I wanted to get rid of the excess skin that was hanging, which was weighing me down, and that's why I decided to undergo an aesthetic breast lift and enlargement procedure. Instead of being satisfied and starting a new life, I got disabled due to a medical error, says za Center for Investigative Journalism of Montenegro (CIN-CG) Jovana (name changed to protect identity), a middle-aged woman who agreed to speak openly about this problem and who initiated legal proceedings because of the consequences she still suffers.
In February 2018, she was admitted as a patient of a clinic in Podgorica, which normally specializes in the treatment of ear, throat and nose diseases, where her doctors M. i R. (real names known to the editorial office, but are protected due to the ongoing court process) performed the operation. According to CIN-CG's interlocutor, the operation was performed in an apartment located above the premises of this clinic. Jovana was allowed home the next day and the problems started immediately.
She was in severe pain, could not be independent, and the wounds from the operation festered and bled. She was completely weak and for two months she had to constantly go to bandages.
"After that, on the recommendation of the doctor who performed the operation, I performed an intervention to tighten the skin and connective tissue again. I regularly sent them photos that showed the consequences - my breasts were completely deformed, my skin was constantly cracking, which is why I was forced to treat it with hydrogen, iodine and medical antibiotic strips against infection," she says.
Jovana also claims that she was not informed about the risks of the operation by the doctor.
After the second procedure, which did not correct the problems, Jovana's mental health also deteriorated. She closed in on herself and distanced herself from close people.
When it became clear that things were not going to get better, in February 2020, Jovana decided to sue the clinic and the mentioned doctors who operated on her.
One of them, by the way, is a specialist in ENT surgery. From his biography, which is available online, it can only be seen that he is a member of the World Academy of Cosmetics.
CIN-CG contacted the clinic and asked questions to the doctors who operated on Jovan, however, we have not received any answers until the publication of this article.
CIN-CG had access to the court files. One of the doctors, as can be seen from the minutes of the main hearing before a Montenegrin basic court where the proceedings are being conducted, stated that "the patient insisted on the operation", even though he told her that "there is no need for it".
"At the end of the conversation, we had to agree that tastes should not be discussed... I told her that there was a possibility that such an intervention would leave scars, especially because she had previously had an intervention on her chest... The operative and postoperative course went completely smoothly," he said. is that doctor and pointed out that, in his opinion, the operation was performed correctly in terms of quality and aesthetic appearance.
He also stated that before the intervention Jovani presented that, since she consumes cigarettes, the process of skin regrowth is slower in people who smoke.
Another doctor also stated in court that he explained to Jovani that it was one of the most complex operations in reconstructive surgery, especially because the operation had already been performed on her once.
"I listed to her the possibility of infection, formation of hematoma, seroma, inadequate healing of wounds... I suggested to the patient the type, size and brand of implants...", he stated and pointed out that all the operations that were performed on Jovan after this one, unfortunately "were not of a predictable nature ".
"In my practice, I have performed these operations two or three times on my patients because the skin, due to years of aging and the action of gravity, stretches unpredictably and creates unacceptable results compared to those that exist after the operation," according to the testimony of this doctor. from the court.
An increasing number of women in the world decide to undergo cosmetic surgery, often due to a combination of social factors - environmental pressures and expectations, but also psychological reasons. In June 2024, the International Society for Aesthetic and Plastic Surgery (ISAPS) published the results of its annual Global Survey on Aesthetic/Cosmetic Procedures, which in the last four years showed a growth of as much as 40 percent when it comes to these surgical procedures. Women make up about 86 percent of all cosmetic surgery patients.
"We live in a time where everything needs to be ideal, perfect, without flaws, these are the messages that are marketed through social networks, not only to women, but also to men, because they also resort to cosmetic surgery, but women still dominate in this. Today, beauty is one of the most important criteria, on the basis of which one often gains status and advances in society," the psychologist tells CIN-CG. Stella Burzanović.
She explains that constant comparison with the appearance of others often leads to dissatisfaction, and some mental disorders and diseases can develop, such as dysmorphophobia (fear of ugliness), body dysmorphic disorder, anxiety, depression, addictions...
"Persons with body dysmorphic disorder will never be satisfied with their appearance, because it will always be necessary to 'fix' something more in order to get closer to the ideal image they want to achieve. Patients with this type of disorder often resort to obsessive-compulsive behavior: staring in the mirror, comparing their physical appearance with others and constantly looking for compliments... The most common reasons for the emergence of this disorder are insufficiently developed self-esteem and self-confidence, fear of abandonment, loneliness and isolation, perfectionism ..." Burzanović states.
Doctors are obliged to avoid unnecessary examinations and procedures, but still carry them out
Jovana is one of 182 women who responded to the CIN-CG online questionnaire about medical-aesthetic procedures that are carried out in Montenegro in specialized clinics, salons and other institutions that are not traditional hospitals. Of that number - 22 underwent at least some medical-aesthetic procedure. Most often, it involved injecting hyaluronic acid, Botox or some other filler, surgical procedure - liposuction, lip and breast augmentation, rhinoplasty (nose surgery), laser hair removal treatment, microdermabrasion (controlled removal of thickened and dead skin layer with the aim of removing the old skin and remove defects)... Most of them, 15, decided to undergo surgery to improve their physical appearance.
About 20 percent faced complications or side effects after the procedure, mainly because they were not sufficiently informed about the possible outcomes of the operations.
"I decided to remove the capillaries from my legs and I paid 400 euros for this procedure in a private clinic in Podgorica. However, due to problems with internal veins, I was not even a candidate for laser capillary removal, but I was not told this in time", says one respondent.
After a year of treatment, her capillaries did not disappear, they only became more visible.
"The rest are bruises and pigmentation. After that, I had an examination by a vascular surgeon, as well as a doppler of the blood vessels, and I was told that the capillary removal procedure would never work for me until I operated on the internal veins," says this woman.
Another subject, who underwent filler injections, claims she had complications because she was given the wrong material.
"I didn't report the case, because when I realized that they introduced a material into my body that I didn't want, several months had already passed and there was no evidence that they didn't use the one I asked for," she says.
According to the Code of Medical Ethics and Deontology (hereinafter: Code of Ethics), which establishes ethical principles in the performance of the professional duties of the members of the Medical Chamber of Montenegro (LJKCG), the doctor is obliged to treat the patient economically and rationally and to avoid unnecessary examinations and procedures, regardless of who bears the costs of the patient's treatment. Also, the doctor has the right to refuse treatment and refer the patient to another doctor if he believes that he is not skilled enough or does not have the technical capabilities for successful treatment.
Aesthetic minimally invasive methods can be performed by doctors of medicine and doctors of dentistry who have a certificate of completion of education in accordance with the European standard approved by the European Committee for Standardization (CEN), issued by a health institution or another body accredited to perform these methods.
More detailed conditions in terms of space, personnel and medical-technical equipment for the performance of this activity are prescribed by the Ministry of Health. Even after a long wait, CIN-CG did not manage to get answers to numerous questions from the authorities from that government department.
Hard to get justice in court
For a long time, Jovana could not secure a court expert who is an expert in the field of aesthetic medicine and who could and wanted to determine the damage caused to her during the operation.
"It is difficult to find an expert in Montenegro who would agree to speak 'against' his colleagues. I had to look for someone from abroad myself who would agree to deal with my case", she states.
In the opinion signed by a specialist in forensic medicine, a specialist in plastic and reconstructive surgery and a specialist in forensic medicine - doctors who made up the commission of medical experts who agreed to work on Jovana's case, as well as the director of the Institute of Forensic Medicine in Nis, it is stated that During the lifting and enlargement of Jovani's breasts, the doctor made an error that was reflected in the placement of the implants, as a result of which the deformity arose.
"The second omission is reflected in the fact that the surgical procedure was performed by a specialist in diseases of the ear, throat and nose (ENT), who also signed the medical report on the performed surgical procedure. Regardless of the fact that the doctor has completed certain courses and is a member of certain associations that deal with aesthetic surgery, he cannot be considered educated, nor professionally qualified for surgical interventions on the breasts", it is also stated in this opinion, in which the CIN -CG had an insight.
This commission of expert doctors also found a "permanent reduction in general life activity" for Jovana.
She is still awaiting the verdict.
Another interlocutor of CIN-CG has a similar experience as Jovana. She also underwent breast surgery in a private clinic in Montenegro, but the operation was unsuccessful, after which she had to be treated outside the country. She has not taken legal action against the doctor who performed her surgery, but is thinking about it.
"All this is, apart from health, also financially exhausting. Young girls should think carefully before deciding to undergo some cosmetic surgery. I wish I had been better informed and had built up my self-confidence," says this woman.
Problems of this kind do not only occur in countries such as Montenegro, whose health system is not at an enviable level, but failures also occur in much more developed societies.
CIN-CG contacted and Anu (real name known to the editorial staff), a girl from Italy, who underwent aesthetic intervention. She thought she had a physical defect on her nose. This bothered her to the point that for years she refused to look in the mirror or take a photo. One day she decided to "correct" everything by undergoing a filler, hyaluronic acid to correct the defect on her nose. However, very soon after the operation, she began to feel unwell and had pains in her head and eyes.
"The doctor failed to check one eye after the injection I received. After many examinations, it was discovered that neuralgia * is a severe pain caused by a damaged or irritated nerve. That's why I've been receiving therapy for more than two years, I'm better, but I'm not the same as before," said an interviewee from Italy for CIN-CG.
She thought it was a harmless procedure.
"The doctor also convinced me of that. However, it is not true that hyaluronic acid is completely absorbed. Very serious problems can occur. In reality, doctors tend to hide many things, they should be more honest and not only interested in money".
In Italy, the price of fillers with hyaluronic acid is very low - several hundred euros, and there is also the problem of hiring forensic experts who would assess the damage after aesthetic operations.
"It is difficult to fight for justice in court. And although aesthetic medicine is now very modern and advanced, it is dangerous and often dangerous and it is easy to fall into a trap", warns Ana.
After the operation, she says, severe depression followed.
"I stopped studying and working because of the pain...".
Cosmetic surgery, which is increasingly advertised, has become a lucrative business, bringing in billions of euros worldwide. When such big money is involved, ethics are often overlooked. That is why the developed systems have strict laws and procedures. It is known exactly who can carry out these types of intervention, and if there is an omission, they pay huge damages.
One of the famous cases in which the patient received a large compensation for cosmetic surgery that did not end well is the case of a British actress Leslie Ash who underwent cosmetic lip surgery in 2003, during which the doctor injected her with an inappropriate filler. The operation resulted in serious complications, including scarring and permanent lip deformity, which significantly affected the actress's physical appearance and career. Because of this, Ash sued the doctor who performed the procedure and was awarded five million pounds.
This case shows how performing cosmetic surgery can sometimes have serious consequences, but also how legal systems can provide protection and justice for patients who have suffered damages due to medical errors.
CIN-CG addressed all basic courts in the country and asked them if there were any verdicts in the period from 2018 to August 2024 that related to the criminal offense - negligent provision of medical assistance. Most of the courts that responded confirmed that there were no such judgments in that period.
Beauty salons of questionable credibility also operate in Montenegro
In Montenegro, some beauty salons on the Instagram social network advertise the services of applying hyaluronic acid "without a knife". Prices range from several tens to several hundred euros.
CIN-CG found out through well-informed interlocutors that there are beauty salons in our country whose staff provide aesthetic services without the appropriate licenses and diplomas. On the pages of some of the salons that advertise these services, it is stated that they are provided by a practicing doctor, a specialist in cosmetic surgery.
"It was only after I went through certain courses that I paid a lot of money for and tried to make money myself afterwards, that I realized that the diplomas I received on that basis were invalid, because the salon where I attended the training did not actually have valid licenses," says the girl. who was trained to apply permanent makeup.
One of the subjects of CIN-CG underwent laser hair removal treatment in a beauty salon. She paid 100 euros for the service, and later struggled with the rash that appeared on her.
The Law on Health Protection characterizes aesthetic minimally invasive non-surgical methods as "new health technologies that include methods and procedures of prevention, diagnosis, treatment and rehabilitation of changes that occur as a result of aging, i.e. methods whose application has a beneficial effect on health and physical appearance".
That law stipulates that aesthetic minimally invasive non-surgical methods of head and neck medicine can be performed by a health institution that has a license to use new health technology. At the request of a health institution, and based on the opinion of the Commission for the Assessment of Health Technologies, the Ministry of Health issues a permit for the use of new health technology.
According to the Law on Health Care, a legal entity that performs aesthetic minimally invasive non-surgical methods of "anti-aging" head and neck medicine without a decision from the Ministry of Health will be fined in the amount of one thousand to 20 thousand euros, and the responsible person in the legal entity in the amount of 100 up to two thousand euros.
The Administration for Inspection Affairs (UIP) told CIN-CG that in the previous period, patients did not report that the mentioned services were provided to them in residential buildings. However, they had reports that such services are provided in beauty salons and health institutions that do not have a license for this type of intervention.
"During 2024, health inspectors found in two cases the offense of providing these services without a decision from the Ministry of Health, and in both cases they imposed fines on the legal and responsible person and issued a decision prohibiting the performance of the activity in question", according to the UIP .
According to the International Society for Aesthetic and Plastic Surgery (ISAPS), liposuction was the most common surgical procedure in 2023, as well as in 2022, followed by breast augmentation, eyelid surgery, abdominoplasty, and rhinoplasty. The most popular non-surgical procedures were botulinum toxin, hyaluronic acid, hair removal, non-surgical skin tightening and non-surgical fat reduction.
"The majority of breast augmentation (about 54 percent) and rhinoplasty (about 66 percent) were performed on people between the ages of 18 and 34, while the frequency of hyaluronic acid procedures increased by 29 percent," according to ISAPS's latest Global Survey on Aesthetic/ cosmetic procedures from 2024.
"Years, time, it's merciless, gravity does its thing, lifestyle, too much stress, all of that leaves a mark on your face. Isn't it wonderful that tens of thousands of lived days, which have left a mark on your skin, can be removed with a few treatments" - the ad is on the Facebook page of a beauty salon on the Montenegrin coast advertising some of the anti-aging treatments.
From the World Health Organization (WEAVE) for years, they have been warning about the harmfulness of ageism, i.e. stereotypes, prejudices and discrimination based on age and state that it is necessary to change the negative narratives about age and aging.
"Ageism is pervasive, affects people of all ages from childhood onwards, and has serious and far-reaching consequences for people's health, well-being and human rights. It mostly remains invisible, despite the negative impact on individuals and society," they explain WHO.
People with body dysmorphic disorder are more likely to develop addictions
Psychologist Burzanović also points to the danger of developing an addiction to cosmetic surgery. People with body dysmorphic disorder are more likely to become addicted to plastic surgery and are at increased risk of developing alcohol or drug addiction to try to escape disappointment with their appearance.
"When a person starts one procedure, it may happen that he will require quite a few others, because he will notice more and more 'irregularities' in himself", states Burzanović and points out that it is therefore very important to talk openly with experts, psychologists and psychotherapists, before a decision is made to perform an aesthetic operation or procedure.
"Young people need to know that we are all unique, special in our own way and different and that is what makes the world perfect. We should take care of what we have", she believes.
The American Addiction Center states that the need for aesthetic procedures can also be a kind of addiction. Medically speaking, most plastic surgeries are not necessary, although there are medical benefits to some procedures, such as rhinoplasty and cleft palate repair, the Center says. They emphasize that plastic surgery should always be a free choice.
"Apart from the risks that accompany any medical operation, there is nothing wrong with plastic surgery as long as the surgeon is competent and the patient has realistic expectations," the official website of this organization states.
They warn, however, that one plastic surgery operation can give a positive result, but that multiple operations can have unwanted consequences.
“Some of the risks of plastic surgery include blood clots, scarring, bruising and swelling, excessive bleeding, nerve damage, tissue death, infections including pneumonia, anesthesia risks - shock, respiratory failure, allergy and cardiac arrest. In some cases of addiction, people undergo multiple surgeries to correct the results of the previous ones. Multiple operations, even when performed correctly, sometimes result in an unnatural and bizarre appearance”.
This center warns that the consequences of plastic surgery can lead a person to start using addictive drugs to relieve pain.
“If a person repeatedly undergoes plastic surgery, they may also be repeatedly exposed to prescription opioids and thus risk developing opioid addiction. Addiction to opioids, both legal and illegal, kills hundreds of Americans every year," the center's website states.
One of the interlocutors of CIN-CG went through several aesthetic surgeries, in order to achieve a "perfect look". Some of those operations, such as facelifts and canthopexy (achieving the cat-eye effect), ended in failure and left her not only physically scarred, but her mental health destroyed as well.
Aesthetic operations, like other operations, carry significant risks and therefore it is necessary to perform them in accordance with the highest ethical standards. Doctors should carefully assess the patient's psychological state, the reality of his expectations and the possibility of unwanted consequences before proceeding with the procedure. In addition, patients need to be fully informed about the risks and possible complications so that they can make an informed decision.
Failure to adhere to these ethical principles can lead to serious physical and psychological consequences for patients, as CIN-CG's research has shown. That is why the health system of Montenegro would have to recognize this burning problem and control this area more strictly.
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