Plastic Surgeon Who Livestreamed Procedures on TikTok May Lose License

An Ohio plastic surgeon who livestreamed procedures on TikTok, and who at least 11 patients say caused severe complications from treatment at her clinic and rehab center, is fighting to keep her medical license in hearings this week.

Katharine R. Grawe, MD, also known as "Dr. Roxy" on TikTok, had her license suspended in November 2022 following concerns about her social media activity and inappropriate care that occurred both during procedures posted to social media and in routine practice.

According to a representative for the State Medical Board of Ohio, the summary suspension was based on "clear and convincing evidence that continued practice by the licensee poses a danger of immediate and serious harm to the public."

Following the conclusion of the hearings this week, the board will review the evidence and vote on how to discipline Grawe's license, which could include revoking it, refusing to renew it, limiting it, or placing Grawe on probation. "The full board is expected to make this final decision this summer," the representative wrote in an email to MedPage Today.

Court documents from 11 lawsuits by patients alleged postoperative infections and injuries so severe that they resulted in a double mastectomy, skin grafting, necrosis, and, in one case, repairs to a small intestine that was punctured six times. There are multiple accounts of infections not spotted and allowed to spread for days, or even weeks.

In one case detailed by the medical board, Grawe performed an abdominoplasty, two Brazilian butt lifts (BBLs), liposuction, and Renuvion J-plasma procedures on a patient on two separate occasions. Grawe livestreamed the second liposuction procedure on social media, looking at the camera and answering questions for her viewers.

According to medical board documents, "Despite liposuction being a blind surgery that requires awareness of the tip of the cannula to avoid injury, your attention to the camera meant at those moments you were not looking at the patient or palpating the location of the tip of the cannula."

The patient was later hospitalized with "free air in her abdomen and hepatic encephalopathy," and later was found to have a perforated small bowel and a necrotizing soft tissue infection that required a long hospital stay and multiple procedures to treat.

In another BBL incident, during which Grawe also gave liposuction, Renuvion J-plasma treatment, and umbilical hernia repair, the patient was recovering at the Foxy Recovery House, also run by Grawe. An aide and a registered nurse working for Grawe advised the patient to take ondansetron (Zofran) and two oxycodone (Percocet) tablets, to eat a light meal, and rest after she complained of vomiting, severe abdominal cramping, burning, swelling, and dark urine, according to court documents.

The patient called 911 anyway, and an exploratory laparotomy was performed, during which the doctor "found an area of the bowel that had been punctured through and through and had bile pouring from the wound," followed by at least three more complete punctures, necrosis in the omentum, and other problems that led to a partial omentectomy and resection of the small intestine.

In 2021, a breast augmentation and mastopexy (breast lift) by Grawe led to a post-surgical infection so severe that the patient's breast implants had to be removed, and ultimately both breasts, along with "approximately a third" of the left pectoralis muscle. In the lead-up, while the patient was experiencing pain, fever, and other symptoms of infection, court documents alleged that Grawe told the patient's next doctor that the implants had been already removed, drains were in place, and that "she did not feel there was much for plastic surgeons to do" -- though the implants had not been removed.

A number of the lawsuits alleged that medical documentation was improperly filed, and even altered, by staff at the Roxy Plastic Surgery clinic, and some described Grawe's employees performing medical procedures despite a lack of training or licensure.

Starting as early as October 2018, the Ohio medical board sent Grawe warning letters, including one 2021 letter that detailed "multi-faceted issues with your care of these patients, including concerns regarding the lack of informed consent, ethical concerns related to privacy and social media, and avoidable complications that required surgical revision."

The board recommended that Grawe complete remedial education courses, including "Finesse in Mastopexy and Augmentation Mastopexy" and "Ethical Social Media," which she completed.

However, Grawe continued to post videos and live broadcasts of medical procedures, at least through October 2022, during which she responded to viewers' questions on livestreams while actively performing surgery. Her TikTok account, where she has over 800,000 followers, is currently private.

According to a report by WSYX, a plastic surgeon from Beverly Hills, California, Lloyd Krieger, MD, testified on behalf of Grawe Thursday, noting that "my opinion was and is that Dr. Grawe complied with the standard of care." After watching the video of the surgery that was livestreamed, Krieger told the board that "procedures were performed in a completely professional way. It met the indications for surgery. Her technical maneuvers were aligned with achieving that goal and it was clearly done in a professional and safe environment."

Grawe's legal representation did not respond to a request for comment in time for publication, but according to WSYX, her team has argued that all surgeries come with risks, and that complications don't always mean there was a breach in standards of care.

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