Cosmetic surgery patients and a patient advocate

Signature Clinic runs eight clinics across the UK and Ireland, focusing on popular cosmetic surgery, non-surgical treatments, cosmetic dentistry and orthopaedic procedures. To gain new customers it encourages patients to post recommendations or reviews on its website or other review sites such as TrustPilot, which can host and verify reviews posted by clients or patients. After receiving a number of negative reviews on TrustPilot, the clinic threatened and pursued legal action against five former patients. 

One of those targeted was Kate Kronenbach, who undertook arm-lift surgery to address loose skin after losing weight. Speaking to BBC Woman’s Hour, Kate spoke about the “excruciating” pain she experienced during the operation. “I had concerns about my outcome within a few days of my surgery, which I did speak to the clinic about via email.” The clinic recommended that she waited 12 months to see her “final results”. After that time elapsed, she approached the clinic again, when they offered to redo the operation. However, Kate had “lost faith in the company”. Kate requested a partial refund, which the clinic refused. As a result, she posted a review online to give “an accurate account of my experience so other people looking for a clinic to go to would have that balance of good and bad.” According to The Times, Kate “received a legal letter threatening her with bankruptcy and accusing her of having ‘the audacity to ask for a refund’”. Signature Clinics demanded £10,000 in damages, with Kate also likely to be liable for their costs if she was unsuccessful in her defence. Fearful of the repercussions, Kate initially took down her review until she spoke to friends after which she decided to republish it. She told the BBC: “I’m allowed to say what I believe to be my own truth.” Further correspondence from J N Stachiw, the solicitor representing Signature Clinics followed as a result of this decision. The solicitor accused Kate of “harassing” and taking part in a “hate campaign against our client” and informed her that police were aware of her “social media threats”.

Another patient called Mohammed underwent a surgical procedure called a blepharoplasty to remove excess skin or fat from the eyelids. Like Kate, he published a negative review on TrustPilot and “[w]hen he refused a request to take down the review, he was issued with a £10,000 defamation claim.” The Clinic’s lawyer, J N Stachiw suggested that deleting the negative review was a precondition of speaking to the surgeon to address his eye concerns.

Tracy, another patient who undertook eye surgery in the Birmingham clinic in February 2023, found a support group on Facebook after the surgery. While she had originally posted favourably about the surgery, her opinion changed, resulting in her posting more critical updates to the group. While on holiday with some friends, she received a letter from the clinic’s solicitor threatening to take her to court. Tracy told BBC’s Woman’s Hour that upon receiving the letter “I felt sick”. In response to the letter, she told the solicitor that she would stop posting on the Facebook group as she “couldn’t afford to get solicitors”. However, he responded by telling her that he would reject her offer and suggested that the fear of imprisonment for breach of an injunction was the only way to stop Tracy’s “itchy fingers”. An application for an injunction was made against  Tracy by Christian Gotti, the founder of Signature Clinic. Retelling the experience, Tracy highlighted how “he threatened me with imprisonment, he threatened me with bankruptcy as well, he threatened me that I may have to sell my house”. Tracy felt too scared to tell her husband and her family about the claim against her because the threat to bankrupt her made her feel like she was going to lose her home.

On 31 January 2024, the Stoke-on-Trent County Court ruled against Mr Gotti’s application for an interim injunction. The judge stated that “[i]n my judgment, the posts relied on, which are said to amount to a course of conduct of harassment, do not come anywhere near meeting that test” and that “there has been a wholesale failure on the part of the claimant to even recognise the application of section 12 of the Human Rights Act 1998 to the relief that he seeks.” The Judge certified the claim as being “totally without merit”. The judgment also includes an analysis of the Clinic’s conduct, as well as the correspondence from J N Stachiw. Referring to the threat of bankruptcy and imprisonment, the judge was “satisfied the communications from the applicant would undoubtedly have caused her very significant distress, worry and fear.” They concluded, stating: “even if I am wrong to strike out the claim or application under Rule 3.4(2)(a), I am satisfied that it should be struck out under Rule 3.4(2)(b)”, which relates to “abuse of the court’s process”. Mr Gotti was later ordered to pay Tracy’s costs on the “indemnity basis” in the sum of £118,840.37.

For a period of time, TrustPilot added a banner to the Signature Clinic page on its platform stating that “we’ve found out that this company has been pressuring people to remove or edit their negative reviews”. At the time of publication (April 2025) this banner has been removed. 

Signature Clinic ultimately discontinued its claims of malicious falsehood against Mohammed, Kate and two other defamation defendants in the High Court, before settling the libel cases against them. The settlement included an agreement that Signature Clinic  pay the patients’ legal costs.

However, these cases were not the only legal threats the Clinic used to target its critics and others working in the space. Karen Perrett consulted with patients (or prospective patients) across the industry to connect them with plastic surgeons and previous patients and help them make an informed decision. An aspect of this work involves administering a number of Facebook groups, which cover different themes or topics related to plastic surgery.

In July 2023, Christian Gotti applied for an injunction against Karen under the Protection Against Harassment Act 1967 stating that she must remove a Facebook group set up by an account called “Dierdre Foster” and other groups and desist from “further defamatory or derogatory statements against the claimant”. Karen strongly denies any responsibility for Dierdre Foster’s account or posts. 

On 3 August 2023, a hearing at Hereford County Court in Worcester was scheduled to hear Mr Gotti’s application for an interim injunction against Karen. The court ordered that Karen was “forbidden by herself, or by encouraging others to post or be involved in any social media groups actively posting comments or remarks considered to be defamatory against Signature Medical Ltd or its staff present or past.” 

According to the crowdfunder that Karen set up to fund her appeals, once the injunction was granted by the court, “Mr Gotti said through his lawyer that he was ‘pleased’ I had ‘stayed off Facebook’ and that I had ‘probably reassessed my skillset and moved into other areas of work ‘ and ‘May this new status quo continue’.” Throughout correspondence between Karen and Mr Gotti’s lawyer, J N Stachiw, she was threatened with “prison and contempt of court proceedings repeatedly”. Further to that “he explicitly used the words ‘Prison’; … ‘Contempt’ and ‘Criminal’ more than 12 times over the course of a year and in various separate letters and emails”. 

After the granting of the injunction, J N Stachiw alleged that Karen had “broken” the terms of the injunction. “However, no application for committal of the respondent was ever issued.” In 2024, Karen made an application to the courts to have the injunction discharged. However, Gotti and his lawyer responded that because no claim form had ever been issued the court did not have jurisdiction and so the court should discharge the injunction but could not award Karen her costs.  However, as pointed out by Karen, “[t]his was despite the fact that they had relied on this injunction being in force and had confirmed several times that it had given their client what it wanted and also used it on many occasions to keep me off social media under the fear of the threat of imprisonment”.

This argument has taken on a more complex dimension as the parties to the legal action determine who is liable for covering Karen’s legal costs of the wrongfully granted injunction. In September 2024, in an appeal brought by Mr Gotti, his counsel again argued that the court did not have jurisdiction to award any costs or damages to Karen”. The court highlighted the potential benefits to Mr Gotti and Signature Clinic that this argument would bring forwards (if it succeeded) as “the appellant has had the advantage of an injunction which bound the respondent in what she could and could not do, but on its discharge there was no power of the court to intervene in respect of costs or any losses caused by the grant of this interim injunction to the respondent. In short a win, win outcome for the appellant.”  Ultimately, the Judge agreed that the court did have jurisdiction, finding that the “fact the process might be flawed or done in the wrong way…does not negate the fact that there were proceedings”. While this appeal by Mr Gotti was rejected, he sought permission to appeal again, which was accepted in December 2024. Lord Justice Lewison, in granting permission to appeal, described Mr Gotti’s argument as “an affront to common sense” but said that it nevertheless “raises novel and wide-ranging points” in terms of the importance of a claim form in civil proceedings. The Judge said this was a “compelling reason” to grant permission to appeal “irrespective of its prospects of success”. A hearing has been listed before the Court of Appeal for July 2025.