After writing posting an online review of what she considered to be a rather nightmarish dermatological procedure, a D.C. resident now finds herself on the receiving end of a lawsuit from a doctor she says left her with a visible scar. Moreover she now finds herself as the latest example of a consumer being hit with legal action over a bit of Internet feedback on less-than-satisfactory services.

Barb Howe says she visited Medical Cosmetic Enhancements, a clinic in Chevy Chase, Md., last July for a photo-facial, a skin treatment that uses doses of light to improve a patient’s skin. She purchased the procedure with a coupon offered by LivingSocial. During her visit, Howe tells DCist, her face was pressed by the photo-facial device in such a way that when the procedure was finished, she was left with a visible mark on the left side of her mouth.

Howe continues that after complaining to the technician who performed the facial, she spoke to the clinic’s on-staff dermatologist, Dr. Andrew Varano, who was “very rude” in refusing her request for a refund. (LivingSocial, however, did provide her with a credit for another coupon.)

Howe went home and took her gripes to Yelp, where she excoriated Varano and Medical Cosmetic Enhancements:

This is a really terrible business. They put out a LOT of coupons on Living Social and Groupon and like the others who made the mistake of buying those coupons thinking we were getting a great deal I had a disappointing experience. I got the IPL photo facial which is probably a scam. It does nothing. What’s worse is that it burned me and left a nice new scar near my lip. Thanks MCE! I had a bad feeling about them from the start but I didn’t want to lose the $160 I’d given them. Now I’d pay twice that to have this scar removed! I hope others can learn from my experience and never, ever patronize this place, no matter how cheap their coupons may be! Stay away!

Howe also lodged a more formal complaint with the Better Business Bureau.

When Medical Cosmetic Enhancements took notice of the Yelp review a few months later, though, the clinic was quite displeased, and sent Howe a cease-and-desist letter. In the letter, the clinic’s attorney, Jennifer S. Zucker of the law firm Wiley Rein LLP, included a 2006 photo taken from Howe’s Flickr account as evidence that scar in question was not caused by the 2011 facial.

“In other words, your complaints are entirely unsupported and false, and any attempts you make to receive compensation based upon these complaints are fraudulent claims,” Zucker wrote in the November 2 letter.

Courtesy of Barb Howe

In the 2006 photo, Howe appears to have a scar or wrinkle about three-quarters of an inch long jutting from the left side of her mouth. The scar she alleges was caused by the facial appears to be in roughly the same position in a recent photo.

Howe left the review intact, where it remains on her personal Yelp page, though it does not appear on Medical Cosmetic Enhancements’ page. Varano followed up with a small-claims defamation suit filed January 10 in D.C. Superior Court. In his affidavit on the suit, Varano, who is seeking $5,000 in damages, said that he told Howe the scar was already there. “I explained her facial scar was pre-existing,” he wrote. Neither Varano or Zucker responded to interview requests.

But Howe says she is being bullied, and if she can prove the scarring was caused by the dermatology clinic, she would hardly be the first person to be dragged into court over an unfavorable Yelp review. A Fairfax woman was briefly ordered to remove negative Yelp posts about a D.C.-based contractor who is suing her for defamation, though the injunction was subsequently lifted with the intervention of the American Civil Liberties Union and Public Citizen, a consumer advocacy group.

“We tend to think that the availability of forums where people can give their impressions and experiences of businesses is something that’s useful for consumers,” says Paul Levy, an attorney with Public Citizen who specializes in Internet speech cases. “That certainly includes Yelp. I post reviews when I travel and when I go to restaurants. It’s a good thing that it’s out there.”

Levy adds though, that in Howe’s case, it will have to be figured out if she is spreading false information about Varano or if she was legitimately harmed by Medical Cosmetic Enhancements’ equipment, which will be deliberated at the small-claims hearing scheduled for February 5. Upon reading Howe’s Yelp review, Levy says that while her complaints appeared to be grounded largely in opinion of Varano’s treatment of her, how she got the scar will be the big factual dispute.

“And opinion is not actionable,” he says. “Defamation is filed over false statements of fact. I’m not prepared to say this is a SLAPP [strategic lawsuit against public participation] suit or intimidation.”

This post has been updated.