A sweeping investigation into cosmetic surgery chains has sparked renewed warnings from industry groups and a push for greater transparency in California’s physician discipline process.

The report underscores the risks in a booming market and the gaps in watchdog oversight.

“Plastic surgery is real surgery with real risks, and the risk of complications is never zero,” said Scott Hollenbeck, immediate past president of the plastic surgeons group.

And in an exclusive interview, TJ Watkins, a member of California’s medical licensing board, called for greater transparency in the secretive process for disciplining physicians, saying the board should alert the public about doctors under investigation for alleged misconduct.

The investigative series examined claims of disfiguring injuries and even deaths tied to cosmetic procedures, prompting calls for more consumer safeguards. It pointed to cases where patients felt misled by marketing that downplays risk.

One story revealed that California plastic surgeon Heidi Regenass had three patients die within a few months after liposuction and fat transfer operations, according to medical malpractice lawsuits filed in California courts.

Those lawsuits highlighted fatal outcomes alongside questions about clinical judgment.

A complaint to the medical board from a patient’s daughter triggered an internal board review of the surgeon, but the public will hear nothing until the investigation is concluded, which can take years.

“If you were really protecting the patients, there would be a notice right now that says this doctor is being investigated,” said Watkins.

Regenass, a board-certified plastic surgeon, did not respond to numerous requests for comment on the patient deaths. In response to medical malpractice lawsuits filed by families of the three women, she has denied any negligence or that her actions caused any deaths.

On Feb. 9, the California medical board filed an administrative complaint against Regenass unrelated to the three patient deaths. The complaint accuses Regenass of “repeated negligent acts” in caring for a 49-year-old woman who had liposuction on her abdomen and arms with a fat transfer to her buttocks in July 2022.

The board alleged that the surgeon “failed to document an appropriate physical examination prior to surgery” and did not keep “adequate and accurate records” of the woman’s care. The board requested an administrative hearing on the accusations, though no date has been set.

Some patient lawsuits have accused cosmetic surgery companies of hiring doctors who lacked adequate training or had troubled pasts, and of using high-pressure sales tactics and misleading advertising pitches that downplay safety risks. The companies dispute these allegations and have won dismissal of some suits.

Other cases have been settled under confidential terms, including a Georgia judge awarding $52 million to the family of a woman who died after liposuction and a Brazilian butt lift.

Christopher Nuland, an attorney and lobbyist for the Florida Society of Plastic Surgeons, said that the “Body Shops” investigation underscores the need for vigilance from all parties.

“There is an opportunity for better legislation, such as regulating post-surgical recovery centers and better enforcement of existing laws,” he said in an email, and “But patients need to take an active part by ensuring that they are seeing a board-certified plastic surgeon in an accredited facility and that neither has a history of bad outcomes.”

Nuland said his group supports a bill pending in the Florida Legislature that would require licenses and set quality standards for recovery houses where patients often stay to recuperate for a few days after cosmetic surgery.

The measure aims to curb lax post-operative care and reduce recoveries in unregulated facilities.

Cosmetic surgery companies, some financed by private equity investors, are competing in a growing U.S. body-contouring market in which patients are charged up to $20,000 out-of-pocket, or on credit, for these procedures, with ads promising life changing body reshaping techniques and quick recovery times.

There has been little regulatory oversight, and in one 2025 development Ballard’s complaint was forwarded “for further investigation” to the state health quality unit.

Tamala Smith Ballard, whose mother Tamala Smith died in 2023 after Regenass operated, filed a complaint with the California Medical Board in early 2025.

In March 2025, the board notified Ballard it had forwarded her complaint to the state Department of Consumer Affairs Health Quality Investigation Unit’s Santa Ana field office “for further investigation.”

Ballard said a state investigator interviewed her in June, but neither the existence of the review nor its status has been made public. Ballard provided copies of her correspondence with the state to a newsroom.

Asked for comment, California Medical Board spokesperson Alexandria Schembra said the board “is not authorized to post complaint information about a physician” unless it obtains an emergency suspension of the doctor’s license or files a formal administrative complaint.

“The public reporting of a patient death prior to the Board having sufficient evidence to prove that the licensee violated the Medical Practice Act would require the Legislature and Governor to enact a law change,” she wrote in an email.

But Watkins said he believes that the disciplinary process is rigged in favor of doctors, mostly because of the power of medical groups in the state lobbying to thwart change. “Nobody is protecting the patient.”

NBC News producer Jason Kane and correspondent Erin McLaughlin contributed to this report.