Cosmetic surgery investigation prompts push for tighter safety standards

An investigation into cosmetic surgery chains by KFF Health News and NBC News has prompted consumer warnings from industry groups representing plastic surgeons and a call for more transparency regarding doctor disciplinary actions in California.

The American Society of Plastic Surgeons, which represents 12,000 doctors, now warns patients to “do their homework” before undergoing liposuction, a Brazilian butt lift, a “mommy makeover” or other cosmetic procedures.

“Plastic surgery is real surgery with real risks, and the risk of complications is never zero,” said Scott Hollenbeck, immediate past president of the Plastic Surgeons Group.

And in an exclusive interview, California Medical Licensing Board member TJ Watkins called for greater transparency in the secretive doctor discipline process, saying the board should alert the public about doctors under investigation for alleged misconduct.

Hollenbeck and Watkins were reacting to the media series, which examined allegations of disfiguring injuries and even deaths linked to cosmetic surgeries.

A story revealed that three patients of California plastic surgeon Heidi Regenass died within months after liposuction and fat transfer surgeries, according to medical malpractice lawsuits filed in California courts.

A complaint filed with the medical board by a patient’s daughter has triggered an internal review of the surgeon by the board, but the public will not hear anything until the investigation is complete, which could take years.

“If you really protected patients, there would be a notice now that this doctor is under investigation,” said Watkins, one of seven non-doctors appointed to the California Medical Board to represent consumers.

Regenass, a board-certified plastic surgeon, did not respond to numerous requests for comment on the patient deaths. In response to medical malpractice lawsuits filed by the families of the three women, she denied any negligence or that her actions caused any deaths. One case was settled in 2024, while the other two are pending in California courts.

On February 9, the Medical Board of California filed an administrative complaint against Regenass, unrelated to the three patient deaths. The complaint accuses Regenass of “repeated negligent acts” in the care of a 49-year-old woman who had post-surgical problems after liposuction of the abdomen and arms and fat transfer to her buttocks in July 2022. The commission alleged that the surgeon “failed to document an appropriate physical examination before the operation” and did not keep “adequate and accurate records” of the care provided to the woman after that she was injured. The commission requested an administrative hearing on the charges, but no date has been set.

Attorneys for Regenass did not respond to a request for comment on the new complaint.

Some patient lawsuits have accused cosmetic surgery companies of hiring doctors who lacked adequate training or had difficult pasts, and of using high-pressure sales tactics and deceptive advertising pitches that downplay safety risks, according to federal and state court records. The companies dispute these allegations and have obtained the dismissal of some lawsuits. Other cases have been settled on confidential terms, although a Georgia judge late last year awarded $52 million to the family of a woman who died after liposuction and a Brazilian butt lift.

Christopher Nuland, an attorney and lobbyist for the Florida Society of Plastic Surgeons, said the investigation “underscores the need for vigilance on the part of all parties.”

“There is an opportunity for better legislation, such as regulating post-surgical recovery centers and better enforcement of existing laws,” he said in an email. “But patients should actively participate by ensuring that they are seeing a board-certified plastic surgeon at an accredited facility and that neither has a history of poor outcomes.”

Nuland said his group supports a bill pending in the Florida Legislature that would require licensing and set quality standards for convalescent homes where patients often stay to recover for a few days after cosmetic surgery. Florida officials have struggled for years to regulate unlicensed facilities that often charge patients hundreds of dollars a night, even though they sometimes lack adequate medical staff.

Cosmetic surgery companies, some funded by private equity investors, compete in a growing U.S. market in which patients must pay up to $20,000 out of pocket, or on credit, for these procedures. Advertisements promise life-changing body contouring techniques with minimal risk and quick recovery times.

As cosmetic surgery companies have grown, there has been little regulatory oversight. There is no federal public database to help patients track these companies’ safety records, their staffing standards, or how often patients suffer serious complications. And complaints to medical boards about surgeons or other doctors can remain secret for years.

Ste’Aira Ballard, whose mother, Tamala Smith, is one of three Regenass patients who died, filed a complaint with the California Medical Board in early 2025. Smith died in 2023.