Facts

On March 2, 2018, plaintiff Astghik Djikneyan first saw Dr. Susan Chobanian at Dr. Chobanian's office. Djikneyan wanted to elevate the tip of her nose. Radiesse was injected into the right labial angle to elevate the tip. There was no written consent form as Dr. Chobanian does not use written consent forms for fillers. On March 14, 2018, Djikneyan returned to Dr. Chobanian's office and complained of a bump on the base of the right nostril. Dr. Chobanian injected Wydase (another name for Hylenex or hyaluronidase) to dilute the filler.

On Aug. 30, 2019, Djikneyan returned and stated she wanted a rhinoplasty. On Sept. 12, 2019, Djikneyan signed a consent form that reflected, among other things, that "no guarantee or assurance has been given to me by Dr. Chobanian as to the results of the operation. There may be varying degrees of discomfort and variations of the period of recovery during and following such surgery and that more than one procedure may be necessary to complete fully the treatment depending on my healing capacity." The rhinoplasty was performed that day.

On June 2, 2020, Djikneyan returned complaining that the left alar rim of her left nostril was higher than the right. Dr. Chobanian reviewed pre-op photos with Djikneyan and explained that pre-operatively there was an existing natural asymmetry. The left nostril was not symmetrical to the right nostril in three areas. Dr. Chobanian explained she could inject a filler (Radiesse) to try to minimize the asymmetry. Dr. Chobanian chose Radiesse as the filler of choice because it is a strong filler and because Djikneyan had a good experience with this filler in the past and had no allergic reaction.

Dr. Chobanian brought the box of Radiesse into the room, obtained verbal informed consent, prepared the syringe in front of Djikneyan using the needle that came with the product for insertion. Dr. Chobanian then injected 0.1cc of the filler to the superficial layer to the left outer rim of the nose, where the redness later developed.

On June 3, 2020, Djikneyan returned complaining of pain and redness at the injection site. Dr. Chobanian thought it was possibly an infectious or allergic reaction and she gave Djikneyan topical Benadryl cream and told her to use compresses. Dr. Chobanian also thought it could be a sign of infection (although there was no pus, abscess and nothing to culture), and she prescribed Bactrim for five days. On June 5, 2020, Dr. Chobanian prescribed another dose of Bactrim for another five days. But had an allergic reaction.

On June 15, 2020, Djikneyan returned complaining of continuing redness and pain. Dr. Chobanian injected the tip of the nose with 0.5cc saline, 0.5cc Kenalog, and 0.1cc Hylenex to attempt to dilute the Radiesse and the Kenalog. Kenalog can cause redness and therefore Dr. Chobanian diluted it with Hylenex.

On July 6, 2020, the pain and redness resolved. Some redness remained at the tip of the nostril, and Djikneyan complained of a bump. On July 15, 2020, Djikneyan asked for a steroid injection. Dr. Chobanian explained to her that this may make the redness worse. Ms. Djikneyan was given an injection of Hylenex instead.

On Oct. 28, 2020, Djikneyan returned and reported no pain, redness, or swelling and that she was happy.

On Nov. 18, 2020, Djikneyan returned for her final visit. She complained again that the left side of the nasal tip was still swollen (the left nostril was thicker). Dr. Chobanian reviewed the pre-op photos with Djikneyan and again pointed out the natural asymmetry. Dr. Chobanian offered to do a skin test to see if she had an allergy to Radiesse, but Djikneyan declined. During trial, Djikneyan admitted on cross-examination that she neither took the ordered antibiotic nor filled the prescriptions, as she believed that she did not have an infection.

PLAINTIFF'S CONTENTIONS: Plaintiff generally alleged that following an allergic reaction to Radiesse in 2018 and a cosmetic rhinoplasty performed in 2019, Dr. Chobanian injected her with Radiesse in 2019, without her knowledge or informed consent, causing an allergic reaction and bump at the site of the injection on her nose. Dr. Chobanian then injected hyaluronidase, also without her knowledge or informed consent, to dissolve the Radiesse causing her to experience pain, but this was ineffective to dissolve the filler. Plaintiff contended that she did not need an expert for this informed consent trial.

DEFENDANT'S CONTENTIONS: Dr. Chobanian alleged that plaintiff gave full and complete informed consent to the use of the filler Radiesse. The use of Radiesse to correct asymmetry was within the standard of care. The Radiesse did not cause the subsequent redness but it was probably caused by a staph infection that Dr. Chobanian properly ordered treatment for by an antibiotic. Dr. Chobanian's use of hyaluronidase to dilute the effect of Kenalog (which can cause redness) and to dilute the filler was within the standard of care and did not cause harm.

Insurer

Company - Med Pro Group Policy Limits - $1 Million

Settlement Discussions

Pre-trial, plaintiff made no demand. Dr. Chobanian offered to settle all claims in exchange for waiver of costs per CCP 998, which was not accepted. Defendant's unchallenged cost bill is $20,865.

Damages

Plaintiff originally claimed economic damages totaling approximately $1 million for loss of earning capacity as a social media influencer, out-of-pocket expenses, and loss of ability to provide household services. Defendant's Motion in Limine precluding economic damages for loss of earning capacity was granted as such damages were speculative. Plaintiff did not present evidence of any other alleged economic loss. Plaintiff's counsel argued to the jury that non-economic damages should be awarded in the amount of $250,000.

Result

Defense verdict.

Other Information

Defendant designated two specially retained experts but did not call these experts at time of trial. Instead, counsel used the defendant, Dr. Chobanian, as the only expert called in the trial.

Deliberation

49 minutes.

Poll

11-1 for Susan Chobanian, M.D.

Length

Six days.