A couple of days after a harrowing beauty surgical procedure process, Erin Schaeffer mentioned, she awakened with fluid leaking from an open wound in her abdomen.
Schaeffer went on to spend every week in a Florida hospital battling a extreme an infection after a kind of tummy tuck and liposuction on the Jacksonville department of Sono Bello, a nationwide beauty surgical procedure chain.
Greater than a 12 months later, scars stay on her decrease physique — and in a lawsuit she is accusing Sono Bello of utilizing an inadequately educated obstetrician-gynecologist to take away her extra pores and skin and fats, a process she says precipitated excruciating ache.
“I literally felt like I was skinned alive,” mentioned 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 docket. The go well with 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 court docket submitting. And in an interview with KFF Well being Information and NBC Information, Robert Centeno, Sono Bello’s medical director for the East area, mentioned its surgeons endure “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 elimination to liposuction, topped $22 billion in 2024.
The chains promote an array of body-reshaping operations, comparable to “Mommy Makeovers” and liposuction, concentrating on prospects keen 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 firms specializing in credit score for elective medical procedures. Sono Bello boasts it’s “America’s top cosmetic surgery specialist.”
However a joint investigation by KFF Well being Information and NBC Information 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 circumstances 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, court docket data present. Sono Bello and the opposite firms have denied the allegations in court docket.
“These people promise to turn you into the fairest person in the land, and the risks aren’t often worth the reality,” mentioned Sean Domnick, a Florida legal professional who heads the American Affiliation for Justice, a trial attorneys’ group.
Sono Bello’s Centeno disagrees. He mentioned the corporate’s mission is to “help each and every one of our patients live their best lives now.” Sono Bello provides “life-changing transformations” that improve an individual’s “appearance as well as their quality of life,” mentioned Centeno, a surgeon himself on the firm’s Troy, Michigan, workplace.
The docs who carry out such surgical procedures, court docket data present, are generally paid extra for taking over sufferers with a excessive physique mass, as weight problems raises the danger of devastating problems.
And because the chains develop, there’s little regulatory oversight. Whereas 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 happy 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 workers gave her Xanax, a tranquilizer, and the painkiller oxycodone in tablet kind, in keeping with medical data Sono Bello turned over to Schaeffer’s legal professional. Through the process, she obtained an infusion of lidocaine to numb the realm however remained awake. Sono Bello says the native anesthesia is safer and promotes quicker therapeutic with “minimal discomfort,” so sufferers might return to work or different regular actions inside every week.
That didn’t occur for Schaeffer, who mentioned she felt a lot ache throughout the operation that she started to cry and “begged” the physician to cease close to the top.
“I said, ‘I don’t care what I look like,’” she mentioned 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 mentioned. Sono Bello medical workers instructed her that was regular and that she was nice, she mentioned. Two days later, nonetheless, blood and fluid spilled out of her abdomen when she bought up.
On one go to to the workplace, Herrera instructed her she required surgical procedure at a hospital to deal with her wounds. However, Schaeffer recounted, Herrera mentioned he couldn’t prepare that as a result of he was an obstetrician, not a plastic surgeon, and didn’t have hospital privileges domestically. Herrera has hospital privileges within the Orlando space, about 140 miles southwest of Jacksonville.
“I was just in utter shock,” Schaeffer mentioned.
Sono Bello spokesperson Mark Firmani mentioned the corporate doesn’t require its docs to have native hospital privileges, although many do have them.
Centeno mentioned Schaeffer’s painful expertise will not be frequent.
“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 mentioned. Sufferers of Sono Bello and another clinics even have complained to the Higher Business Bureau of unexpectedly painful procedures.
Centeno mentioned that Herrera nonetheless works for the corporate, however the physician’s title doesn’t seem on the corporate’s Jacksonville web site. Herrera runs an OB-GYN and aesthetics apply, which incorporates skincare therapies, in Winter Backyard, 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 displays “exceptional technical skills, productivity, and off-the-charts brand loyalty.”
Herrera accomplished a Sono Bello fellowship program that teaches a “suite of aesthetic procedures” in a six- to eight-week course below the path of an organization surgeon. The corporate says the fellowship provides “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 put up on a Sono Bello web site, Herrera mentioned 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. Firm spokesperson Firmani mentioned Herrera continues to be a member of the Sono Bello crew.
Many established plastic surgeons who spoke with KFF Well being Information and NBC Information 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 more cash to spend drawing in sufferers and “the ability to operate and provide quality patient care is now less important,” mentioned Mark Domanski, a plastic surgeon in Northern Virginia.
Physician Entrepreneurs
Shaped in 2008 by entrepreneurial doctor Tom Garrison, Sono Bello now runs greater than 100 facilities nationwide. Non-public fairness traders have pumped $816 million into the corporate, most of it since 2023, in keeping with PitchBook, which tracks the trade. Sono Bello advertises extensively on tv and on-line, geared toward what one main investor termed the “everyday woman and man.” It has marketed having “150+ board-certified surgeons who have performed over 300,000 laser lipo & body contouring procedures.”
Sono Bello limits its choices to companies comparable 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.
Whereas Sono Bello boasts that the overwhelming majority of its sufferers are happy, court docket data 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 circumstances, together with 4 fits involving affected person deaths, since April 2013, court docket data present. Sono Bello has settled three of 4 wrongful dying circumstances filed since Might 2018, whereas one is pending, court docket data present.
Schaeffer’s go well with in Jacksonville is amongst not less than 19 filed for the reason that begin of March 2023. Many are pending within the courts, and the corporate has denied the allegations.
Different physicians who’ve prolonged their manufacturers to a number of cities and relied closely on social media and splashy web sites to usher in 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 web site says. Alvarez is a board-certified plastic surgeon.
Sufferers filed not less than 30 medical negligence circumstances in opposition to Mia Aesthetics and its associates from November 2020 by means of March of this 12 months, court docket data present. A dozen fits goal its Miami surgical procedure middle. The corporate has sought, and infrequently gained, dismissal of malpractice fits as a result of sufferers signed contracts agreeing to arbitration of any disputes, court docket dockets present. Alvarez didn’t reply to requests for remark.
Owned by New York doctor Sergey Voskin since 2016, Objectives Aesthetics and Plastic Surgical procedure has branched out from a small beauty surgical procedure workplace within the Brooklyn borough of New York Metropolis to a community of a dozen surgical procedure facilities it manages in eight states.
Objectives clinics and affiliated surgeons have been named as defendants in not less than 40 malpractice fits filed from October 2018 by means of March, court docket data present. The Atlanta department accounted for greater than 20 such circumstances in Georgia courts from September 2022 by means of June 2024. Most are pending. Objectives defended two lawsuits introduced by the households of New York sufferers who died shortly after having liposuction procedures, court docket data present. Objectives denied the allegations and gained dismissal of some circumstances by invoking arbitration agreements, in keeping with court docket dockets. The corporate says these agreements are generally used all through the medical trade.
Voskin declined to be interviewed. In an announcement, Objectives lawyer Joshua Lurie mentioned 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 mentioned 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 Ensures
Malpractice fits by themselves are usually not proof of wrongdoing. No one tracks the end result of those lawsuits, which frequently are settled below 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 end result doesn’t imply the physician was negligent. To show negligence, injured sufferers typically should present their care fell under what a fairly prudent physician with related coaching would have accomplished.
That may be a problem. Sometimes, 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.
Earlier than their procedures, sufferers should signal consent types acknowledging that their expectations should be “realistic” and that problems or dissatisfaction with the end result doesn’t essentially imply the surgeon botched the job. The American Society of Plastic Surgeons investigates ethics complaints in opposition to its members, however not allegations of competence or malpractice.
Some pre-surgery contracts enable for low-cost “revisions” for disgruntled sufferers. Sono Bello has supplied 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.”
Different contracts comprise disclaimers, comparable to reminding sufferers that dramatic “before and after” pictures extensively proven in on-line ads and different solicitations might not replicate typical outcomes.
I don’t care what I seem like. I can’t deal with the ache.
Erin Schaeffer
Demonstrating the affect of social media in driving gross sales, Objectives 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” comply with pay damages of $10,000 for every violation.
In a civil investigation of Objectives’ advertising and marketing ways, Georgia Legal professional Normal Chris Carr alleged that coverage, and others, violated state client safety legal guidelines. In September 2022, Objectives agreed to cease utilizing the non-disparagement clause and to pay the state $119,480 to settle the matter, with out admitting any wrongdoing.
Each Objectives and Mia Aesthetics have clauses of their service contracts that require arbitration of any disputes in lieu of court docket motion, a course of many client advocates consider favors the trade. These agreements have gotten extra frequent 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 useless in her condo a day after liposuction at a Objectives workplace in New York Metropolis in March 2021. She died from a pulmonary thromboembolism, a blood clot in her lung, as a complication of beauty surgical procedure, in keeping with an post-mortem report.
Her household sued the corporate alleging negligence. However, in June 2024, a decide dominated that Mendez had signed a kind requiring the case to be heard in arbitration and the lawsuit was dismissed.
Legal professional Gary Zucker, who represents the household, is interesting. “It’s been a one-two punch for the family,” Zucker mentioned.
Objectives legal professional Lurie known 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 mentioned sufferers can decide out of the arbitration settlement, which “has happened multiple times.”
‘A Hard Sell’
When Erin Schaeffer first visited Sono Bello, a gross sales agent instructed her she was a “perfect candidate” for a tummy tuck process, she mentioned in an interview with KFF Well being Information and NBC Information.
Although she wished to consider it and speak it over together with her household, she mentioned, the salesperson persuaded her to go forward. As a result of 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 means of outdoors firms to repay a lot of the $19,838 invoice over a five-year interval, in keeping with her medical data. She mentioned she’s now paying $420 a month.
“I definitely felt like it was a hard sell,” Schaeffer mentioned. “She didn’t want me to leave out of there without putting money down on it.”
Schaeffer mentioned she didn’t meet the physician till a few week earlier than the process, and solely briefly. Some sufferers suing different firms have argued in court docket 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, mentioned sufferers want time with their physician to completely perceive the professionals and cons of surgical procedure and shouldn’t be pressured into fast choices.
“It is not possible to do that when you see the doctor an hour before surgery for the first time,” he mentioned. “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 mentioned.
Good Candidates
Many plastic surgeons discourage individuals with weight problems from present process liposuction and different beauty procedures due to an elevated threat of infections and different critical medical problems. Candidates are thought of overweight at a physique mass index of 30 or above. Sono Bello sufferers have a median BMI of 31, in keeping with Centeno. On the time of her surgical procedure, Schaeffer had a BMI of 36.
However there’s no consensus over who must be turned away due to their measurement — and insurance policies differ.
Sono Bello says its AbEX tummy tuck will be accomplished safely with a physique mass index as excessive as 42, properly past the physique mass limits for a conventional abdominoplasty accomplished utilizing normal anesthesia. The AbEX removes unfastened and sagging pores and skin across the abdomen “to achieve a more toned and sculpted look,” in keeping with the corporate.
Centeno mentioned that top BMI “does confer additional risk, which can be managed.” However he mentioned 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.”
But excessive BMI sufferers have alleged they suffered devastating problems, in keeping with KFF Well being Information’ evaluate of the court docket circumstances filed in opposition to Sono Bello and different firms.
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, in keeping with court docket filings. Throughout an workplace go to eight days later, she complained of swelling and ache in her stomach, however a nurse “dismissed her complaints,” in keeping with the go well with. 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 hooked up a photograph of her wound which, the go well with alleges, ought to have alerted the workers that it wanted “immediate evaluation by a qualified medical professional.”
On Nov. 5, she awakened “feeling extremely hot,” and “nearly fainted,” in keeping with her criticism. Her husband drove her to an pressing care middle, which identified her with sepsis and rushed her to a hospital by ambulance.
When she awoke the subsequent morning, her bedsheets have been soaked with physique fluid. As she stood up, “fluid began to pour out of her stomach and hit the floor,” in keeping with the criticism. She spent six days within the hospital.
Edwards alleges in her lawsuit that Sono Bello’s medical workers 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, in keeping with court docket paperwork. “I am very upset.”
In a single 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 court docket submitting, the corporate famous that infections are a threat of surgical procedure, and that Edwards had signed a consent kind 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 below confidential phrases.
Worth Models
Whereas sufferers with excessive BMI are riskier, additionally they are extra profitable for Sono Bello surgeons, court docket data present.
The corporate pays its surgeons for procedures primarily based 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 lady. 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 identified “severe sepsis with shock,” in keeping with the criticism. 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 knowledgeable for Webb’s authorized crew, mentioned 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,” in keeping with the go well with.
In a court docket 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 below confidential phrases, court docket data present.
Centeno mentioned Sono Bello surgeons are paid extra for larger 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 mentioned individuals hoping to reshape their our bodies must do plenty of analysis earlier than plunging forward with cosmetic surgery. She mentioned she hoped to do away with extra pores and skin and fats after dropping 100 kilos.
As a substitute, 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 mentioned.
“I trusted. I believed in what they told me, which I think most people do,” Schaeffer mentioned.
“Not anymore.”
Have you ever had liposuction, a “Mommy Makeover,” a tummy tuck, a Brazilian butt raise, or one other sort of beauty surgical procedure? We’d like to listen to about your expertise. Click on right here to contact our reporting crew.
