness early in their recovery which is part of the healing processThe signed consent form reads as follows:Unsatisfactory Result: Although good results are expected, there is no guarantee or warranty expressed, or implied, on the results that may be obtainedYou may be disappointed with the results of surgeryAsymmetry, unanticipated shape and size, loss of function, wound disruption, poor healing, and loss of sensation may occur after surgerySize may be incorrectUnsatisfactory surgical scar location or appearance may occurIt may be necessary to perform additional surgery to improve these results.Often patients have unrealistic expectations with their desired outcomeFinal results are overwhelmingly limited to skin quality and elasticity, patient compliance, body frame, history of weight loss, and current body weightWhen a patient has loose skin from weight loss or pregnancy some patients mistakenly claim there is leftover fat when in reality the loose skin is creating that appearance. The patient also claims she was charged $3,for liposuction of her thighsShe was actually charged $as specifically shown in her quoteShe feels this was a tactic to get more moneyThe patients main objective was for fat injections elsewhere on her body and this was recommended to obtain more fat for the volume she desired which is contrary to her complaint because she states she still didn’t achieve the results she wantedIn my experience with a vast number of liposuction patients, removing excess fat in the thighs results in significant contour deformities and loose hanging skinObviously this would not be desiredRemoving all of the fat is very easy but making it still look natural or good is another storyIf too much fat is removed from the thighs there is no good treatment to correct this save a possible thigh lift which leaves a large scar down the thigh and is typically not desirable. Unfortunately, there was an oversight by our office staff and the patient’s before and after photos were posted on our website without her permissionShe notified us of this and the photos were taken down within the hour and we expressed our sincere apologiesThere were no identifiable aspects of her photos as tattoos were photoshopped from the imagesOur practice takes HIPAA policies very seriously and are saddened that this happenedPolicies have been set in place to make sure this never happens againThe patient stated she requested a refund at this pointI was notified about the photos and her request immediatelyIt was unclear at the time whether the patient was asking for a refund for the procedure or for the cost of the possible future revision surgery of the two areas of concernRefunding the patient the money for a surgery that most would consider an excellent result is not only inappropriate but not standard in any cosmetic surgery practiceAs stated above, patient satisfaction cannot be guaranteedThat being said, our goal at Advanced Plastic Surgery Institute is patient satisfaction and I am sensitive to the fact the patient lost confidence in our office which is why we offered to pay for another physician to correct the two areas of concernThe patient did not have to make several phone calls as stated in her complaint for us to respondBecause of continuing weight changes due to her current pregnancy, we recommended that she get a quote now which would then be paid to the surgeon whenever she is healthy enough after breast feeding to proceed with the surgery as waiting a year or so can potentially change the areas which may require even more extensive liposuctionThe patient responded to our offer with a complaint to the Revdex.comThere is no guarantee that another liposuction procedure with fat transfer will actually give the patient her desired outcome but if paying for a surgeon to improve the two areas when she is able to will help we are happy to complyThe patient’s urgency for a refund despite not being able to undergo surgery for another months according to her makes me concerned she is in financial trouble and looking for money rather than actually undergoing another procedure in the futureThis is a more than fair offer and a full refund for the service provided is not an optionThank you for your consideration in the matter. Josh O*** MDAdvanced Plastic Surgery InstituteP: ###-###-####F: ###-###-####

I am willing to accept this offer IF I can schedule a revision with a new surgeon and Advanced Plastic Surgery will provide that surgeon with payment over a year in advance. Please see attached document for explanation as I am limited to 2000 characters.

To Whom It May Concern: I’m responding in regards to the complaint from Nicole J[redacted]. I just received this letter today and I believe I’m 8 days from the calendar date of the notice so I apologize if it is tardy. I am between surgeries and cannot spend the time to give an appropriate response...

until later tonight when you will be closed. I will send my response Monday. Thank you for your understanding. Josh O[redacted] MD