Harmonization lawsuits: how to reduce your legal risk

Nobody opens an orofacial harmonization (HOF) clinic thinking about lawsuits, but almost every professional knows someone who has received a notice. The causes repeat: an expectation the result did not meet, a complication that was poorly communicated, a missing document that would have proved what was agreed. Legal risk never reaches zero, but a good part of it comes from avoidable failures.

This guide frames the subject as prevention: what to document, how to align expectations, how to handle a complication and what to do if a conflict arrives. It is not legal advice and does not predict the outcome of any case: each one depends on the evidence, the professional board and the applicable law. Talk to a health law attorney about your own situation. The legal references here are those of Brazil.

What types of liability exist?

The same fact can have consequences in different spheres, which run separately:

As for consumer law, Brazil's Consumer Protection Code treats the liability of independent professionals differently from that of suppliers in general: it is determined by verifying fault. That does not remove the duty to inform and to document. There is also legal debate, with differing decisions, over whether aesthetic procedures create an obligation of means or of result. Because the question is decided case by case, the prudent path is to clearly record what was explained and agreed, rather than depend on a favorable interpretation.

Where do conflicts come from?

Looking at the pattern of complaints, four points repeat:

Almost all of these points are resolved in the consultation, before the procedure. The cost of prevention is time; the cost of fixing things afterward is much higher.

How do you align expectations before injecting?

Expectation is the most underestimated cause. The patient arrives with a reference (a photo, a person, a filter) and brings it into the room. The professional needs to find out what that reference is and say, honestly, what is and is not possible.

1. Ask before you explain. "What bothers you most?" "How do you picture the result?" "What do you want to avoid?"
2. Describe what the procedure usually does and its limits: results vary, there may be pre-existing asymmetry, a follow-up visit may be needed.
3. Use honest visual support. Photos and simulations help, as long as they are presented as illustration, not a promise. See illustrative simulation.
4. Talk about risks in understandable terms, including the rare and serious ones. See safety and complications.
5. Record what was discussed in the patient record, with the date.
6. Give time for the patient to decide, when there is no clinical urgency.

Which documents make up the defense?

In a dispute, the one who can demonstrate what was done and agreed prevails. The set below is usually the minimum:

On retention and confidentiality

The patient record has rules for retention, access and disposal. In Brazil, Law 13,787/2018 covers the digitization and retention of patient records and generally provides for a minimum of 20 years from the last entry, and your board may have its own rules. Confirm the current rule. Documents and photos are sensitive personal data: keep them with restricted access and comply with the LGPD (Brazil's data protection law). See also consent and LGPD for photos.

How do you handle a complication to reduce conflict?

How you act when an adverse event happens weighs as much as the event itself. General principles:

1. Put the patient first. Clinical care comes before any legal concern.
2. Be prepared. Have emergency supplies and a protocol, including hyaluronidase when using hyaluronic acid. See the emergency checklist.
3. Acknowledge and follow up. Do not downplay or hide anything. Explain what is happening in plain language.
4. Refer when necessary. Events such as suspected vascular occlusion call for fast action and, often, a specialized service.
5. Record everything, with date and time: signs, actions, instructions, contacts and follow-ups.
6. Stay in contact until it is resolved. An abandoned patient tends to turn to the board or the courts.
7. Communicate through a formal channel and avoid discussing the case in groups, on social media or in informal conversations.

Do not forget to check the coverage of any liability insurance and the deadline to notify the insurer, which is usually short.

How do you deal with a dissatisfied patient?

Dissatisfaction is not always a technical failure. Sometimes it is expectation. Either way, the first response matters:

• Listen without interrupting and record what the patient said.
• Reassess calmly, with standardized comparison photos.
• Explain what is visible and what to expect at each stage of healing.
• Propose the path: observe, adjust, reassess, refer.
• Avoid promises to redo the work "for free" or refund the money in the heat of the moment; agree on it calmly and record it.
• Do not argue by message late at night or in public.

When there is an agreement to adjust or refund, formalize it in writing, with a lawyer's guidance.

What not to do

• Delete or alter the patient record, messages or photos after the conflict. Altering a record is serious and can make things worse than the original event.
• Post your defense on social media, which can breach confidentiality and escalate the conflict.
• Respond on your own to a notice, without guidance.
• Pressure the patient to withdraw the complaint.
• Promise results in the sales pitch to close the plan. The promise becomes evidence against you.
• Skip the consent because you already know the patient.

Does advertising come into this?

Yes. Marketing that promises results, an irregular before and after, or a patient's image used without authorization is one of the most common sources of ethics complaints and damages claims. Review your marketing against your professional board's rules: see advertising in HOF. Operating documents count too: see the clinic's health license.

What should you do when you receive a notice?

1. Breathe and do not respond right away. Read carefully what is being asked and by when.
2. Gather the documents as they are: patient record, consent forms, photos, messages, quotes. Do not "improve" anything while organizing them.
3. Find a health law attorney as soon as possible. Deadlines are short.
4. Notify your insurer, if you have one, within the contract's deadline.
5. Protect confidentiality and restrict who has access to the case.
6. Keep practicing carefully: avoid commenting on the case with other patients or colleagues.
7. Write down the timeline of events while your memory is fresh, giving it only to your lawyer.

Prevention checklist

• Do I have an up-to-date medical history and a complete patient record for every visit?
• Is the consent specific to each procedure and filled in?
• Do I record the lot and expiration date of every product applied?
• Are photos standardized and stored securely?
• Do I align expectations beforehand and record the conversation?
• Do I give written aftercare instructions and leave a contact channel?
• Do I have a protocol and supplies for complications?
• Does my marketing follow my board's rules and do I have an image release form?
• Has a lawyer reviewed my consent forms and contracts?
• Do I know what to do if I receive a notice?

Reducing legal risk in HOF is, at bottom, doing well the least glamorous part of the clinic: explaining, recording, following up. Those who do it consistently practice more safely, and if a conflict does come, they arrive with documents instead of memories.