A board-certified plastic surgeon in Florida was arrested this week on charges of second-degree homicide and negligent manslaughter after the death of his wife several months ago. Benjamin Brown’s wife, 33-year-old Hillary Brown, died following surgical procedures performed by her husband. (Second-degree murder is defined as murder that is not premeditated.)

According to an order of emergency restriction for the plastic surgeon’s medical license filed by the Florida Department of Health in May, Dr. Brown performed the surgeries on his wife at his office, Restore Plastic Surgery in Gulf Breeze, Florida, in November 2023 and she went into cardiac arrest. Hillary Brown was transferred to the hospital, where she never regained consciousness and was taken off life support after a week.

The Florida health department investigation found that Hillary Brown prepared her own IV bags of local anesthesia for her surgeries, which included arm liposuction, abdominal scar revision, lip injections, and an ear adjustment. (Hillary Brown worked in her husband’s office, but was not a licensed health care practitioner.) Hours earlier, she had also “ingested a ‘handful’ of multi-colored pills, which included Valium,” the report says. Hillary Brown showed signs of lidocaine toxicity during the procedures, but her husband continued to administer lidocaine and operate on her. According to the investigation, after his wife had a seizure and became unresponsive, Dr. Brown did not immediately initiate CPR and instruct his staff to call 911. “Over the next 10-20 minutes, a medical assistant asked Dr. Brown if they should call 911 and Dr. Brown said ‘no,’ or ‘wait,’” the report reads. When an ambulance was finally called, EMS transferred Hillary Brown to the hospital “in cardiac arrest with an elevated lactic acid level and suspected lidocaine toxicity.”

Lidocaine is a local anesthetic that is administered by IV and used to numb pain by blocking nerve endings. It does not cause unconsciousness. “Lidocaine toxicity means that there is too much lidocaine in the blood system,” explains board-certified plastic surgeon Melissa Doft, MD, who practices in New York City. “It results in toxicity to the neurological and cardiovascular systems.” According to Dr. Doft, signs of potential lidocaine toxicity include bradycardia (slow heart rate); low blood pressure; depressed myocardial contractility, or inability for the heart to contract properly; and depressed conduction through the cardiac conduction system, “which can lead to cardiovascular collapse and death.” However, Dr. Doft notes that lidocaine toxicity is not always fatal.

Dr. Brown was released from Santa Rosa County Jail on a $50,000 bond. “Dr. Brown intends to plead not guilty and vigorously fight the allegations against him in court,” his defense attorney Barry Beroset said in a statement to NBC News. According to the Tampa Bay Times, when Dr. Brown’s medical license was restricted in May, his crisis management team released a statement, saying, “Dr. Brown continues to live an endless nightmare without his wife Hillary by his side, and these inaccurate allegations only further deepen his immense pain.”

As this tragic case gains national attention, other plastic surgeons have expressed shock over the office setting and safety standards under which Dr. Brown was operating. What’s not shocking, however, is to hear of a plastic surgeon operating on their spouse. It’s not as uncommon as you might think—and it’s certainly not a new phenomenon. Back in 1992, Allure reported on plastic surgeons operating on their spouses: “Since plastic surgery was pioneered to correct physical injuries, a doctor would once have risked professional ostracism if he did purely aesthetic work on anyone, let alone a family member; operating on relatives was considered downright unethical,” wrote Sharon Churcher. “By the 1980s, however, cosmetic procedures were an accepted specialty—one of the fastest growing in American medicine. And if it was OK for a woman to walk in off the street and tell a doctor she wanted to retool herself, then why not extend the same privilege, the argument ran, to a doctor’s wife?” (In the ’90s, about 96% of board-certified plastic surgeons were male, according to the American Society for Aesthetic Plastic Surgery.)

In 2010, a survey of 465 plastic surgeons revealed that 83.9 percent had operated on a spouse or family member, for a simple reason—the surgeons said they believed they were the best surgeon for the job. (In the same survey, 88 percent said they would operate on a spouse or family member.) In 2024, the American Society of Plastic Surgeons (ASPS) code of ethics doesn’t limit surgeons in operating on their relatives. “ASPS does not have a policy that specifically addresses plastic surgeons performing plastic surgery on family members,” the organization tells Allure.

Anu Bajaj, MD, a board-certified plastic surgeon in Oklahoma City, says that while the plastic surgeon’s code of ethics doesn’t forbid or discourage working on family members, “some state medical boards may make rules against it and some hospitals and hospital systems may make rules.”

In most cases, however, it’s up to the individual doctor to gauge the level of professional detachment they will be able to exercise when treating a loved one, as well as their motivations. As Churcher wrote in 1992, when a male plastic surgeon operates on his wife, “he might seem open to another accusation: That he’s nothing more than a Pygmalion, indulging his fantasies by playing on his wife’s insecurities about her appearance, then adjusting her to his specifications.” In deciding what they should and should not do in treating a family member, a provider has to “have a one-on-one with their conscience,” says Dr. Bajaj.

And a plastic surgeon may feel differently when working on an aunt or uncle versus their spouse. “It’s one thing to operate on a [more distant] family member, doing a procedure you do all day every day,” says Kelly Killeen, MD, a board-certified plastic surgeon in Beverly Hills. “It’s very different to be changing the face and figure of someone you’re sleeping with every night.”

Operating on spouses “is a grey area in medicine,” says Dr. Doft. “But in this case, I think the issue is less about the patient being his wife and more about the lack of supervision with the preparation of medications, possible overdose with sedatives/lidocaine, and reluctance to bring the patient to the ER.” In Dr. Doft’s practice, liposuction patients are given IV sedation with an anesthesiologist present at all times. “Therefore, we’re not relying on pre-operative medications for sedation or high doses of lidocaine. [This case] reminds us that surgery is not without risks and it is paramount to seek a board-certified plastic surgeon even for procedures that may seem simple, like liposuction.”

Dr. Killeen agrees: “As a patient planning an elective surgery, you want to make sure every piece of the puzzle is together: a properly trained, ethical plastic surgeon doing surgery, a certified, properly trained anesthesia provider, and a facility that is the proper facility for what you’re having done.”

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