An American psychologist who specializes in body image issues said Johnson's case was a reminder that "plastic surgery is a surgery and it has the possibility of complications like any other surgery."
"There's kind of this myth of transformation, that if I can get rid of these dark circles and if I can get a facelift and get these boobs replaced, I'm going to feel great. I'll be a new woman," said Ann Kearney-Cooke, director of the Cincinnati Psychotherapy Institute. "They may be forgetting what's at stake here, too."
According to the court documents, Johnson grew up in a mining village, did well in school and left at 16 for a hair-dressing course. "But she had greater ambition than a career in hairdressing," the judge wrote. Johnson soon was on a fast-track in the civil service, interrupted by pregnancy and the birth of a special-needs child in 1985. She worked part-time for several years before building a lucrative consulting business with top corporate clients.
Kearney-Cooke, co-author with Bob Greene of "The Life You Want: Get Motivated, Lose Weight, and Be Happy," said that although she doesn't know Johnson, patients who have risen from similarly modest beginnings sometimes "don't feel they really have made it – and they feel that to make it, you have to look perfect." A less-vulnerable woman might have told the plastic surgeon, "No, I just want my nose and the bags under my eyes done. Enough."
In the United States, Heidi Montag underwent a marathon 10-procedure makeover in November 2009, and a year later, expressed in an interview with Life & Style magazine buyer's remorse about scars and disfigurements in her breasts, chin, and body: "Surgery ruined my career and my personal life and just brought a lot of negativity into my world. I wish I could jump into a time machine and take it all back."
Haeck said that in many cases where patients sue over breast scarring, "either the communication broke down, because the patient wasn't listening to the word 'scar,' or the patient had it inherent in their own genetic makeup to form coarse scars." He said 80 percent of U.S. patients' plastic surgery claims never make it to court, and of the 20 percent that go to court, "the plastic surgeon wins in 80 percent of those cases."
He called the British award in Johnson's case "astounding," and noted that when U.S. juries are determining economic damages in plastic surgery cases, they tend to take into consideration that plastic surgeons' liability insurance on average covers $1 million per incident. In rare cases, juries will exceed that "to send a very strong message to the surgeon." In California and Texas, economic awards are capped at $250,000, although medical damages can be "as high as needed."