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 every 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.
Greater than a yr 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 actually felt like I used to be 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 Courtroom. The swimsuit accuses Herrera, a board-certified OB-GYN, of “performing procedures that he was not educated or certified to carry out.”
Sono Bello and Herrera denied the allegations in a joint courtroom submitting. And in an interview with KFF Well being Information and NBC Information, Robert Centeno, Sono Bello’s medical director for the East area, stated its surgeons endure “very rigorous coaching.”
Backed by private-equity financing, Sono Bello is the most important 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, similar to “Mommy Makeovers” and liposuction, focusing on prospects prepared to pay as much as $20,000 out-of-pocket for a brand new determine, typically 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 high beauty surgical procedure 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 loss of life 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 issues, and of high-pressure gross sales techniques that minimized security dangers, courtroom data present. Sono Bello and the opposite corporations have denied the allegations in courtroom.
“These folks promise to show you into the fairest individual within the land, and the dangers aren’t typically definitely worth the actuality,” stated Sean Domnick, a Florida legal professional who heads the American Affiliation for Justice, a trial attorneys’ group.
Sono Bello’s Centeno disagrees. He stated the corporate’s mission is to “assist each one in every of our sufferers stay their finest lives now.” Sono Bello presents “life-changing transformations” that improve an individual’s “look in addition to their high quality of life,” stated Centeno, a surgeon himself on the firm’s Troy, Michigan, workplace.
The docs who carry out such surgical procedures, courtroom data present, are generally paid extra for taking up sufferers with a excessive physique mass, as weight problems raises the chance of devastating complications.
And because the chains develop, there’s little regulatory oversight. Whereas the FDA maintains a database of complaints about medication or medical units, 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 employees gave her Xanax, a tranquilizer, and the painkiller oxycodone in capsule type, in line with medical data Sono Bello turned over to Schaeffer’s legal professional. Through the process, she obtained an infusion of lidocaine to numb the world however remained awake. Sono Bello says the native anesthesia is safer and promotes quicker therapeutic with “minimal discomfort,” so sufferers could return to work or different regular actions inside every 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 stated, ‘I don’t care what I seem like,’” she stated in an interview. “‘I can’t deal with the ache.’”
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 wonderful, she stated. Two days later, nonetheless, blood and fluid spilled out of her abdomen when she acquired up.
On one go to to the workplace, Herrera advised her she required surgical procedure at a hospital to deal with her wounds. However, Schaeffer recounted, Herrera stated he couldn’t prepare 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 used to be simply 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 truth is that over 90% of our sufferers who’ve our procedures accomplished are extraordinarily snug through the process and so they do fairly effectively,” he stated. Sufferers 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 follow, which incorporates skincare remedies, 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 received Sono Bello’s annual “New Talent Award,” given to an organization physician who displays “distinctive technical expertise, productiveness, and off-the-charts model loyalty.”
Herrera completed a Sono Bello fellowship program that teaches a “suite of aesthetic procedures” in a six- to eight-week course underneath the route of an organization surgeon. The corporate says the fellowship presents “patient-focused coaching in awake whole physique contouring and pores and skin excision procedures.” Sono Bello permits physicians who’ve accomplished formal residencies in additional than half a dozen sorts 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 talented surgeon for over 13 years with intensive expertise in different areas however restricted data on physique sculpting.” Herrera didn’t reply to calls and emails requesting remark and directed Sono Bello to reply on his behalf. Firm spokesperson Firmani stated Herrera continues to be a member of the Sono Bello group.
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 issues that come up.
Medical practices owned by personal fairness or funding corporations have extra money to spend drawing in sufferers and “the flexibility to function and supply high quality affected person care is now much less vital,” stated 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. Personal fairness traders have pumped $816 million into the corporate, most of it since 2023, according to PitchBook, which tracks the business. Sono Bello advertises broadly on tv and on-line, geared toward what one main investor termed the “everyday woman and man.” It has advertised having “150+ board-certified surgeons who’ve carried out over 300,000 laser lipo & physique contouring procedures.”
Sono Bello limits its choices to providers similar 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, courtroom 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, courtroom data present. Sono Bello has settled three of 4 wrongful loss of life circumstances filed since Could 2018, whereas one is pending, courtroom data present.
Schaeffer’s swimsuit in Jacksonville is amongst at the least 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 supplies “the very best high quality cosmetic surgery at reasonably priced costs proving that being stunning and saving cash are two realities that may exist concurrently,” its website says. Alvarez is a board-certified plastic surgeon.
Sufferers filed at the least 30 medical negligence circumstances in opposition to Mia Aesthetics and its associates from November 2020 by way of March of this yr, courtroom data present. A dozen fits goal its Miami surgical procedure heart. The corporate has sought, and infrequently received, 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, Targets 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 network of a dozen surgery centers it manages in eight states.
Targets clinics and affiliated surgeons have been named as defendants in at the least 40 malpractice fits filed from October 2018 by way of March, courtroom data present. The Atlanta department accounted for greater than 20 such circumstances in Georgia courts from September 2022 by way of June 2024. Most are pending. Targets defended two lawsuits introduced by the households of New York sufferers who died shortly after having liposuction procedures, courtroom data present. Targets denied the allegations and received dismissal of some circumstances by invoking arbitration agreements, in line with courtroom dockets. The corporate says these agreements are generally used all through the medical business.
Voskin declined to be interviewed. In a press release, Targets lawyer Joshua Lurie stated the medical workplaces it manages have carried out greater than 10,000 procedures and have “one in every of, if not the very best monitor data of security amongst related sorts of medical practices.”
Lurie stated the “overwhelming majority” of malpractice claims are “meritless.” These “dangerous religion filings create an implication of danger when none exist and when, once more, there’s a very negligible detrimental final result from surgical procedure in comparison with the entire procedures carried out,” he wrote.
No Ensures
Malpractice fits by themselves usually are not proof of wrongdoing. No one tracks the end result of those lawsuits, which regularly are settled underneath confidential phrases that preserve key particulars out of public view and prohibit sufferers from discussing their experiences. Surgeons typically argue that issues are a danger of surgical procedure and {that a} poor final result 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 performed.
That may be a problem. Usually, the surgical procedure chains struggle again by arguing that issues are a danger of any surgical process and that they by no means assure outcomes.
Earlier than their procedures, sufferers should signal consent kinds acknowledging that their expectations should be “reasonable” and that issues or dissatisfaction with the consequence 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 dedication,” which states: “In case your surgeon’s analysis determines your outcomes to be poor, we’ll contact up the world for free of charge to you.”
Different contracts comprise disclaimers, similar to reminding sufferers that dramatic “earlier than and after” pictures broadly proven in on-line ads and different solicitations could not mirror 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, Targets 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 “a possibility to treatment any alleged points” conform to pay damages of $10,000 for each violation.
In a civil investigation of Targets’ advertising and marketing techniques, Georgia Legal professional Common Chris Carr alleged that coverage, and others, violated state client safety legal guidelines. In September 2022, Targets 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 Targets and Mia Aesthetics have clauses of their service contracts that require arbitration of any disputes in lieu of courtroom motion, a course of many client advocates consider favors the business. 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 loss of life case filed by the household of Angela Mendez, 57, who was discovered useless in her condo a day after liposuction at a Targets 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 line with an post-mortem report.
Her household sued the corporate alleging negligence. However, in June 2024, a choose dominated that Mendez had signed a type 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 household,” Zucker stated.
Targets legal professional Lurie referred to as arbitration “a standard follow all through the business and plenty of industries” that’s “meant to hurry the method to return to resolutions in a extra expedited style.” In a 2023 deposition, Lurie stated sufferers can decide out of the arbitration settlement, which “has occurred a number of instances.”
‘A Arduous Promote’
When Erin Schaeffer first visited Sono Bello, a gross sales agent advised her she was a “excellent candidate” for a tummy tuck process, she stated in an interview with KFF Well being Information and NBC Information.
Although she wished to consider it and speak it over along with her household, she stated, 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 fee and signed up for a credit score plan by way of exterior corporations to repay many of the $19,838 invoice over a five-year interval, in line with her medical data. She stated she’s now paying $420 a month.
“I positively felt prefer it was a tough promote,” Schaeffer stated. “She didn’t need me to depart out of there with out placing cash down on it.”
Schaeffer stated she didn’t meet the physician till a few 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 follow that pulls sharp criticism from extra conventional surgeons.
Scott Hollenbeck, president of the American Society of Plastic Surgeons, stated sufferers want time with their physician to completely perceive the professionals and cons of surgical procedure and shouldn’t be pressured into fast selections.
“It’s not attainable to try this once you see the physician an hour earlier than surgical procedure for the primary time,” he stated. “It is best to have time to course of what they advised you, give it some thought, and decide.”
“That’s finest performed with a surgeon, not a marketer,” Hollenbeck stated.
Good Candidates
Many plastic surgeons discourage folks with weight problems from present process liposuction and different beauty procedures due to an elevated risk of infections and different critical medical issues. Candidates are thought of overweight at a body mass index of 30 or above. Sono Bello sufferers have a median BMI of 31, in line with Centeno. On the time of her surgical procedure, Schaeffer had a BMI of 36.
However there’s no consensus over who needs to be turned away due to their dimension — and insurance policies differ.
Sono Bello says its AbEX tummy tuck could be performed safely with a physique mass index as excessive as 42, effectively past the physique mass limits for a traditional abdominoplasty performed utilizing common anesthesia. The AbEX removes free and sagging pores and skin across the abdomen “to realize a extra toned and sculpted look,” in line with the corporate.
Centeno stated that prime BMI “does confer further danger, which could be managed.” However he stated it might be “discriminatory, unethical, and inappropriate for Sono Bello or every other medical follow to disclaim care to a affected person based mostly solely on their BMI.”
But excessive BMI sufferers have alleged they suffered devastating issues, in line with KFF Well being Information’ overview of the courtroom circumstances filed in opposition to 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, in line with courtroom 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 line with 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 “instant analysis by a professional medical skilled.”
On Nov. 5, she awoke “feeling extraordinarily sizzling,” and “practically fainted,” in line with her criticism. Her husband drove her to an pressing care heart, which identified 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 started to pour out of her abdomen and hit the ground,” in line with the criticism. 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 bother.
“I’ve sepsis and will have died,” she texted to Sono Bello’s workplace line, in line with courtroom paperwork. “I’m very upset.”
In a single textual content that was included in her lawsuit, she wrote: “So I’d respect some kind of empathy from you!! For those who solely knew what I’ve been by way of and also you went by way of this I’m positive you wouldn’t be giving me this snotty angle.”
Sono Bello denies any negligence. In a courtroom submitting, the corporate famous that infections are a danger of surgical procedure, and that Edwards had signed a consent type that acknowledged partially: “The follow of drugs and surgical procedure shouldn’t be a precise science and outcomes usually are not assured.” Sono Bello filed a movement for abstract judgment that argued her care was not negligent and “not a considerable issue” in inflicting her alleged accidents. The case was settled earlier this month underneath confidential phrases.
Worth Models
Whereas sufferers with excessive BMI are riskier, in addition they are extra profitable for Sono Bello surgeons, courtroom data present.
The corporate pays its surgeons for procedures based mostly partially on the affected person’s BMI, utilizing a method it calls a “surgical worth 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 identified “extreme sepsis with shock,” in line 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 professional for Webb’s authorized group, stated the operations by no means ought to have occurred as a result of she was at “very excessive danger for a number of procedures given her superior age and excessive BMI,” in line with the swimsuit.
In a courtroom deposition, Sono Bello surgeon Charles Kim testified that working on Webb earned him “surgical worth items” 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 underneath confidential phrases, courtroom data present.
Centeno stated Sono Bello surgeons are paid extra for greater BMI sufferers as a result of they “require further work and extra complexity by way of decision-making.” He added that “our excessive BMI sufferers routinely endure our procedures safely with an especially excessive affected person satisfaction price.”
Schaeffer stated folks hoping to reshape their our bodies have to do a number 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.
As a substitute, she missed seven weeks of labor recovering from her tummy tuck in Jacksonville. “I went into this process to attempt to make myself really feel higher after shedding the burden, and I got here out with one thing even worse,” she stated.
“I trusted. I believed in what they advised me, which I feel most individuals do,” Schaeffer stated.
“Not anymore.”
Have you ever had liposuction, a “Mommy Makeover,” a tummy tuck, a Brazilian butt raise, or one other kind of beauty surgical procedure? We’d like to listen to about your expertise. Click here to contact our reporting group.