Fred Schulte, KFF Health News
Just a few days after a harrowing beauty surgical procedure process, Erin Schaeffer stated, she awoke with fluid leaking from an open wound in her abdomen.
Schaeffer went on to spend per week in a Florida hospital battling a extreme an infection after a sort of tummy tuck and liposuction on the Jacksonville department of Sono Bello, a nationwide beauty surgical procedure chain.
More than a yr later, scars stay on her decrease physique — and in a lawsuit she is accusing Sono Bello of utilizing an obstetrician-gynecologist who was inadequately educated to take away her extra pores and skin and fats, a process she says brought on excruciating ache.
“I literally felt like I was skinned alive,” stated the 37-year-old, who works as a coaching supervisor for United Parcel Service.
Schaeffer and her husband, Jonathan, are suing Sono Bello and Manuel Herrera in Duval County Circuit Court. The swimsuit accuses Herrera, a board-certified OB-GYN, of “performing procedures that he was not trained or qualified to perform.”
Sono Bello and Herrera denied the allegations in a joint courtroom submitting. And in an interview with KFF Health News and NBC News, Robert Centeno, Sono Bello’s medical director for the East area, stated its surgeons bear “very rigorous training.”
Backed by private-equity financing, Sono Bello is the biggest of a breed of beauty surgical procedure chains vying for a slice of the rising body-contouring market within the U.S. One analysis agency estimated that the market, which incorporates procedures starting from wrinkle removing to liposuction, topped $22 billion in 2024.
The chains promote an array of body-reshaping operations, akin to “Mommy Makeovers” and liposuction, focusing on clients prepared to pay as much as $20,000 out-of-pocket for a brand new determine, usually on credit score with steep rates of interest from corporations specializing in credit score for elective medical procedures. Sono Bello boasts it’s “America’s top cosmetic surgery specialist.”
But a joint investigation by KFF Health News and NBC News discovered that Sono Bello and different beauty surgical procedure chains have been the goal of scores of medical malpractice and negligence lawsuits alleging disfiguring accidents — together with 12 wrongful dying instances filed over the previous seven years.
Injured sufferers have accused the chains of hiring docs with minimal beauty surgical procedure coaching, of failing to acknowledge and deal with life-threatening infections and different harmful surgical problems, and of high-pressure gross sales ways that minimized security dangers, courtroom information present. Sono Bello and the opposite corporations have denied the allegations in courtroom.
“These people promise to turn you into the fairest person in the land, and the risks aren’t often worth the reality,” stated Sean Domnick, a Florida lawyer who heads the American Association for Justice, a trial legal professionals’ group.
Sono Bello’s Centeno disagrees. He stated the corporate’s mission is to “help each and every one of our patients live their best lives now.” Sono Bello presents “life-changing transformations” that improve an individual’s “appearance as well as their quality of life,” stated Centeno, a surgeon himself on the firm’s Troy, Michigan, workplace.
The docs who carry out such surgical procedures, courtroom information present, are typically paid extra for taking over sufferers with a excessive physique mass, as weight problems raises the danger of devastating complications.
And because the chains develop, there’s little regulatory oversight. While the FDA maintains a database of complaints about medication or medical gadgets, there’s nothing related for beauty surgical procedures.
Schaeffer had liposuction at Sono Bello in January 2024 and was glad with the outcomes. On the morning of March 29, 2024, she went in for extra liposuction and a mini-tummy tuck that Sono Bello calls AbEX. The medical employees gave her Xanax, a tranquilizer, and the painkiller oxycodone in capsule type, based on medical information Sono Bello turned over to Schaeffer’s lawyer. During the process, she acquired an infusion of lidocaine to numb the world however remained awake. Sono Bello says the native anesthesia is safer and promotes sooner therapeutic with “minimal discomfort,” so sufferers could return to work or different regular actions inside per week.
That didn’t occur for Schaeffer, who stated she felt a lot ache through the operation that she started to cry and “begged” the physician to cease close to the tip.
“I said, ‘I don’t care what I look like,’” she stated in an interview. “‘I can’t handle the pain.’”
Two days later, she spiked a fever, and a day after that her pubic space swelled up “severely,” she stated. Sono Bello medical employees advised her that was regular and that she was nice, she stated. Two days later, nonetheless, blood and fluid spilled out of her abdomen when she bought up.
On one go to to the workplace, Herrera advised her she required surgical procedure at a hospital to deal with her wounds. But, Schaeffer recounted, Herrera stated he couldn’t organize that as a result of he was an obstetrician, not a plastic surgeon, and didn’t have hospital privileges regionally. Herrera has hospital privileges within the Orlando space, about 140 miles southwest of Jacksonville.
“I was just in utter shock,” Schaeffer stated.
Sono Bello spokesperson Mark Firmani stated the corporate doesn’t require its docs to have native hospital privileges, although many do have them.
Centeno stated Schaeffer’s painful expertise shouldn’t be widespread.
“The reality is that over 90% of our patients who have our procedures completed are extremely comfortable during the procedure and they do quite well,” he stated. Patients of Sono Bello and another clinics even have complained to the Better Business Bureau of unexpectedly painful procedures.
Centeno stated that Herrera nonetheless works for the corporate, however the physician’s identify doesn’t seem on the corporate’s Jacksonville website. Herrera runs an OB-GYN and aesthetics apply, which incorporates skincare remedies, in Winter Garden, Florida, close to Orlando, and is board-certified by the American Board of Obstetrics & Gynecology.
Sono Bello has thought of him a rising star; Herrera’s work in 2023 gained Sono Bello’s annual “New Talent Award,” given to an organization physician who reveals “exceptional technical skills, productivity, and off-the-charts brand loyalty.”
Herrera completed a Sono Bello fellowship program that teaches a “suite of aesthetic procedures” in a six- to eight-week course beneath the route of an organization surgeon. The firm says the fellowship presents “patient-focused training in awake total body contouring and skin excision procedures.” Sono Bello permits physicians who’ve accomplished formal residencies in additional than half a dozen varieties of surgical procedure to use for its fellowship.
In a post on a Sono Bello website, Herrera stated that earlier than taking the fellowship course, he “had been a skilled surgeon for over 13 years with extensive experience in other areas but limited knowledge on body sculpting.” Herrera didn’t reply to calls and emails requesting remark and directed Sono Bello to reply on his behalf. Company spokesperson Firmani stated Herrera remains to be a member of the Sono Bello group.
Many established plastic surgeons who spoke with KFF Health News and NBC News fear that chain surgical procedure teams could also be inclined to spend extra effort on advertising and marketing and gross sales than on ensuring their docs are correctly credentialed and able to dealing with any problems that come up.
Medical practices owned by non-public fairness or funding corporations have extra money to spend drawing in sufferers and “the ability to operate and provide quality patient care is now less important,” stated Mark Domanski, a plastic surgeon in Northern Virginia.
Doctor Entrepreneurs
Formed in 2008 by entrepreneurial doctor Tom Garrison, Sono Bello now runs greater than 100 facilities nationwide. Private fairness traders have pumped $816 million into the corporate, most of it since 2023, according to PitchBook, which tracks the trade. Sono Bello advertises broadly on tv and on-line, aimed toward what one main investor termed the “everyday woman and man.” It has advertised having “150+ board-certified surgeons who have performed over 300,000 laser lipo & body contouring procedures.”
Sono Bello limits its choices to companies akin to liposuction and its model of tummy tucks, which it believes its surgeons have mastered. It doesn’t carry out Brazilian butt lifts, or fats transfers, although many different beauty surgical procedure chains do.
While Sono Bello boasts that the overwhelming majority of its sufferers are glad, courtroom information present that allegations of substandard medical care have trailed its speedy development.
Sono Bello and its company associates and surgeons have defended greater than 60 medical malpractice instances, together with 4 fits involving affected person deaths, since April 2013, courtroom information present. Sono Bello has settled three of 4 wrongful dying instances filed since May 2018, whereas one is pending, courtroom information present.
Schaeffer’s swimsuit in Jacksonville is amongst at the least 19 filed because the begin of March 2023. Many are pending within the courts, and the corporate has denied the allegations.
Other physicians who’ve prolonged their manufacturers to a number of cities and relied closely on social media and splashy web sites to herald sufferers have additionally confronted lawsuits.
Mia Aesthetics, shaped in 2017 by Texas surgeon Sergio Alvarez, runs a dozen beauty surgical procedure clinics from Miami to Las Vegas. Mia Aesthetics gives “the highest quality plastic surgery at affordable prices proving that being beautiful and saving money are two realities that can exist simultaneously,” its website says. Alvarez is a board-certified plastic surgeon.
Patients filed at the least 30 medical negligence instances towards Mia Aesthetics and its associates from November 2020 by March of this yr, courtroom information present. A dozen fits goal its Miami surgical procedure middle. The firm has sought, and sometimes gained, dismissal of malpractice fits as a result of sufferers signed contracts agreeing to arbitration of any disputes, courtroom dockets present. Alvarez didn’t reply to requests for remark.
Owned by New York doctor Sergey Voskin since 2016, Goals Aesthetics and Plastic Surgery has branched out from a small beauty surgical procedure workplace within the Brooklyn borough of New York City to a network of a dozen surgery centers it manages in eight states.
Goals clinics and affiliated surgeons have been named as defendants in at the least 40 malpractice fits filed from October 2018 by March, courtroom information present. The Atlanta department accounted for greater than 20 such instances in Georgia courts from September 2022 by June 2024. Most are pending. Goals defended two lawsuits introduced by the households of New York sufferers who died shortly after having liposuction procedures, courtroom information present. Goals denied the allegations and gained dismissal of some instances by invoking arbitration agreements, based on courtroom dockets. The firm says these agreements are generally used all through the medical trade.
Voskin declined to be interviewed. In an announcement, Goals lawyer Joshua Lurie stated the medical workplaces it manages have carried out greater than 10,000 procedures and have “one of, if not the highest track records of safety among similar types of medical practices.”
Lurie stated the “vast majority” of malpractice claims are “meritless.” These “bad faith filings create an implication of risk when none exist and when, again, there is a very negligible negative outcome from surgery compared to the total procedures performed,” he wrote.
No Guarantees
Malpractice fits by themselves are usually not proof of wrongdoing. Nobody tracks the result of those lawsuits, which regularly are settled beneath confidential phrases that maintain key particulars out of public view and prohibit sufferers from discussing their experiences. Surgeons usually argue that problems are a threat of surgical procedure and {that a} poor consequence doesn’t imply the physician was negligent. To show negligence, injured sufferers typically should present their care fell under what a reasonably prudent doctor with similar training would have carried out.
That could be a problem. Typically, the surgical procedure chains battle again by arguing that problems are a threat of any surgical process and that they by no means assure outcomes.
Before their procedures, sufferers should signal consent kinds acknowledging that their expectations have to be “realistic” and that problems or dissatisfaction with the outcome doesn’t essentially imply the surgeon botched the job. The American Society of Plastic Surgeons investigates ethics complaints towards its members, however not allegations of competence or malpractice.
Some pre-surgery contracts permit for low-cost “revisions” for disgruntled sufferers. Sono Bello has provided a “satisfaction commitment,” which states: “If your surgeon’s evaluation determines your results to be deficient, we will touch up the area at no cost to you.”
Other contracts include disclaimers, akin to reminding sufferers that dramatic “before and after” pictures broadly proven in on-line commercials and different solicitations could not replicate typical outcomes.
I don’t care what I appear like. I can’t deal with the ache.
Erin Schaeffer
Demonstrating the affect of social media in driving gross sales, Goals as soon as required sufferers to signal a non-disparagement clause. The contract acknowledged that sufferers who bad-mouth the corporate on social media with out first giving the corporate “an opportunity to remedy any alleged issues” conform to pay damages of $10,000 for each violation.
In a civil investigation of Goals’ advertising and marketing ways, Georgia Attorney General Chris Carr alleged that coverage, and others, violated state shopper safety legal guidelines. In September 2022, Goals agreed to cease utilizing the non-disparagement clause and to pay the state $119,480 to settle the matter, with out admitting any wrongdoing.
Both Goals and Mia Aesthetics have clauses of their service contracts that require arbitration of any disputes in lieu of courtroom motion, a course of many shopper advocates imagine favors the trade. These agreements have gotten extra widespread amongst plastic surgeons. The arbitration clauses have prevented some aggrieved sufferers from getting their day in a courtroom.
That occurred in a wrongful dying case filed by the household of Angela Mendez, 57, who was discovered lifeless in her house a day after liposuction at a Goals workplace in New York City in March 2021. She died from a pulmonary thromboembolism, a blood clot in her lung, as a complication of beauty surgical procedure, based on an post-mortem report.
Her household sued the corporate alleging negligence. But, in June 2024, a decide dominated that Mendez had signed a type requiring the case to be heard in arbitration and the lawsuit was dismissed.
Attorney Gary Zucker, who represents the household, is interesting. “It’s been a one-two punch for the family,” Zucker stated.
Goals lawyer Lurie referred to as arbitration “a common practice throughout the industry and many industries” that’s “intended to speed the process to come to resolutions in a more expedited fashion.” In a 2023 deposition, Lurie stated sufferers can choose out of the arbitration settlement, which “has happened multiple times.”
‘A Hard Sell’
When Erin Schaeffer first visited Sono Bello, a gross sales agent advised her she was a “perfect candidate” for a tummy tuck process, she stated in an interview with KFF Health News and NBC News.
Though she wished to consider it and speak it over together with her household, she stated, the salesperson persuaded her to go forward. Because beauty surgical procedure is elective, insurance coverage doesn’t cowl it. Schaeffer made a down cost and signed up for a credit score plan by exterior corporations to repay a lot of the $19,838 invoice over a five-year interval, based on her medical information. She stated she’s now paying $420 a month.
“I definitely felt like it was a hard sell,” Schaeffer stated. “She didn’t want me to leave out of there without putting money down on it.”
Schaeffer stated she didn’t meet the physician till a couple of week earlier than the process, and solely briefly. Some sufferers suing different corporations have argued in courtroom filings that they didn’t meet the surgeon till the day of their operations, a apply that attracts sharp criticism from extra conventional surgeons.
Scott Hollenbeck, president of the American Society of Plastic Surgeons, stated sufferers want time with their physician to totally perceive the professionals and cons of surgical procedure and shouldn’t be pressured into fast selections.
“It is not possible to do that when you see the doctor an hour before surgery for the first time,” he stated. “You should have time to process what they told you, think about it, and make a decision.”
“That is best done with a surgeon, not a marketer,” Hollenbeck stated.
Good Candidates
Many plastic surgeons discourage individuals with weight problems from present process liposuction and different beauty procedures due to an elevated risk of infections and different critical medical problems. Candidates are thought of overweight at a body mass index of 30 or above. Sono Bello sufferers have a median BMI of 31, based on Centeno. At the time of her surgical procedure, Schaeffer had a BMI of 36.
But there’s no consensus over who needs to be turned away due to their dimension — and insurance policies range.
Sono Bello says its AbEX tummy tuck will be carried out safely with a physique mass index as excessive as 42, nicely past the physique mass limits for a traditional abdominoplasty carried out utilizing basic anesthesia. The AbEX removes unfastened and sagging pores and skin across the abdomen “to achieve a more toned and sculpted look,” based on the corporate.
Centeno stated that top BMI “does confer additional risk, which can be managed.” But he stated it could be “discriminatory, unethical, and inappropriate for Sono Bello or any other medical practice to deny care to a patient based solely on their BMI.”
Yet excessive BMI sufferers have alleged they suffered devastating problems, based on KFF Health News’ assessment of the courtroom instances filed towards Sono Bello and different corporations.
One affected person is Marissa Edwards, then 45, a California medical receptionist with three youngsters. At 5 toes 3 inches tall, she weighed 237 kilos, with a physique mass index of 41.
She had AbEX and liposuction at a Sono Bello clinic in San Diego on Oct. 11, 2022, based on courtroom filings. During an workplace go to eight days later, she complained of swelling and ache in her stomach, however a nurse “dismissed her complaints,” based on the swimsuit. On Nov. 4, Edwards observed the incision was opening, whereas a rash shaped round her stomach button. In a textual content to Sono Bello, she connected a photograph of her wound which, the swimsuit alleges, ought to have alerted the employees that it wanted “immediate evaluation by a qualified medical professional.”
On Nov. 5, she awoke “feeling extremely hot,” and “nearly fainted,” based on her grievance. Her husband drove her to an pressing care middle, which recognized her with sepsis and rushed her to a hospital by ambulance.
When she awoke the following morning, her bedsheets had been soaked with physique fluid. As she stood up, “fluid began to pour out of her stomach and hit the floor,” based on the grievance. She spent six days within the hospital.
Edwards alleges in her lawsuit that Sono Bello’s medical employees failed to acknowledge and reply to early indicators of hassle.
“I have sepsis and could have died,” she texted to Sono Bello’s workplace line, based on courtroom paperwork. “I am very upset.”
In one textual content that was included in her lawsuit, she wrote: “So I would appreciate some type of empathy from you!! If you only knew what I have been through and you went through this I’m sure you wouldn’t be giving me this snotty attitude.”
Sono Bello denies any negligence. In a courtroom submitting, the corporate famous that infections are a threat of surgical procedure, and that Edwards had signed a consent type that acknowledged partly: “The practice of medicine and surgery is not an exact science and results are not guaranteed.” Sono Bello filed a movement for abstract judgment that argued her care was not negligent and “not a substantial factor” in inflicting her alleged accidents. The case was settled earlier this month beneath confidential phrases.
Value Units
While sufferers with excessive BMI are riskier, in addition they are extra profitable for Sono Bello surgeons, courtroom information present.
The firm pays its surgeons for procedures based mostly partly on the affected person’s BMI, utilizing a method it calls a “surgical value unit.”
The compensation plan surfaced in a lawsuit filed in December 2023 by Shirley Webb, then a 79-year-old Nevada girl. Hoping to slim down for a dream cruise, she paid $14,703 for an AbEX tummy tuck and liposuction of her abdomen on the Sono Bello department in Las Vegas.
Eighteen days after her operation, she was “oozing and bleeding” from her surgical wounds, and her son rushed her to a hospital, the place docs recognized “severe sepsis with shock,” based on the grievance. She spent a number of months in hospitals and rehabilitation care, operating up medical payments of greater than $2.6 million, her lawyer acknowledged throughout a deposition.
Lloyd Krieger, a California plastic surgeon who served as a medical skilled for Webb’s authorized group, stated the operations by no means ought to have occurred as a result of she was at “very high risk for multiple procedures given her advanced age and high BMI,” based on the swimsuit.
In a courtroom deposition, Sono Bello surgeon Charles Kim testified that working on Webb earned him “surgical value units” that boosted his pay to about $2,000 for the process.
Sono Bello and Kim denied Webb’s negligence claims and the events settled the case in early 2025 beneath confidential phrases, courtroom information present.
Centeno stated Sono Bello surgeons are paid extra for greater BMI sufferers as a result of they “require additional work and additional complexity in terms of decision-making.” He added that “our high BMI patients routinely undergo our procedures safely with an extremely high patient satisfaction rate.”
Schaeffer stated individuals hoping to reshape their our bodies have to do plenty of analysis earlier than plunging forward with cosmetic surgery. She stated she hoped to eliminate extra pores and skin and fats after dropping 100 kilos.
Instead, she missed seven weeks of labor recovering from her tummy tuck in Jacksonville. “I went into this procedure to try to make myself feel better after losing the weight, and I came out with something even worse,” she stated.
“I trusted. I believed in what they told me, which I think most people do,” Schaeffer stated.
“Not anymore.”
Have you had liposuction, a “Mommy Makeover,” a tummy tuck, a Brazilian butt elevate, or one other sort of beauty surgical procedure? We’d like to listen to about your expertise. Click here to contact our reporting group.
