A court has issued an order demanding that a physician compensate a minor patient, who suffered permanent blindness in one eye as a result of a filler injection procedure in the nose, with damages exceeding 300 million won. The court clarified that the procedure's prevalent nature and the widely known risk of surgical complications do not serve as valid justifications to exempt the physician from liability.

The Seoul High Court recently ordered a doctor to pay a total of 316,623,620 won ($240,715), including 100 million won in solatium, plus delayed interest, in a damages suit filed by a patient who went blind in one eye after receiving the filler injection.

In February 2017, after receiving a filler injection in the nose at a clinic operated by the doctor, the patient became blind in her right eye and suffered from right eye strabismus and scarring. At the time, she was a minor, one day shy of her 18th birthday.

When the patient filed a lawsuit for damages, the doctor countered that he acted within the scope of his discretion, stating that "the day after the procedure, she turned 18 years old and would have been regarded as an adult in most other countries." He also said he performed the filler injection at the request of the patient who was “very close to the age of an adult.” He added that he used a low injection dose.

Also, he noted that filler injections for minors are "widely practiced" in the medical community in Korea.

However, the court of the first trial and then the appellate court did not accept the doctor’s argument. The court found that the physician was liable for using a banned substance on a minor and failing to explain the risk of complications or the need for emergency treatment.

The court said, "At the time of the procedure, the patient was 17 years, 11 months, and 30 days old, which is clearly a minor, and it is difficult to say that she was ‘very close' to the age of an adult."

The fact -- that the procedure was already being performed on minors "extensively and that there was no problem in minor patients before the plaintiff -- was not a mitigating factor, the court said.

Rather, "the precautions for the procedure must be strictly followed to protect minors who are not yet physically and mentally mature," it said.

The doctor argued that although the medical staff exercised due care and properly injected the filler material, side effects such as retinal vascular occlusion, which led to her blindness, were "inevitable" and there was "no way to foresee or avoid" the after-effects, including vision loss. As the damage to her eyesight was "permanent between 60 and 90 minutes" and there was no established treatment, it could not be said that the patient had been harmed by the breach of the duty of care, he argued.

There was also no breach of the duty of explanation because the patient decided to undergo the procedure after being told that "skin necrosis may occur," he went on to say. Even if there was no mention of vision loss in the consent form, it was "widely known through the news and the Internet" and therefore she must have been "aware" of it, he said. It is "common knowledge" that skin necrosis is caused by vascular occlusion, he added.

However, the appeal court rejected both of these arguments. 

"If she had been fully instructed by the physician on how to treat her, she could have been treated and reversed before 60 to 90 minutes had elapsed, the court said.

Even taking into account common sense, the patient was not a medical professional and would not know that vascular occlusion can cause skin necrosis and result in vision loss, the court said.

The internet contains many examples of blindness as well as promotional materials highlighting the positive aspects of cosmetic surgery, so it would have been difficult to believe that the patient was fully informed about the specific risks or able to make an informed decision, the court said.

The court noted that "the patient was not informed that the filler injections were prohibited for use in minors and that complications such as blindness were possible due to retinal vascular occlusion, and therefore she was unable to exercise her right to self-determination as to whether or not to undergo the procedure." 

It also said that "she was not instructed that she should seek immediate emergency medical attention if she developed symptoms of a suspected retinal vascular occlusion, thus losing the opportunity to receive timely medical treatment."

Accordingly, the court sentenced the doctor to pay a total of 316,236,620 won plus delayed interest.