Concerns About Safety and Advertising in Cosmetic Surgery

The topic of cosmetic surgery, particularly liposuction, continues to raise alarm as cases of severe complications and fatalities emerge from clinics across the United States. This article explores some of the tragic realities faced by individuals and families who sought aesthetic improvements, only to be met with devastating outcomes.

Yves here. I have to admit to being naive. I thought that death by liposuction was limited to clinics in countries like Mexico and Turkiye, or to illegal operators in the U.S., such as those practicing without a medical license. However, the report below reveals multiple cases of deaths and serious complications arising from liposuction at private-equity backed Elite Body Sculpture and other plastic surgery chains within the U.S. Despite these incidents, these facilities continue to use dangerously misleading advertising tactics, often targeting women who constitute the majority of their clientele.

By Fred Schulte. Originally published at KFF Health News

Lenia Watson-Burton, a 37-year-old U.S. Navy administrator, anticipated that cosmetic surgery would effectively eliminate stubborn fat—exactly as the online advertisements claimed.

Tragically, she died three days after undergoing a liposuction-like procedure known as AirSculpt at Elite Body Sculpture’s San Diego location, according to court records.

Surgery chains expanding across multiple states rely heavily on advertising to draw clients—utilizing television, print ads, social media influencers, and even promotional texts. These advertisements typically promise transformational body shaping with minimal pain and swift recovery times.

However, there is no federal mandate requiring these surgical companies to provide evidence supporting the truthfulness and precision of their marketing claims. No agency monitors how often patients affected by these sales pitches suffer complications like infections, nor whether surgical teams effectively follow up on injuries or whether new aesthetic devices are used safely by adequately trained surgeons.

In 2023, Watson-Burton’s family filed a medical malpractice lawsuit against Elite Body Sculpture and plastic surgeon Heidi Regenass, claiming that the surgeon’s use of a thin cannula caused a perforation of Watson-Burton’s bowel, leading to her death.

The lawsuit also accused Elite Body Sculpture of publishing false or misleading advertising on its website, including descriptions of AirSculpt as “gentle on the body” and implying “Our patients take the fewest possible risks and can return to their regular routines within 24-48 hours post-operative.”

Watson-Burton was among three patients who died following liposuction and fat transfer procedures performed by Regenass from October 2022 to February 2023, according to court documents. The families of all three women have filed lawsuits against the surgeon, who has denied any wrongdoing. The Watson-Burton family’s case was settled in 2024, while two other wrongful death cases remain pending, including one from an Ohio woman whose mother relied on claims of safe and quick recovery as advertised on Regenass’ website.

Neither Regenass nor her legal representatives have provided comments despite numerous requests. Emails and calls to Elite Body Sculpture’s Miami headquarters went unanswered.

Authorities at both state and federal levels hold the power to restrict false or misleading medical advertising, yet enforcement is inconsistent, particularly regarding online promotions. As a result, patients must conduct their own research when considering cosmetic surgery marketing pitches.

“While consumers should be able to trust that advertising claims are substantiated by law, it is prudent for them to adopt a critical perspective,” remarked Mary Engle, executive vice president at BBB National Programs.

‘Up a Cup’

Founded by cosmetic surgeon Aaron Rollins, Elite Body Sculpture claims in SEC filings that it provides a “premium patient experience and luxurious, spa-like atmosphere” across its expanding network of centers. The publicly traded company in Miami Beach, supported by private equity investors, markets AirSculpt as “much less invasive” compared to traditional liposuction and promises “faster healing with superior results.” The ads boast that AirSculpt requires no scalpel or stitches and leaves only a small scar, allowing patients to stay awake throughout the procedure and walk out immediately, achieving dramatic results. However, some risks are mentioned.

Rollins, who recently gained media attention for listing his Indian Creek mansion for $200 million, has not responded to repeated inquiries for comment. A representative for Rollins, Robert Peal, acknowledged an email but did not provide any remarks. On November 4th, the company announced that Rollins had resigned as executive chairman of AirSculpt Technologies and from its board of directors.

Many patients choose to have fat removed from their midsection or elsewhere injected into their buttocks, often referred to as a Brazilian butt lift. Others utilize the fat for breast enhancement, branded by the company as “Up a Cup.” Since March 2023, at least seven patients have filed lawsuits claiming that Elite Body Sculpture engaged in misleading advertising or misrepresented the outcomes of procedures, asserting that they experienced more pain or took longer to heal than the marketing suggested; court records indicate. One lawsuit has been dismissed, while the company has refuted the allegations in the others.

In their lawsuit, the Watson-Burton family argued that several of Elite Body Sculpture’s marketing claims regarding AirSculpt were untrue.

For instance, the company’s website claimed that AirSculpt utilizes “automated technology” designed to stop before the cannula penetrates too deeply and could cause serious harm, as per the lawsuit. This safeguard failed to protect Watson-Burton, who paid $12,000 for the procedure in hopes of a quick recovery ahead of a scheduled deployment with the U.S. Navy.

Instead of being gentle, AirSculpt proved “extremely painful, highly invasive, unsafe, and required more than a short 24-hour recovery, resulting in damage to internal organs,” according to the lawsuit.

After the operation, Watson-Burton contacted the San Diego center on October 27, 2022, to report “severe pain” in her upper abdomen, but staff did not take any steps to assess her condition, as claimed in the lawsuit. The following morning, she was rushed to the hospital by ambulance, where emergency surgery confirmed the severity of her injuries, which included three bowel perforations and sepsis.

Watson-Burton died on October 29, 2022. An autopsy report attributed her death to complications from cosmetic surgery, citing septic shock following bowel perforation. Her death certificate listed the cause as “complications of abdominoplasty.”

In court documents, Elite Body Sculpture maintained that Watson-Burton experienced an “uncommon surgical complication.” The company denied any liability and claimed it did not guarantee or claim that injuries to organs could not occur. They also repudiated any misrepresentation in their advertisements.

The legal dispute ultimately did not proceed fully in court. The parties reached a settlement in August 2024, with Elite Body Sculpture agreeing to pay $2 million— the limit of its insurance coverage—to Watson-Burton’s family. Regenass, who did not carry liability insurance, agreed to pay an additional $100,000 as part of the settlement.

Promises Not Fulfilled

Similar to Watson-Burton, Tamala Smith, aged 55 from Toledo, Ohio, was attracted to Regenass for liposuction and a fat transfer due to advertising on social media.

Smith died less than two weeks later, one of two women who succumbed following elective surgeries conducted by Regenass from December 2022 to February 2023, according to court records. Regenass performed operations for both women at Pacific Liposculpture, which operates three surgery centers in Southern California, as detailed in court records.

Both women’s families are suing Regenass, a board-certified plastic surgeon, and the surgery center. In both pending cases in California courts, Regenass and the center have denied the allegations and filed motions to dismiss, denying responsibility for the fatalities.

Smith was a traveling registered nurse working overnight shifts in Los Angeles. She was drawn to Regenass after seeing her Instagram profile, according to a lawsuit filed by Smith’s daughter, Ste’Aira Ballard, who resides in Toledo.

The advertisements positioned Regenass as an “awake liposuction and fat transfer specialist,” while her website assured patients of minimal pain and a return to work within 24-48 hours, as highlighted in the lawsuit.

During Smith’s three-hour operation on February 8, 2023, at Pacific Liposculpture’s Newport Beach office, fat was removed from her abdomen and flanks before being transferred to her buttocks. According to the lawsuit, Smith reached out the office multiple times in the following days to report persistent pain and swelling; staff assured her this was normal, and she never spoke directly to the surgeon.

When Ballard couldn’t contact her mother, she called the hospital, only to discover that Smith hadn’t shown up for her overnight shift for two days. The hospital summoned police for a welfare check at the extended-stay hotel where Smith was living.

Officers found her body surrounded by towels and sheets stained with brown and green fluids, as indicated in the coroner’s report filed with the court. Medical paperwork detailing post-operative instructions from the liposuction clinic covered a countertop in the room. Ballard learned of her mother’s death when a police officer answered Smith’s phone and delivered the heartbreaking news.

“Oh my God, I fell to the floor,” said Ballard in an interview with KFF Health News and NBC News. The shock and grief still weigh heavily on her. “It troubles me that someone who dedicated her life to helping others ended up deceased in a hotel, as if her life didn’t matter,” she expressed.

Ballard believes her mother trusted Regenass based on her online persona. She asserts that her mother, a registered nurse, would not have chosen the surgeon had she known another patient had died after a procedure performed by Regenass at the Pacific Liposculpture San Diego office. Terri Bishop, 55, a truck driving instructor from Temecula, California, also succumbed on December 24, 2022, approximately three weeks after undergoing a similar operation at Pacific Liposculpture, a facility that has a history of regulatory issues.

Pacific Liposculpture has not responded to requests for comments. In their filings, the company denies any involvement in the deaths and seeks to dismiss the cases, claiming Ballard waited too long to bring forth the lawsuit.

Bishop died from “arteriosclerotic cardiovascular disease aggravated by viral pneumonia (Influenza A H1 2009),” according to a Riverside County medical examiner’s description in the court record. The family disputes this finding, alleging Bishop died from blood clots, a recognized surgical complication. A trial is scheduled for June 2026.

In Smith’s case, the Los Angeles County medical examiner concluded she passed away from “renal failure of unknown cause.” The autopsy report stated, “This is a natural death since an injury directly linked to the surgery was not identified.”

Ballard is demanding a deeper investigation to elucidate her mother’s circumstances.

“I don’t think they provided a clear explanation of the risks and potential complications that could arise,” Ballard remarked. “They seem to be making promises they cannot keep.”

Ballard has filed a complaint against Regenass with the California Medical Board, which is currently under investigation, as indicated by documents she shared with KFF Health News and NBC News. She advocates for greater transparency regarding the backgrounds of surgeons offering their services to the public. She also hopes the investigation will yield more information about her mother’s fate.

“I can’t comprehend how she returned to me in a body bag,” she lamented.

‘Buyer Beware’

Concerns about advertising practices in cosmetic surgery are not new.

During a 1989 congressional hearing by a subcommittee of the House Small Business Committee, there were numerous testimonies recounting horror stories from patients who suffered due to surgeons with dubious qualifications. Subcommittee Chairman Ron Wyden (D-Ore.) noted that patients were routinely victimized by deceptive marketing promising a “quick, easy, and painless way to change your life through cosmetic surgery.”

Wyden urged for reform, stating, “Cosmetic surgery consumers essentially navigate on their own. It feels more akin to a used car sales market than a medical practice.” Wyden currently serves as a U.S. Senator representing Oregon.

Decades later, the digital landscape has evolved, introducing an enormous volume of online advertising filled with flashy “before and after” photos, social media posts, and endorsements from influencers designed to attract business for surgical centers. For instance, Elite Body Sculpture reported spending $43.9 million on “selling expenses” in 2024, which equates to $3,130 per “customer acquisition,” according to their SEC filings.

According to Federal Trade Commission guidelines, medical advertising needs to be “truthful, not deceptive, and supported by credible and reliable scientific evidence,” stated Janice Kopec from the agency’s Bureau of Consumer Protection.

Any claims that are “suggested or reasonably implied” must also be accurate; this includes the general impression conveyed by promotional text and visuals, as delineated by the FTC. However, the agency refrained from providing further clarification.

Medical businesses are at liberty to determine what documentation, if any, to provide to the public. Most cosmetic surgery websites offer scant or no substantiation for specific claims—such as recovery times or pain levels—on their platforms.

“No requirement mandates that this substantiation be made available to consumers, either on a website or upon request,” Engle, who is also a former FTC official, expressed in an email.

The law allows for “puffery,” or overly boastful statements that no rational person would take at face value or that cannot be substantiated, like, “You’ve tried the rest, now try the best,” Engle clarified.

Determining the line between acceptable promotional claims and unfounded assertions can be contentious.

Athēnix, a private equity-backed cosmetic surgery chain with several locations, defended its use of terms like “safer” and “better results” in response to a lawsuit filed by Orange County District Attorney Todd Spitzer in August 2022 charging the company with false advertising.

Spitzer contended that Athēnix claimed its “micro-body-contouring” technique was “safer” than conventional liposuction and offered “excellent results with less pain and downtime,” without any supporting evidence, as stated in the lawsuit.

“No studies exist to underpin these claims, and no scientific consensus on these new techniques has been established,” Spitzer argued.

The matter was resolved in July 2023 when Athēnix agreed to a $25,000 settlement without admitting wrongdoing, according to court records. Prior to the settlement, Athēnix maintained that such terminology was subjective and, therefore, not false advertising.

While there are no clear indications that local or state authorities are enhancing scrutiny of cosmetic surgery advertising, federal regulators have communicated their intent to crack down on dubious promotional claims made by pharmaceutical companies.

In a letter to drug manufacturers issued in September, FDA Commissioner Marty Makary stated that “deceptive advertising has regrettably become the norm” on social media and that the agency would no longer tolerate such violations.

‘Bad Advice’

To substantiate medical negligence claims, injured patients must typically demonstrate that their care fell short of what a “reasonably prudent” doctor with similar qualifications would have offered. Surgeons may defend themselves by claiming that complications are inherent in any procedure and that poor outcomes do not imply negligence.

Some lawsuits filed by patients injured from surgery allege that advertising from surgical chains misled them or that their surgeons failed to elucidate potential risks of injuries, known in medical terms as informed consent.

Caitlin Meehan is one such patient. She underwent a $15,000 AirSculpt procedure at Elite Body Sculpture’s clinic near Philadelphia in March 2023, lured by the company’s characterization of it as “Lunch Time Lipo,” as claimed in a lawsuit filed in late August. The complaint asserts that during her consultation, the responsible doctor asserted that no serious, life-threatening, or lasting complications were expected.

However, during her procedure, gases became trapped beneath her skin, causing an extensive condition known as subcutaneous emphysema, the lawsuit indicates. Meehan was shocked to discover her face, neck, and upper body severely swollen, leading to shortness of breath.

A friend who drove her to the appointment requested the staff call for an ambulance, yet the staff deemed it unnecessary, as per the lawsuit. After an hour-long drive home, Meehan experienced a burning sensation in her skin, prompting her to call 911. She spent four days hospitalized and continues to bear scars, according to her legal action. The lawsuit remains open, and the company has yet to respond formally in court.

Scott Hollenbeck, immediate past president of the American Society of Plastic Surgeons, indicated that returning to work a day after liposuction seems unrealistic due to the bruising and swelling that commonly occurs.

“The notion that one could return to work within 24 hours following an effective liposuction procedure is exceptionally poor advice,” Hollenbeck stated.

‘I Felt Horrible’

Advertisements promising minimal discomfort have also faced criticism in patient lawsuits.

Over 20 additional medical malpractice cases examined by KFF Health News reported similar claims of unexpected pain during operations at cosmetic surgery chains utilizing lidocaine for pain management in “awake liposuction.”

One patient suing Elite Body Sculpture in Cook County, Illinois, alleged she “was crying due to [the] intense pain” experienced during her operation in September 2023. She claimed the doctor informed her he couldn’t provide any further local anesthetic and chose to continue the procedure. The defendants have not yet filed a response in court. The facility did not respond to inquiries for comments.

Engle, the former FTC official, mentioned that while claims of discomfort might be somewhat subjective, they nonetheless need to be “truthful and substantiated,” ideally supported by “valid, reliable clinical studies reflecting patients’ experiences.”

NBC News producer Jason Kane contributed to this report.