Skin Pigmentation after Laser Treatment Compensation Claim 게시글 상세보기 - 등록일, 조회수, 첨부파일, 상세내용, 이전글, 다음글 제공
Skin Pigmentation after Laser Treatment Compensation Claim
Date
2024-12-10
Hit
190
A. On April 23, 2020, the Claimant decided to undergo laser peel at the Respondent’s cosmetic clinic (hereafter referred to as “Respondent Clinic”) for blemishes and melasma on the Claimant's face.
B. The Claimant developed skin pigmentation after the laser peel and underwent 20 sessions of toning treatment during the period May 4, 2020 to February 19, 2021, but no improvement was observed. The Claimant visited another dermatologist, and the Claimant was told that the Claimant needs long-term therapy for hyperpigmentation and hypopigmentation.
C. The Claimant submitted the following estimate of medical expenses that the Claimant will pay, issued by another dermatologist on September 3, 2021:o Diagnosis: Post-inflammatory hyperpigmentation (PIH) o Hyperpigmentation and hypopigmentation observed on both cheeks of the patient. Determined as mottled hypo- and hyperpigmentation, a typical side effect of laser toning treatment. Two regimens are prescribed: (a) laser toning + PICO laser toning + Genesis + Ionzyme every two weeks; and (b) PICO laser MLA Fraxel every four weeks. o Currently undergoing low-level laser toning + Genesis for hyperpigmentation; periodic medical skincare to repair the epidermal basement membrane; and low-level PICO laser MLA Fraxel at 4-week intervals for hypopigmentation. Requires at least one year of treatment.o It will cost KRW 7,950,000 in all: KRW 4,950,000 for 30 sessions of Regimen (a); and KRW 3,000,000 for 15 sessions of Regimen (b). o Note: The Claimant visits the dermatologist every other week since the Claimant's residence is quite far from the clinic. Expected to take about a year; however, Regimen (a) may be needed longer depending on the progress.
D. In this case, the Claimant spent KRW 605,000 at the Respondent's Clinic during the period May 4, 2020 to November 5, 2020, KRW 570,000 during the period March 15, 2021 to June 1, 2021, and KRW 2,500,000 on June 15, 2021 at another dermatologist as medical expenses for checkup (out-of-pocket).
A. Claimant’s AllegationThe Claimant asserts that the procedure on the first day was extremely painful, and that the wound turned brown as scab began to fall off, indicating that the Respondent’s overtreatment without careful determination caused excessive irritation and hyperpigmentation.According to the Claimant's allegation, the subsequent laser treatment was performed on the wound, but the pigmented area widened and white spots appeared. The Respondent should have referred the Claimant to an upper-level hospital when the Claimant's symptoms were not resolved, but continuous intervention worsened the Claimant's condition and prevented the Claimant from seeking appropriate medical attention, resulting in the Claimant requiring long-term care. The Claimant demands payment of KRW 25,000,000 for damage.
B. Respondent’s AllegationThe Respondent alleges that the Claimant showed improvement in the regions 3？4 weeks after the procedure but developed PIH after one month, which was unavoidable due to the Claimant’s negligence and congenital skin characteristics. The post-procedure precautions were explained to the Claimant at least three times: by the director before the procedure, by a nurse after the procedure, and by a staff member when the Claimant went home.According to the Claimant's assertion, lighter color in the areas of age spots and skin discoloration of the cheeks on both sides seem to be a temporary worsening of pigmentation and melasma. Such reactions are relatively common to melasma treatments, occurring in about 5.6% of patients, and are usually resolved within 1？2 years.
A. Here are our expert’s views on the dispute in this case.o The Claimant’s pre-procedure skin condition and adequacy of the Respondent’s regimen- Based on the photos submitted, the Claimant had melasma and age spots all over the face, which can be improved by laser toning and laser peel.o Physician’s duty to warn patients before the procedure- The doctor should inform patients that laser toning may typically involve temporary erythema and pigmentation that may occur afterward, and melasma, if applicable, will require ongoing care.o The Claimant’s condition and cause based on the image taken after the 20th session of toning on February 19, 2021- Pigmentation and hypopigmentation due to laser treatment are observed in the given photos, which may have been caused by aggressive skin resurfacing, i.e., if the energy level is too high. For laser resurfacing, one can reduce the likelihood of pigmentation and hypopigmentation with lower energy radiation over multiple sessions rather than a single intense exposure.o Adequacy of intervention chosen by another dermatologist- The dermatologist was supposed to observe laser-induced hyperpigmentation and hypopigmentation when the Claimant visited the clinic; thus, their treatment decision is believed to have been appropriate.o Adequacy of medical expenses estimate by another dermatologistAlthough it is convincing that the Claimant's condition was better than when the Claimant first visited the clinic, hyperpigmentation and hypopigmentation remained at the time of making the medical opinion; thus the opinion is appropriate.o Conclusion- Laser-induced pigmentation may gradually improve over time and resolution can be accelerated with proper laser treatment.
B. Whether the Respondent is Liable1) Respondent’s Liabilitya) Medical NegligenceThe Respondent alleges that the Claimant received appropriate care in line with the high standards expected of the procedure provided by the Respondent, and that the Respondent gave proper post-procedure instructions to the Claimant. However, the Respondent's argument is unacceptable and unpersuasive in light of the following facts evident from our fact-finding and expert opinion:(A) The Claimant had melasma and age spots all over the face prior to the procedure, so the regimen chosen by the Respondent, including laser peel and toning, was suitable for the Claimant's condition. However, the Claimant showed symptoms in the image taken after the 20th session of laser toning on February 19, 2021, which may be caused by aggressive resurfacing with too-high energy level.(B) The Claimant was diagnosed with hypopigmentation by another dermatologist. Hypopigmentation is caused by the destruction of melanocytes; skin rejuvenation includes laser irradiation on melasma and age spots with a certain intensity, but in this case, the Claimant’s hypopigmentation is believed to have occurred due to too-high energy laser. Skin discoloration was observed in the vicinity of the procedure sites and causal relationship is accepted. Furthermore, the dermatologist determined that the Claimant's condition is post-inflammatory hyperpigmentation (PIH).Therefore, the Respondent’s negligence resulted in the Claimant’s PIH, so the Respondent has liability for damage arising therefrom.b) Breach of Duty to Inform PatientsCosmetic surgery is done to achieve personal aesthetic satisfaction in appearance so it lacks the urgency or necessity of other medical procedures intended to treat diseases. A physician should listen carefully to the dissatisfaction of a patient with his/her appearance and specific outcomes that he/she wants and, based on the physician's expertise, choose rigorously and recommend intervention that will provide the outcomes. The physician is obligated to give a detailed explanation to the patient in such a way that the patient can fully understand the necessity, difficulty, method, extent to which the patient’s appearance will be affected, and possible risks and potential side effects with reference to the patient’s gender, age, and physical features, so that the patient can make an informed decision (see the court decision of the Supreme Court, e.g., Decision No. 93다52402, dated February 10, 1995).In light of the jurisprudence above, the procedures may have side effects such as erythema, hyperpigmentation, and PIH, and they may not be as effective as the Claimant expected. The Respondent should have explained in detail to the Claimant before the procedures, so that the Claimant could give informed consent based on a full understanding of the benefits and risks. However, the details of the explanation were not verified from the medical records filed with the Commission. The evidence is insufficient to support the Respondent’s allegation that the Respondent's duty to inform was adequately exercised. The Claimant’s right to choice is believed to have been violated during the treatment. Therefore, the Respondent is liable for damage arising from a breach of duty to warn patients.2) Limitation of LiabilityOn the other hand, the Respondent chose the regimen suitable for the Claimant; laser-induced hyperpigmentation will be gradually resolved over time, and the Claimant received the treatment at no additional charge beyond the contracted number of sessions. It is reasonable to limit the amount of damages to 40% of the total medical expenses for another dermatologist, excluding the treatment cost at the Respondent Clinic. The specific breakdown of damages is as follows:a) Property Damage(1) Medical Expenses Paid(A) KRW 570,000 at another dermatologist’s clinic (B) KRW 2,500,000 at another dermatologist’s clinic (C) KRW 3,070,000 in total (2) Medical Expenses to be Paid: KRW 7,950,000 o KRW 4,950,000 for 30 sessions of Regimen (a)o KRW 3,000,000 for 15 sessions of Regimen (b) (3) KRW 4,408,000 in all (=(3,070,000+7,950,000) x 40%)b) CompensationConsidering the Claimant’s age, the progress of this case and its outcome, the Claimant’s current condition, the Respondent’s breach, and the Claimant’s emotional distress, the amount of damages shall be KRW 2,000,000.
1. The Claimant shall be awarded KRW 6,408,000 by August 23, 2022.
2. Any overdue amount shall be paid with delay penalties amounting to 5% p.a. for each day within the period from August 24, 2022 until paid.
3. Subject to the Respondent’s performance, the Claimant agrees not to file any lawsuits―civil or criminal―against the Respondent and medical staff working at the Respondent Clinic in connection with this dispute.
