Litigation and Complications Arising From Aesthetic Body Surgery: a Systematic Review

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Mussabekova, Yuliya Menchisheva, Álvaro Varela Morillas This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6680003/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Aesthetic body surgeries are increasingly performed worldwide, often driven by social media, shifting beauty standards, and medical tourism. Despite being elective procedures, they carry significant risk for complications and medico-legal disputes. This systematic review explores litigation trends, common complications, and legal outcomes in body aesthetic surgeries. Methods A systematic review was conducted per PRISMA guidelines, with registration on PROSPERO (ID: CRD420251043585). Forty-one studies published since 1 January 2020 were included, sourced from 7 databases, 2 trial registries, and grey literature. Eligible studies reported on adult patients undergoing body aesthetic surgeries and subsequent medico-legal claims. Data were extracted regarding surgical procedures, complications, legal allegations, and verdicts. Risk of bias was assessed using JBI and ROBINS-I tools. Results Liposuction, abdominoplasty, gluteoplasty, and breast augmentation were the most litigated procedures. Fat embolism, infection, and implant rupture were the most common complications cited in claims. Allegations frequently involved inadequate informed consent (over 50%), procedural errors, and insufficient follow-up. Plaintiff success rates ranged from 20–40%, especially when complications were severe or documentation was poor. Surgeon-favorable outcomes were more likely when thorough documentation and informed consent were evident. Conclusion Litigation in aesthetic body surgery is largely preventable and frequently associated with poor communication, inadequate consent, and procedural missteps. Standardizing informed consent, restricting high-risk procedures to certified specialists, and improving postoperative care may reduce litigation and improve patient safety. Forensic Medicine Plastic & Reconstructive Surgery Aesthetic surgery Medico-legal claims Body contouring Surgical complications Litigation Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 INTRODUCTION Aesthetic body surgery has witnessed a marked increase in global demand over recent decades [ 1 ]. Body contouring procedures now represent a substantial portion of elective surgeries worldwide, from liposuction and abdominoplasty to gluteal and breast augmentation [ 2 ]. This rise has been facilitated by the confluence of advanced surgical techniques, social media influence, and shifting ideals of beauty [ 3 ]. While most of these procedures are elective and performed on otherwise healthy individuals, they are not without risk [ 4 – 6 ]. Postoperative complications, patient dissatisfaction, and failure to meet aesthetic expectations have given rise to a growing number of medico-legal disputes globally [ 7 – 9 ]. Given the socio-economic and psychological implications of aesthetic procedures, legal scrutiny is increasing [ 10 , 11 ]. Surgeons and clinics face mounting pressure to align with medical, ethical, and legal standards [ 12 ]. Complication rates vary by procedure, practitioner experience, and setting, yet dissatisfaction - even with objectively satisfactory results-can prompt litigation [ 13 , 14 ]. As elective interventions hinge on personal expectations, the discrepancy between perceived and actual outcomes remains a primary driver of complaints [ 15 ]. The global nature of aesthetic medical tourism, coupled with uneven regulatory frameworks, further complicates liability assessment [ 16 ]. By consolidating international evidence on medico-legal risks in aesthetic body surgery, this review provides valuable insights into the risk factors, legal precedents, and preventative strategies. It serves as a resource for surgeons, policy-makers, and legal experts aiming to improve clinical practice, informed consent procedures, and patient safety. Ultimately, understanding the interplay between surgical outcomes and legal accountability can contribute to reducing preventable complications and minimizing litigation in body aesthetic surgery. METHODOLOGY The protocol for this study was registered in PROSPERO (ID: CRD420251043585)( https://www.crd.york.ac.uk/PROSPERO/view/CRD420251043585 ) and compiled by the Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines [ 17 ]. The study selection process is illustrated using the PRISMA flow chart [ 18 ]. Supplementary Material Appendix 1 (Tables 1 –4) has more details on the search methodology. Eligibility criteria Specific inclusion and exclusion criteria to ensure the selection of relevant studies were established (Supplementary Material, Appendix 1, Table 1 ). The inclusion criteria encompassed studies involving adult patients (aged ≥ 18) of any gender who underwent elective body aesthetic surgeries. Procedures considered included liposuction, abdominoplasty, breast augmentation, gluteoplasty, cruroplasty, and brachioplasty, as well as combinations thereof. Only studies that addressed postoperative complications, legal disputes, malpractice claims, or forensic evaluations in the context of these procedures were included. All eligible studies were published from 1 January 2020, in English, and had full-text availability. Retrospective, prospective, cross-sectional studies, case series, and case reports were included. The exclusion criteria involved studies focusing on non-body anatomical regions (e.g., facial surgery) and non-surgical procedures (injectable procedures - injection of hyaluronic acids, botox, hydroxyapatites, laser ablations, tattoo). Ultimately, non-English articles, those published prior to 2020, and publications categorised as comments, editorials, letters, reviews (both systematic and otherwise), guidelines, position papers, as well as in vitro and animal research were removed. Information sources A comprehensive literature search was conducted across seven electronic databases (MEDLINE (Ovid), EMBASE (Ovid), Cochrane Library, PubMed, Web of Science (Clarivate Analytics), SCOPUS (Elsevier), and Google Scholar); two registers (ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP)). Additional sources were also searched from platforms, including WorldCat, ProQuest Dissertations & Theses (PQDT), Open Access Theses and Dissertations (OATD), and the King's College London Research Portal. The date range for all searches was from 1 January 2020 onwards. Citation searching yielded an additional 12 records. Conference proceedings were searched through SCOPUS and Web of Science, while preprints were checked from SSRN and F1000Research Preprints. Supplementary Material Appendix 1 (Table 5) provides detailed information pertaining to the supplemental search strategies. The last update on searches occurred on 18 May 2025. Search strategy A comprehensive literature search strategy was created in collaboration with a seasoned research librarian to ensure the exhaustive inclusion of all pertinent studies, irrespective of language, study type, or publication status, covering published, unpublished, in-press, and ongoing research [ 19 ]. The Population, Intervention, Comparison, Outcome (PICO) framework was utilised to establish an organised and systematic methodology for formulating the research question and directing the literature review (Supplementary Material, Appendix 1, Table 2 ). The following research question was formulated: In patients who experienced complications after body surgery (P), how does the occurrence of medico-legal litigation (I) influence clinical and legal risk management strategies (O)? PICO Framework: • Population (P): Individuals who underwent body aesthetic surgery. • Intervention (I): Evaluation of postoperative complications and medico-legal disputes. • Comparison (C): Not applicable • Outcome (O): Identification of causes of medico-legal challenges, common complications, and proposed solutions. The following combinations of Medical Subject Headings, entry terms and keywords were used in the electronic search: “human”, “body surgery”, “liposuction”, “lipectomy”, “body contouring”, “embolism, fat”, “abdominoplasty”, “gluteoplasty”, “cruroplasty”, “brachioplasty”, “breast augmentation”, “mammoplasty”, “buttock augmentation”, “liability”, “legal”, “malpractice”, “forensic medicine”, and “court”. Boolean operators (AND/OR) were used to maximize relevance. Selection process The selection process used the automated screening technology Rayyan AI, developed by the Qatar Computing Research Institute. All retrieved studies were subjected to a two-phase screening process conducted independently by two reviewers (SM and YM) to ascertain their eligibility at each stage of the selection process. Included and excluded studies are presented in Supplementary Material Appendix 1 (Tables 6 and 7). Data collection process EndNote, a reference management program, was employed to optimise the data collection and organisation process. Duplicate articles were eliminated. The articles were chosen based on their titles and abstracts for relevancy, adhering to the inclusion and exclusion criteria given below (Supplementary Material, Appendix 1, Table 1 ). All abstracts underwent independent evaluation. Any disagreements were settled through the intervention of the third author (AVM) [ 20 ]. Google Scholar Alerts was utilised to update citations until the 18 May 2025, ensuring the incorporation of the most recent and pertinent publications. Articles meeting the criteria for full-text review were extracted. A standardised data extraction form was utilised to gather information regarding study characteristics (author, year, country, study type), total cases analysed, types of body plastic surgery procedures involved, primary medico-legal allegations and legal outcomes, prevalent postoperative complications, and litigation risk factors. Study risk of bias assessment The assessment of bias risk was performed utilising two validated instruments according to the study design. The Joanna Briggs Institute (JBI) critical assessment checklist (Australia, JBI) was utilised for case reports and case series [ 21 ]. The Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) (UK, Cochrane) was used to evaluate potential biases in both retrospective and prospective studies [ 22 ]. Two independent evaluators (SM and YM) performed a risk of bias evaluation. Supplementary Material Appendix 1, Tables 8–10, provide comprehensive evidence of the evaluation process. RESULTS A total of 41 studies met the inclusion criteria and were analyzed in this systematic review (Supplementary Material, Appendix 1, Table 6). The excluded studies are listed in Supplementary Material Appendix 1 (Table 7). The PRISMA flow diagram (Fig. 1 ) delineates the methodical selection process for research inclusion. These studies were geographically distributed as follows: USA (17) − 41,5%, Italy (4) – 9.6%, Canada (3) – 7.3%, Brazil (3) – 7.3%, UK (3) – 7.3%, Egypt (2) – 4.9%, others (South Korea, China, Germany, Kuwait, Romania, Peru, Vietnam, France, Switzerland): 1 study each (total 9 studies, 21.9% of total). Most studies were published between 2021 and 2024, with a noticeable peak in 2021 (14 studies) − 34.1%. Other annual distributions were: 2020 (4 studies) -9.75%, 2022 (5 studies)- 12.2%, 2023 (7 studies) -17%, 2024 (9 studies) − 21.9%, and 2025 (2 studies) – 4.8%. The characteristics of the studies assessing the legal landscape of aesthetic body surgery are presented in Table 1 , while a comparative analysis trends and outcomes in plastic surgery malpractice litigation are presented in Table 2 . The key characteristics of the cases and case series are described in detail in Table 3 . Table 1 Assessment of the legal landscape of aesthetic body surgery № First author, Year, Country Database Used, Time Frame of Analysis Total Cases Types of surgeries Main Complications Main Allegations Legal outcomes. Cases Won by Surgeons 1. Fan et al., 2020, USA [ 23 ] CRICO Benchmarking System, 2008–2019 174 Breast reconstruction, breast augmentation Infection, emotional trauma, cosmetic injury, scarring, wound dehiscence, skin necrosis, hematoma, rupture, implant displacement Improper performance, mismanagement, informed consent failure 41 cases paid; avg. payout $ 130,422 2. Boyd et al., 2021, USA [ 26 ] MPLA, AMS, 1991–2016 3008 Breast augmentation, reduction, breast surgery Unhappy results (20%), infection (10%) Improper performance, lack of follow-up, infection 761 paid claims, $ 141 361 756 total 3. Gibstein et al., 2023, USA [ 28 ] LexisNexis, 1988–2020 21 Breast surgery and reconstruction, abdominoplasty, liposuction, skin debridement and grafting Procedural error (52.4%), lack of consent (52.4%), supervision failure (52.4%) Inadequate supervision, resident inexperience, consent failure 38.1% defense verdicts, 28.6% plaintiff, 33.3% settled; median payout $ 5.1M 4. Remington et al., 2024, USA [ 30 ] Candello database, 2009–2018 2674 Breast surgeries, body-contouring, face-lift, eyelid surgeries, nasal surgeries. Emotional trauma (20.9%), infection (9.7%), scarring (8.2%) Poor technique, communication failures, documentation issues 26.8% paid claims; avg. payment $ 204,121 5. Reese et al., 2024, USA [ 32 ] Westlaw Campus, 2013–2021 32 Abdominoplasty, liposuction, buttock augmentation Infection (40.6%), scarring (31.3%), emotional distress (31.3%) Negligent technique (71.9%), poor postoperative care (62.5%) Only 1 plaintiff verdict; 56.3% for defense; few settlements 6. Rawash et al., 2025, Egypt [ 34 ] Cairo Medicolegal Area, 2016–2020 98 Liposuction, abdominoplasty, buttock augmentation Dehiscence, mortality (3.1%) Disfigurement, dissatisfaction, burns 44.9% positive for plaintiff; death in 3 cases; liposuction most litigated 7. Facchin et al., 2023, Italy [ 54 ] Hospital database, 2015–2019 788 procedures, 8 legal cases Abdominoplasties, torsoplasties, breast surgeries, brachioplasties, thighplasties, liposuctions 46% total (19% major, 27% minor); highest in thighplasty (63%) Cosmetic dissatisfaction, consent misinterpretation Only 1 payout; rest dismissed or surgeon won 8. ElHawary et al., 2021, Canada [ 56 ] LexisNexis, Westlaw, 1990–2019 86 Liposuction, fat grafting Death (42%), nerve or organ damage, scarring, unsatisfactory aesthetic results. Negligence, lack of consent 64% surgeon wins; avg. payout $ 1.45M 9. Zhang et al., 2021, Canada [ 57 ] CMPA, 2013–2017 414 Breast augmentation, abdominoplasty, body contouring Scarring (16.6%), deformity (15.9%), mental health (6.9%) Poor communication, consent, diagnosis failure 47.8% unfavorable; 43.4% compensated 10. Sarmiento et al., 2020, USA [ 59 ] Westlaw, 2000–2017 165 Abdominoplasty, Gender affirmation surgery, breast reconstruction, liposuction Disfigurement (42%), injury (24%), psychological distress (9%) Gross negligence, informed consent, surgical error 60% surgeon wins; payouts median $ 600,000 11. Feola et al., 2021, Italy [ 60 ] ORMe (Civil Court of Rome), 2012–2016 144 Breast augmentation, breast reconstruction, liposuction, body lifts (arm lift, buttock enhancement, thigh lift, and tummy tuck) Non-fatal injuries (97.9%), fatal (2.1%) Informed consent violations, procedural errors, unsatisfactory results 70.14% defendants were found liable 12. Moura et al., 2023, USA [ 61 ] Westlaw, 1979–2022 64 Breast surgery, fat reduction, body lift, aesthetic genital surgery, aesthetic face and neck surgeries. Permanent injury (21.4%), poor outcomes, death (3.1%) Out-of-scope practice (55.7%), informed consent, standard breaches 60.9% surgeon wins, 34.4% plaintiff, avg. payout $ 340,520 13. ElHawary et al., 2023, Canada [ 62 ] LexisNexis, Westlaw, 1970–2020 105 Breast surgeries, abdominoplasty, liposuction, blepharoplasty, rhinoplasty, face lifting, upper and lower extremity surgeries Most linked to informed consent issues Lack of informed consent, surgical error, unmet expectations 64.2% in favor of surgeon; avg. payout $ 61,076 14. Gong et al., 2023, USA [ 63 ] Westlaw, 1990–2020 96 Breast reduction surgeries Nipple malpositioning (14.6%), disfigurement (46.9%) Surgical negligence, poor planning, consent issues 67.7% defense verdicts, median payouts $ 221K– $ 650K 15. Kang et al., 2024, South Korea [ 64 ] Retrospective analysis, 2006–2012, 2017–2021 23 (2006–2012) 75 (2017–2021) Liposuction, mammoplasty, breast reconstruction, blepharoplasty, rhinoplasty, face and neck lift, orthognathic surgeries. N/A Breach of duty, dissatisfaction, medical malpractice 86.95% positive for plaintiff (2006–2012), 81.33% (2017–2021) Note*: not applicable, not available, not assessed, and/or no answer - N/A Table 2 Trends and outcomes in plastic surgery malpractice litigation: a comparative analysis № First author, Year, Country Methodology & Time Frame Total Cases Type of Surgery Complication Types Study Focus Key Findings Conclusion 1. O’Connell et al., 2021, UK [ 24 ] Review of litigation claims, 2012–2018 449 Breast surgeries Infection (9.4%), hematoma, skin necrosis Analysis of claims related to breast surgery Most claims due to delays in diagnosis and dissatisfaction with outcomes; annual litigation cost estimated at £5.57 to £9.59 million. Need for improved consent processes and addressing patient expectations to reduce litigation risks. 2. Henry et al., 2021, UK [ 25 ] Observational study; 2015–2020 26 Abdominoplasty, gluteal enhancement, breast augmentation and reduction, genioplasty, thigh lift. Wound infection (50%), wound dehiscence (42%), fat necrosis (12%). Evaluation of complications from cosmetic surgery tourism Majority of patients were female with mean age 35.1 years; NHS cost totalled £152,946, average £5,882.54. Patients seeking cosmetic surgery abroad face significant risks; the NHS bears the financial burden of these complications, needing better patient education. 3. Santis et al., 2022, Brazil [ 27 ] Review of literature and legislative proposal, 2018–2021 N/A Liposuction, Mammoplasty Intraoperative complications, infections, allergic reactions, death Examination of the underreport-ting of complications Significant disparity between reported complications and some procedures performed. Compulsory notification is proposed to improve data collection and patient safety. 4. Schafer et al., 2023, USA [ 29 ] Retrospective cohort analysis, 2016–2020 28,171 (1400 complications) Augmentation mammaplasty, Reduction mammaplasty, Trunk liposuction, Mastopexy, Abdominoplasty Superficial wound disruption, hematoma, seroma, pulmonary embolism Comparison of 30-day complication rates Overall complication rate was 5.0%; combined procedures had a higher complication rate (7.6%) compared to the index (4.2%). Increased risk noted for trunk liposuction and augmentation mammaplasty necessitates careful patient evaluation and shared decision-making. 5. Weidmanet al., 2024, USA [ 31 ] Retrospective analysis; QUAD A database, 2019–2021 46,244 cases Fat grafting (gluteal augmentation) – 436 cases Wound infection, wound disruption, hematoma, seroma, thromboembolism, death Analysis of complications related to fat grafting Overall complication rate of 0.94%; gluteal augmentation accounted for 37.6% of complications; 4 deaths reported. Increased reporting requirements are essential for enhancing patient safety and understanding the complication profile of these procedures. 6. Valentine et al., 2024, USA [ 33 ] Cross-sectional study, 2019–2021 246,119 Liposuction Unplanned hospital presentation, wound disruption, venous thromboembolism, infection, death Analysis of outpatient liposuction complications The complication rate was 0.40%; the most common complication was unplanned hospital presentation (24%); the Southeast region had the highest incidence. Liposuction associated with serious complications in outpatient settings, highlighting the need for enhanced safety measures. 7. Dyer et al., 2021, France [ 42 ] Court ruling; analysis of litigation claims, 2010–2021 2700 Breast surgeries Rupture, inflammation due to industrial silicone Investigation of compensation claims related to PIP implants TUV Rhineland found negligent; PIP implants made with industrial-grade silicone. Ruling emphasises the need for stringent safety regulations in medical device certification. 8. Di Santis et al., 2020, Brazil [ 43 ] Documentary study; media reports and death certificates, 1987–2015 102 Liposuction Pulmonary thromboembolism, infection, perforation, hemorrhage, fat embolism Investigation of deaths related to liposuction 17.44% deaths due to pulmonary thromboembolism; 45% died on the day of surgery; 98.04% were women. Compulsory notification of complications should be established to develop preventive guidelines. Table 3 Complications and allegations in aesthetic body surgery: a review of case reports № First author, Year, Country Cases Patient Characteris tics Surgery Type Medical Complications Main Allegations Conclusion 1. Venditto et al., 2020, USA [ 35 ] 16 32.7 years, female Brazilian butt lift (BBL), liposuction, abdominoplasty, breast augmentation Infection, wound breakdown, hematoma Inadequate preoperative counselling Cosmetic surgery tourism leads to significant complications. 2. Shrestha et al., 2022, USA [ 36 ] 1 48 years, female Lipoabdominoplasty, ventral hernia repair Necrotizing soft tissue infection, bowel perforation Lack of postoperative monitoring Significant risks from medical tourism necessitate safety standards. 3. Cabar et al., 2022, Brazil [ 37 ] 5 Ages N/A, 4 females, 1 male Multiple procedures Necrotizing soft tissue infection Inadequate informed consent Comprehensive patient information is crucial. 4. Budini et al., 2024, Italy [ 38 ] 13 18 to 40 years (mean 28.8) Multiple procedures Surgical complications, infections Inadequate preoperative counselling Surgical tourism poses significant risks. 5. Koussayer et al., 2024, USA [ 39 ] 3 26 to 48 years, female Mastopexy, liposuction Nontuberculous mycobacteria infections Inadequate postoperative care Medical tourism poses risks for infections. 6. Shaffrey et al., 2024, USA [ 40 ] 1 52 years, female Abdominoplasty, umbilical hernia repair Retained surgical sponge, abscess formation Inadequate postoperative care Improved patient education and continuity of care are needed. 7. Trignano et al., 2021, Italy [ 41 ] 1 28 years, female Breast augmentation Isolated subcutaneous emphysema, infection Inadequate surgical technique and preoperative planning Compliance with guidelines is essential to prevent complications. 8. Wang et al., 2020, China [ 44 ] 1 39 years, female Autologous fat grafting (vaginal tightening, breast augmentation) Severe fat embolism Inadvertent injection of fat into vessels Severe fat embolism post-surgery; anatomical research required. 9. Scarlat et al., 2021, Romania [ 45 ] 1 30 years, female Abdominal liposuction Massive fat pulmonary embolism Lack of medical indication for surgery Fat embolism is a severe complication of liposuction. 10. Zamora-Mostacero et al., 2021, Peru [ 46 ] 1 43 years, female Liposuction, autologous fat transfer Massive hemoperitoneum, mixed pulmonary embolism Inadequate surgical technique Mixed pulmonary embolism necessitates careful procedural technique. 11. Pham, 2022, Vietnam [ 47 ] 1 37 years, female Breast augmentation, abdominoplasty, liposuction Fat embolism, respiratory distress Inadequate monitoring Timely diagnosis of fat embolism is crucial. 12. Wolfe et al., 2022, USA [ 48 ] 2 28 years, female; 26 years, female Gluteal fat grafting Macro-fat embolism, respiratory distress, stroke Lethal complications from fat embolism Early recognition and management are crucial. 13. Shaheen et al., 2023, Egypt [ 49 ] 1 26 years, female Injectable gluteal filler Fatal pulmonary embolism Illegal procedure Injectable fillers pose significant risks. 14. Rogers et al., 2024, USA [ 50 ] 7 29 to 57 years (mean 43) Liposuction, buttock lift Fatal pulmonary embolism Inadequate adherence to safety protocols Adherence to guidelines is crucial to prevent fatalities. 15. Jorge et al., 2021, Germany [ 53 ] 1 22 years, male Power-assisted liposuction, subcutaneous mastectomy Unilateral hematoma, von Willebrand Disease (vWD) Omission of medical history in self-assessment Structured self-assessment questionnaires enhance patient safety. 16. Ibrahim et al., 2021, Kuwait [ 55 ] 1 39 years, female Bilateral breast reduction mammoplasty Total loss of nipple-areola complex, necrosis Faulty surgical decision Proper preoperative planning can prevent severe complications. 17. Dyer, 2024, UK [ 65 ] 6 29 to 57 years (mean 43.67) Liposuction, buttock lift Scarring, complications from inadequate consent Inadequate surgical practice Proper consent and care standards are essential. 18. Perrin et al., 2025, Switzerland [ 58 ] 1 22 years, female Bilateral subpectoral breast augmentation, extended lipoabdominoplasty Retained surgical sponge, hypovolemic shock Inadequate postoperative care Specialist oversight is critical in cosmetic procedures. Complication frequencies Among the complications described across all reviewed articles, infection wad the most frequently reported, appearing in 48.7% (n = 20) of the studies [ 23 – 42 ]. Liposuction-related complications were the second most prevalent, occurring in 26.8% (n = 11) of the studies [ 29 , 31 , 32 , 43 – 50 ]. These complications included fat and thromboembolism. This finding aligns with the broader clinical concern over gluteal fat grafting, commonly known as the Brazilian Butt Lift (BBL), which has gained attention for its elevated mortality risk compared to other procedures [ 51 , 52 ]. Fat embolism was consistently associated with intramuscular fat injection and improper technique, particularly in unregulated facilities or those lacking intraoperative ultrasound guidance. Hemorrhage and hematoma formation were reported in 21.9% (n = 9) of the studies [ 23 , 24 , 29 , 31 – 34 , 38 , 53 ]. Wound dehiscence was identified in 21.9% (n = 9) of studies, predominantly in patients with comorbidities or who had undergone multiple simultaneous procedures [ 23 , 25 , 29 , 31 – 33 , 35 , 38 , 54 ]. Skin necrosis in 19.5% (n = 8) of studies [ 23 , 24 , 28 , 35 , 37 , 38 , 54 , 55 ]. Scarring was reported in 17% (n = 7) of the studies, mostly in the context of breast surgery [ 23 , 28 , 30 , 32 , 54 , 56 , 57 ] as well as implant rupture which identified in 9.7% (n = 4) of the studies [ 31 , 32 , 44 , 58 ]. These ruptures often occurred due to trauma, inadequate implant quality, or technical failure during insertion. Complication Frequencies in Aesthetic Surgery are presented in Fig. 2 . Anatomical Distribution of Complications Based on the review and quantitative extraction from 41 articles on aesthetic surgery complications, a more precise anatomical and procedural analysis reveals important distinctions in both the frequency and severity of postoperative complications. Using the exact case numbers from the studies, a better understanding can be gained regarding which regions and procedures pose the highest risk to patients (Fig. 3 ). Gluteal region: The gluteal region, predominantly involving gluteal fat grafting (e.g., the BBL), revealed the highest proportion of fat embolism cases, with 40 cases out of 515, equating to a 7.77% incidence rate. While this percentage might appear modest, it reflects the most severe and often fatal complication across all regions analyzed. The danger lies in accidental intramuscular or intravascular fat injection, leading to embolic events in the lungs or brain. These findings strongly advocate for intraoperative ultrasound guidance, limited injection volume, and strict adherence to gluteal safety guidelines. Abdominal region: The abdominal area was associated with multiple complication types, particularly due to the popularity of liposuction and abdominoplasty procedures. Infection was the most commonly reported complication, with 50 out of 650 cases (7.69%). This was followed by hematoma (30/650, or 4.62%) and wound dehiscence (20/650, or 3.08%). These complications were often linked to high body mass index, poor hygiene, large resection zones, or concurrent surgeries. Cases with poor postoperative surveillance or surgery in uncertified settings were particularly vulnerable to infection and healing issues. Breast region: Among breast procedures such as augmentation, reduction, and reconstruction, several complications stood out. Implant rupture occurred in 30 of 400 cases (7.5%), largely due to long-term wear, trauma, or technical failure during surgery. Capsular contracture was noted in 25 cases (6.25%), often associated with chronic inflammation or subglandular implant placement. A unique complication in this region—nipple malposition - was found in 14 of 96 breast reduction cases (14.6%), which had the highest litigation success rate when not included in informed consent. Scarring, both hypertrophic and keloidal, was also common, reported in 46.9% of breast-related claims, underscoring the aesthetic and psychological sensitivity of breast outcomes. Thighs and flanks: Liposuction-related complications in the thigh and flank regions were reported in 45 of 300 cases (15%), reflecting a higher complication rate than the abdominal region. These included contour irregularities, skin laxity, and post-liposuction hematoma. High complication frequency in this area was attributed to the anatomical challenge of fat distribution and the technical complexity of creating smooth contours. Complication frequency varies substantially across anatomical zones, with some complications (e.g., fat embolism in gluteal and abdominal areas, nipple malposition in breast surgery) being more likely to lead to severe morbidity or litigation. Understanding these risks at a granular level allows for targeted risk-reduction strategies, including enhanced surgical training, certified facility use, patient education, and procedure-specific informed consent. The anatomical distribution of complications correlated closely with procedure type. Gluteal region complications - especially fat embolism - were the most lethal and the most likely to lead to litigation. Abdominal complications, primarily related to abdominoplasty and liposuction, often manifest as hematomas, infections, or flap necrosis. Breast surgeries were associated primarily with implant rupture and capsular contracture, with a smaller number involving asymmetry and scarring. Thighs and flanks were affected mainly in liposuction cases, particularly in medical tourism settings. Infections and wound dehiscence in these zones were often attributed to inadequate postoperative care or uncredentialed providers. Risk of bias in studies The appropriate checklist was selected based on the research design: the JBI Critical Appraisal Checklist for case reports [ 66 – 69 ] was applied to 18 studies, while the ROBINS-I checklist for observational cohort and cross-sectional studies [ 22 ] was used for the remaining 23 studies. Each study was meticulously reviewed against the specified criteria. A summary of these assessments is provided in Supplemental Tables 8, 9, and 10. An overarching appraisal was derived: case reports led to straightforward inclusion or exclusion decisions, while observational studies were rated for bias as 'Low,' 'Moderate,' 'High,' or 'Unclear' based on the criteria met. The overall risk-of-bias assessments indicated that the majority of studies exhibit a moderate risk across various domains, thereby contributing to the internal validity of the systematic review findings. The funnel plot showed noticeable asymmetry, particularly with a lack of studies on the left side of the plot, where smaller studies with lower favorable verdict rates would typically appear. This asymmetry suggested that such studies may be underrepresented or unpublished, possibly due to selective reporting favoring studies with more defendant-friendly outcomes. Furthermore, the clustering of points toward the right side—indicating higher favorable verdict rates—implies a tendency to publish studies with more positive outcomes for defendants. The forest plot supported this observation, as it displayed substantial heterogeneity (I² > 90%), with favorable verdict rates ranging widely across studies. Taken together, the asymmetrical funnel plot and heterogeneity in the forest plot suggest a likely presence of publication bias, potentially overestimating the true average rate of favorable verdicts for defendants. The funnel plot assessing publication bias in studies reporting legal outcomes in body plastic surgery is presented in Fig. 4 . Common allegations and legal outcomes Frequent allegations in litigation related to body aesthetic surgeries included: poor cosmetic outcomes, inadequate informed consent, procedural errors, surgical site infections, delayed diagnosis of complications, and permanent injuries such as fat embolism, nerve damage, or scarring. Informed consent deficiencies were cited in over 50% of the reviewed cases. Among the legal outcomes, approximately 45–76% of claims were dismissed, while 20–40% resulted in settlements or compensation. Lawsuits with evidence of inadequate documentation or absent informed consent were more likely to result in plaintiff victories. Across the studies, the primary causes of medico-legal issues included: - Inadequate or absent informed consent - Procedural errors and technical complications - Failure to diagnose or manage postoperative complications - Poor patient selection, including patients with unrealistic aesthetic expectations - Lack of postoperative follow-up - Out-of-scope practice by non-plastic surgeons performing high-risk procedures - Communication failures between healthcare providers and patients The legal outcome of malpractice claims in facial plastic surgery varied considerably across studies. Case dismissals were the most common result, ranging from 45–76%, indicating that many claims may lack sufficient legal basis. However, in 20–40% of cases, settlements were reached, reflecting instances where some level of responsibility or compromise was acknowledged. Notably, the highest financial compensations were awarded in cases involving severe functional impairments, as opposed to those based solely on aesthetic dissatisfaction, highlighting the greater legal weight assigned to objective physical harm over subjective concerns. The legal outcomes varied, but the majority of cases favoured the defense (surgeons), especially when documentation was comprehensive. Still, 20–40% of the cases resulted in either a settlement or a verdict favouring the plaintiff, particularly in the context of catastrophic outcomes (e.g., death, embolism, or long-term disfigurement). Claims lacking adequate preoperative documentation were significantly more likely to result in compensation for patients. Statistical findings Out of the studies providing complete legal outcome data, the average rate of favourable verdicts for defendants (surgeons) was approximately 54.3% (95% CI: 49–59%). Statistical analysis revealed a significant correlation between inadequate informed consent and litigation loss. High case volumes were also linked to increased complication and death rates in outpatient centres. Fat embolism, particularly in gluteal fat grafting, was one of the most fatal complications, especially when performed by underqualified providers. A forest plot of the legal outcomes decided in favour of surgeons in plastic surgery is presented in Fig. 5 . Limitations Several limitations were identified in the reviewed studies: inconsistencies in reporting, variations in legal systems, exclusion of confidential settlements, underrepresentation of low- and middle-income countries, and a lack of longitudinal follow-up. Many cases that were resolved through arbitration or pre-court settlements were not captured in formal databases, potentially underestimating the total litigation burden. DISCUSSION This systematic review aimed to identify, categorise, and synthesise the existing evidence on the postoperative complications and medico-legal disputes associated with aesthetic surgeries of the body. The findings provide substantial insight into the types of complications most often associated with litigation, the legal context in which these cases unfold, and the systemic vulnerabilities in current surgical practice that contribute to adverse medico-legal outcomes. The overwhelming representation of studies from the United States underscores the highly litigious environment of American healthcare, where malpractice claims are systematically tracked and publicly recorded. This contrasts with countries that may experience underreporting due to limited access to legal representation, weaker regulatory oversight, or cultural barriers to litigation. Nevertheless, the presence of cases from Brazil, Canada, the UK, and Italy illustrates that litigation in aesthetic medicine is a global concern, with rising case volumes and increasing awareness among patients of their legal rights. The majority of the reviewed studies employed retrospective methodologies, relying heavily on legal database searches (e.g., Westlaw, LexisNexis, CMPA) or national court archives. This methodological choice provides robust data for understanding past litigation but is limited in predicting future trends. Moreover, the retrospective nature makes it challenging to capture informal dispute resolutions and pre-trial settlements, which are common in aesthetic surgery malpractice claims. Future research could benefit from incorporating prospective registries and hospital-based litigation tracking systems [ 70 – 72 ]. Complications leading to legal claims were often preventable, including infection, wound dehiscence, and thromboembolic events [ 70 – 74 ]. The particularly high number of claims involving embolism, especially in liposuction and fat grafting procedures, signals a need for increased vigilance [ 75 – 78 ]. Despite improvements in surgical technique, these complications remain prevalent and are frequently lethal [ 75 , 79 – 81 ]. Notably, a subset of fatal complications occurred in high-volume ambulatory centers, especially in regions with less stringent oversight, such as South Florida in the USА [ 82 , 83 ]. This emphasises the need for regulatory reforms and uniform safety protocols for outpatient cosmetic surgery facilities. The consistent theme across the studies was the central role of informed consent. More than one-third of claims were rooted in allegations of inadequate consent [ 84 , 85 ]. The nature of aesthetic surgery, where subjective patient expectations play a significant role in satisfaction, elevates the importance of a comprehensive consent process [ 2 , 23 , 86 , 87 ]. Surgeons who thoroughly documented the discussion of aesthetic procedure risks, benefits, alternatives, and limitations were more likely to avoid legal liability. This supports the implementation of standardised consent protocols, including visual tools and psychological screening for patients with unrealistic expectations or suspected body dysmorphic disorder (BDD) [ 5 , 88 – 92 ]. The review also revealed procedural errors as another frequent allegation, often stemming from improper technique, unqualified operators (e.g., general practitioners performing aesthetic surgeries), or inadequate supervision in training settings. Cases involving non-specialists or surgeries performed outside their scope of certification had higher rates of adverse outcomes and successful patient claims [ 93 , 94 ]. Legal literature supports restricting certain procedures to board-certified plastic surgeons and mandating continued education in patient safety [ 13 , 75 , 76 ]. Surprisingly, few studies addressed the role of postoperative follow-up in litigation risk [ 8 , 70 , 72 , 95 ]. However, missed and poor communication during recovery were highlighted in qualitative reviews [ 23 , 30 , 34 , 60 ]. This indicates that improving continuity of care and establishing reliable communication channels may reduce dissatisfaction and prevent legal escalation [ 96 ]. Additionally, in the context of medical tourism - another rising trend - patients treated abroad often lacked access to follow-up care, further compounding risks and legal ambiguity [ 16 , 32 , 97 ]. Financially, the data demonstrated that claims involving functional impairment (e.g., embolism, necrosis, chronic pain) resulted in higher compensation compared to claims driven purely by aesthetic dissatisfaction [ 32 , 33 , 43 , 45 , 46 , 50 , 56 ]. This suggests that courts give greater weight to objective injuries than to subjective appearance-related grievances, even in aesthetic surgery. Still, settlements were not uncommon even in subjective cases, particularly when documentation was vague or surgeons were unable to prove proper consent or protocol adherence. The results presented in this study support previous findings in facial aesthetic surgery litigation, indicating that the underlying drivers of lawsuits, such as unmet expectations, inadequate, and poor communication, transcend anatomical regions[ 11, 16, 18, 32]. Body aesthetic surgeries may be uniquely vulnerable due to the scale and invasiveness of procedures such as BBL, abdominoplasty, or high-volume [ 32 , 33 , 36 , 40 , 43 , 45 , 46 , 50 , 56 , 98 ]. These are also increasingly performed in outpatient settings, where emergency preparedness and monitoring may be compromised. CONCLUSION This systematic review highlights the complex interplay between aesthetic body surgery, patient outcomes, and medico-legal accountability. The findings reveal that inadequate informed consent, procedural errors, poor communication, and insufficient postoperative care remain the most common drivers of litigation. Liposuction, abdominoplasty, gluteoplasty, and breast augmentation were the most litigated procedures, with complications such as infections, embolism, scarring, wound dehiscence, skin necrosis, hemorrage/hamatoma, and implant rupture frequently leading to legal claims. Gluteal fat grafting was associated with the highest mortality and legal risk. Across most countries studied, especially in the U.S. and Brazil, litigation was more likely to be successful for plaintiffs when documentation was lacking, or complications were not adequately communicated. From a legal standpoint, the role of informed consent emerged as central. Surgeons who failed to document risk discussions or who operated on patients with unrealistic expectations faced a significantly higher probability of losing in court. In contrast, those who provided comprehensive preoperative counselling and maintained detailed records were generally better protected legally. To mitigate these risks, several strategies are recommended: standardized, detailed informed consent protocols; adherence to procedural scope and guidelines; enhanced training in risk communication and medico-legal education; and incorporation of psychological screening for patients seeking body aesthetic procedures. Additionally, regulators should consider mandatory complication reporting systems and certification requirements for outpatient aesthetic practices. By implementing these strategies, the medical community can improve outcomes while minimizing the legal and ethical risks inherent to aesthetic practice. Declarations Acknowledgement: The authors declare that they have no conflict of interest. References Thawanyarat K, Hinson C, Gomez DA, Rowley M, Navarro Y, Johnson C, Venditto CM (2023) #PRS: A Study of Plastic Surgery Trends With the Rise of Instagram. Aesthet Surg J Open Forum 5: DOI: ojad004.10.1093/asjof/ojad004. Gutowski KS, Chwa ES, Weissman JP, Garg SP, Simmons CJ, Brandt KE, Gosain AK (2023) Practice Profile of Practicing Plastic Surgeons: A 20-year Review of Plastic Surgery Statistics. Plast Reconstr Surg Glob Open 11: e5486. DOI:10.1097/GOX.0000000000005486. Bezzini DR, Washington GN, Abiodun O, Olufajo OA, Jones I, Butts DM, Ortega G, Paul H (2021) The Potential Impact of Plastic Surgery Expertise on Body Contouring Procedure Outcomes. Aesthet Surg J 41: 47-55. DOI: 10.1093/asj/sjaa056. Nguyen L, Afshari A, Grotting JC, Perdikis G, Kye Higdon K (2022) Preoperative Risk Factors and Complication Rates of Breast Augmentation With Fat Grafting. Aesthet Surg J 42: 749-757. DOI:10.1093/asj/sjac061. Rudy H, Lu YH, Rothchild E, Chernovolenko D, Ricci JA (2025) Marijuana Use Increases the Risk of Postoperative Bleeding in Patients Undergoing Abdominal Body Contouring. Aesthetic Plast Surg 49: 1410-1417. DOI:10.1007/s00266-024-04651-5. Comerci AJ, Arellano JA, Alessandri-Bonetti M, Mocharnuk JW, Marangi GF, Persichetti P, Rubin JP, Egro FM (2024) Risks and Complications Rate in Liposuction: A Systematic Review and Meta-Analysis. Aesthet Surg J 44: NP454-NP463. DOI: 10.1093/asj/sjae074. Reisman NR (2024) Medico-Legal Pitfalls Associated with the Male Aesthetic Patient In: A Comprehensive Guide to Male Aesthetic and Reconstructive Plastic Surgery. Springer. DOI: 10.1007/978-3-031-48503-9_8. Dalmar M, El Sheikh M, Baker R, Uppal R (2024) Managing complications following cosmetic surgery after the COVID pandemic: A study of a year at an NHS plastic surgery unit. Journal of Plastic, Reconstructive and Aesthetic Surgery 88: 47- 50. DOI:10.1016/j.bjps.2023.10.135. Wang H, Liu J, Bordes MC, Chopra D, Reece GP, Markey MK, Hoffman AS (2022) When discussing breast reconstruction, do psychosocial characteristics influence which surgical options patients remember? Cancer Research 82: P4-09-04. Feldman D, Grenon V (2022) Malpractice claims in plastic surgery: descriptive-comparative-predictive. Plastic and Reconstructive Surgery–Global Open 10: 37-38. Hibler BP, Eliades PJ, Kagha KC, Avram MM (2021) Litigation Arising From Minimally Invasive Cosmetic Procedures: A Review of the Literature. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al] 47: 1606-1613. DOI:10.1097/DSS.0000000000003202. Abdel-Hamid M (2023) Liposuction - Current legal situation. Vasomed 35: 164. Montrief T, Bornstein K, Ramzy M, Koyfman A, Long BJ (2020) Plastic Surgery Complications: A Review for Emergency Clinicians. West J Emerg Med 21: 179-189. DOI:10.5811/westjem.2020.6.46415. Arbaje AI, Werner NE, Kasda EM, Wu AW, Locke CFS, Aboumatar H, Paine LA, Leff B, Davis RO, Boonyasai R (2020) Learning From Lawsuits: Using Malpractice Claims Data to Develop Care Transitions Planning Tools. J Patient Saf 16: 52-57. DOI:10.1097/PTS.0000000000000238. Elshama SS (2024) How to Investigate Legal and Professional Liability in Cosmetic Intervention Issues. Available at SSRN 4984253 Svider PF, Keeley BR, Zumba O, Mauro AC, Setzen M, Eloy JA (2013) From the operating room to the courtroom: a comprehensive characterization of litigation related to facial plastic surgery procedures. Laryngoscope 123: 1849-1853. DOI:10.1002/lary.23905. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hrobjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372: n71. DOI:10.1136/bmj.n71. Haddaway NR, Page MJ, Pritchard CC, McGuinness LA (2022) PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis. Campbell Syst Rev 18: e1230. DOI:10.1002/cl2.1230. McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C (2016) PRESS Peer Review of Electronic Search Strategies: 2015 Guideline Statement. J Clin Epidemiol 75: 40-46. DOI:10.1016/j.jclinepi.2016.01.021. de Vet HCW, Dikmans RE, Eekhout I (2017) Specific agreement on dichotomous outcomes can be calculated for more than two raters. J Clin Epidemiol 83: 85-89. DOI:10.1016/j.jclinepi.2016.12.007. Moola S, Munn Z, Sears K, Sfetcu R, Currie M, Lisy K, Tufanaru C, Qureshi R, Mattis P, Mu P (2015) Conducting systematic reviews of association (etiology): The Joanna Briggs Institute's approach. Int J Evid Based Healthc 13: 163-169. DOI:10.1097/XEB.0000000000000064. Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hrobjartsson A, Kirkham J, Juni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schunemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JP (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355: i4919. DOI:10.1136/bmj.i4919. Fan B, Pardo J, Yu W, Janes M, James T (2020) Society of Surgical Oncology SSO 2020 - International Conference on Surgical Cancer Care. Ann Surg Oncol 27: 1-230. DOI:10.1245/s10434-020-08278-z. O’Connell RL, Patani N, Machin JT, Briggs TWR, Irvine T, MacNeill FA (2021) Litigation in breast surgery: unique insights from the English National Health Service experience. BJS Open 5: zraa068. DOI:10.1093/bjsopen/zraa068. Henry N, Abed H, Warner R (2021) The ever-present costs of cosmetic surgery tourism: a 5-year observational study. Aesthetic plastic surgery 45: 1912-1919. Boyd JB, Moon HK, Martin S, Mastrogiovanni DB (2021) Plastic Surgery and the Malpractice Industry. Plast Reconstr Surg 147: 239-247. DOI:10.1097/PRS.0000000000007497. Santis ÉPD, Yarak S, Martins MR, Hirata SH (2022) Compulsory notification of injuries in aesthetic procedures. Impact on patient safety. Anais Brasileiros de Dermatologia 97: 491-497. Gibstein AR, Jabori SK, Watane A, Slavin BR, Elabd R, Singh D (2023) Do plastic surgery residents get sued? An analysis of malpractice lawsuits. Plastic and Reconstructive Surgery–Global Open 11: e4721. Schafer RE, Blazel MM, Nowacki AS, Schwarz GS (2023) Risk of Complications in Combined Plastic Surgery Procedures Using the Tracking Operations and Outcomes for Plastic Surgeons Database. Aesthet Surg J 43: 1384-1392. DOI:10.1093/asj/sjad124. Remington AC, Schaffer A, Hespe GE, Yugar CJ, Sherif R, Vercler CJ (2024) Understanding Factors Associated with Paid Malpractice Claims in Plastic Surgery. Plast Reconstr Surg 153: 644e-649e. DOI:10.1097/PRS.0000000000010593. Weidman AA, Foppiani J, Valentine L, Hernandez Alvarez A, Elmer N, Hassell N, Seyidova N, Hwang P, Paul M, Arguello A (2024) Complications from fat grafting and gluteal augmentation in outpatient plastic surgery: an analysis of American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF, QUAD A) data. Aesthetic surgery journal 44: 722-730. Reese A, Navarro A, Kozlowski K, Singh S, Vu G, Neimanis S, Burke M, Morrison C (2024) An Updated Analysis of Body Contouring Malpractice Cases. Ann Plast Surg 92: S275-S278. DOI:10.1097/SAP.0000000000003870. Valentine L, Alvarez AH, Weidman AA, Foppiani J, Hassell NE, Elmer N, Hwang P, Kaul S, Rosenblatt W, Lin SJ (2024) Liposuction complications in the outpatient setting: a national analysis of 246,119 cases in accredited ambulatory surgery facilities In: Aesthet Surg J Open Forum 6:ojad107. DOI: 10.1093/asjof/ojad107. Rawash GA, Ibrahim NA, Farrag IM, Mostafa SY (2025) Medicolegal aspects of medical malpractice claims following aesthetic interventions in Cairo, Egypt. Egyptian Journal of Forensic Sciences 1510.1186/s41935-024-00419-9. Venditto C, Gallagher M, Hettinger P, Havlik R, Zarb R, Argenta A, Doren E, Sanger J, Klement K, Dzwierzynski W, LoGiudice J, Jensen J (2021) Complications of Cosmetic Surgery Tourism: Case Series and Cost Analysis. Aesthet Surg J 41: 627-634. DOI:10.1093/asj/sjaa092. Shrestha S, Lue M, Wang HT (2022) Necrotizing Soft Tissue Infection of Abdominal Wall after Lipoabdominoplasty: Complication following Medical Tourism. Plast Reconstr Surg Glob Open 10: e4416. DOI:10.1097/GOX.0000000000004416. Cabar FR, Ribeiro AEA, Gorga ML (2022) Civil sentencing in health care and their relation with blanket consent in rulings from the Court of Appeals of the State of Sao Paulo. Revista da Associacao Medica Brasileira 68: 422 - 425. DOI: 10.1590/1806-9282.20211298. Budini V, Zanettin C, Brambullo T, Bassetto F, Vindigni V (2024) Aesthetic Surgery Tourism: An Opportunity or a Danger? Aesthetic Plast Surg 48: 3914-3920. DOI:10.1007/s00266-024-04117-8. Koussayer B, Blount T, Alkaelani MT, Le NK, Al Bayati MJ, Moffitt J, Troy J (2024) Medical Tourism in Plastic Surgery: A Case Series of Complications. Eplasty 24: e10. Shaffrey EC, Larson JD (2024) Unintended Souvenirs: Case Report of a Retained Foreign Body During Cosmetic Surgery Tourism. Aesthet Surg J Open Forum 6: ojae070. DOI:10.1093/asjof/ojae070. Trignano E TC, Baccari M, Serra PL, Pili N, Mazzeo E, Rubino C. (2021) Iatrogenic subcutaneous emphysema in aesthetic breast augmentation Medicolegal aspects. . Ann Ital Chir: 131-134. Dyer C (2021) Women harmed by faulty breast implants should be compensated, says French court. BMJ 373: n1307.10.1136/bmj.n1307. Di Santis ÉP, Yarak S, Martins MR, Hirata SH (2020) Deaths related to liposuction in Brazil. Surgical & Cosmetic Dermatology 12: 320-325. Wang C, Wang X, Huang J, Yu N, Long X (2020) Severe fat embolism after autologous fat grafting in vaginal tightening and breast augmentation surgery. J Int Med Res 48: 300060520949109. DOI:10.1177/0300060520949109. Scarlat MS, Poll IA, Capatina CO (2021) Massive Fat Pulmonary Embolism due to Liposuction. A Case Report. Romanian Journal of Legal Medicine 29: 360-364. DOI:10.4323/rjlm.2021.360. Zamora-Mostacero VE, Vargas-Ferrer JE, Paredes-Julca AA, Vasquez-Montoya AT (2021) Skeletal muscle and fatty tissue in mixed pulmonary embolism associated with liposuction: An incidental autopsy finding. Forensic Sci Med Pathol 17: 312-316. DOI:10.1007/s12024-020-00353-x. Pham MQ (2022) Fat Embolism After Plastic Surgery: A Case Report. Plast Aesthet Nurs (Phila) 42: 27-30. DOI:10.1097/PSN.0000000000000414. Wolfe EM, Weber LE, Wo LM, Samaha MJ, Mathew P, Garcia O, Singh D (2022) Two Cases Surviving Macro Fat Emboli Complications Following Gluteal Fat Grafting. Aesthet Surg J 42: 902-906. DOI:10.1093/asj/sjac063. Shaheen S, Al-Habbaa A, Riad MS, Mandour AS, Elzeny MA, Alnady K (2023) Fatal pulmonary embolism following injectable gluteal filler usage: a case report. Egypt Heart J 75: 83. DOI:10.1186/s43044-023-00415-9. Rogers C, Astarita D, Sathyavagiswaran L, Pazmino P, Ramirez-Montanana A (2025) Fat Embolism Fatalities Following Liposuction/Injection in Los Angeles County (2010-2018). Am J Forensic Med Pathol 46: 48-54. DOI:10.1097/PAF.0000000000000993. Kalaaji A, Jönsson V, Haukebøe TH (2022) Gluteal augmentation with fat: patient assessment, operative technique, and safety guidelines In: Plastic and Aesthetic Regenerative Surgery and Fat Grafting: Clinical Application and Operative Techniques Springer, pp 1307-1326 Tillo O, Nassab R, Pacifico MD (2023) The British Association of Aesthetic Plastic Surgeons (BAAPS) gluteal fat grafting safety review and recommendations. Aesthetic Surgery Journal 43: 675-682. Jorge ACSRG, Estler A, Stahl AS, Daigeler A, Stahl S (2021) Incidental Detection of Von Willebrand Disease: Can A Self-Assessment Anamnesis Questionnaire Protect From litigation And Minimize Complications? DOI:10.21203/rs.3.rs-955319/v1. Facchin F, Pagani A, Perozzo FAG, Scarpa C, Bassetto F, Vindigni V (2023) Litigation Cases After Post-Bariatric Surgery: Lesson from the Past. Aesthetic plastic surgery 47: 2479-2485. DOI:10.1007/s00266-023-03287-1. Ibrahim D, Abdel-satar M, Gaballah I (2021) A Case Report of Bilateral Breast Reduction Mammoplasty Crisis in Kuwait: Medical Malpractice or Postoperative Complication. The Egyptian Journal of Forensic Sciences and Applied Toxicology 21: 11-18. DOI:10.21608/ejfsat.2020.32900.1152. ElHawary H, Saed Aldien A, Alam P, Janis JE (2021) When Liposuction Goes Wrong: An Analysis of Medical Litigation. Aesthet Surg J 41: NP1337-NP1338. DOI:10.1093/asj/sjab156. Zhang Z, Calder L, Finestone PJ, Liu R, Bucevska M, Arneja JS (2021) Medico-legal Closed Case Trends in Canadian Plastic Surgery: A Retrospective Descriptive Study. Plast Reconstr Surg Glob Open 9: e3754. DOI:10.1097/GOX.0000000000003754. Perrin M, Schweizer T, Oetliker C, Reuthebuch OT, Babst D, Schaefer DJ (2025) From Aesthetic Breast Augmentation to Extracorporeal Membrane Oxygenation Escaping Death: Why Plastic Surgery Specialty Training and an Ideal Setting Matter. Plast Reconstr Surg Glob Open 13: e6592. DOI:10.1097/GOX.0000000000006592. Sarmiento S, Wen C, Cheah MA, Lee S, Rosson GD (2020) Malpractice litigation in plastic surgery: can we identify patterns? Aesthetic surgery journal 40: NP394-NP401. Feola A, Minotti C, Marchetti D, Caricato M, Capolupo GT, Marsella LT, La Monaca G (2021) A five-year survey for plastic surgery malpractice claims in Rome, Italy. Medicina 57: 571. Moura SP, Shaffrey EC, Lam CS, Wirth PJ, Attaluri PK, Rao VK (2023) Out-of-scope Cosmetic Surgery: A Review of Malpractice Lawsuits against Nonplastic Surgeons. Plast Reconstr Surg Glob Open 11: e4873. DOI:10.1097/GOX.0000000000004873. ElHawary H, Aldien AS, Gorgy A, Salimi A, Gilardino MS (2023) Dissecting medical litigation: an analysis of Canadian legal cases in plastic surgery. Plastic Surgery 31: 161-167. Gong JH, Kim DD, King VA, Mehrzad R (2023) Factors Associated with Court Outcomes of Medical Malpractice Litigations Involving Breast Reductions: 1990 to 2020. Plastic and reconstructive surgery 152: 985e-992e. DOI:10.1097/PRS.0000000000010471. Kang D, Hong SE (2024) Impact of Legal Education Reform on Plastic and Reconstructive Procedure-Related Malpractice Litigation in South Korea. Dyer C (2024) Breast surgeon who left patients scarred, in pain, and unable to wear prostheses is struck off. BMJ (Clinical research ed) 385: q1030. DOI:10.1136/bmj.q1030. Nagano S, Unuma K, Makino Y, Mori H, Uemura K (2024) Acute upper airway obstruction due to cervical hematoma after cervicofacial liposuction. J Forensic Leg Med 104: 102697. DOI:10.1016/j.jflm.2024.102697. Dhooghe NS, Maes S, Depypere B, Claes KEY, Coopman R, Kubat B, Piette MH, Monstrey S (2022) Fat Embolism After Autologous Facial Fat Grafting. Aesthet Surg J 42: 231-238. DOI:10.1093/asj/sjab252. Venditto CM, Grotting JC, Auersvald A, Johnson DJ, Labbe D, Hodgkinson D, Barrera A, Warren RJ, Botti G, Von Laeken N, Bald M (2024) Complete Hemifacial Paralysis Post-facelift: Making Sense of a Plastic Surgeon's Worst Nightmare. Aesthet Surg J 44: 256-264. DOI:10.1093/asj/sjad337. Defraia B, Focardi M, Grassi S, Chiavacci G, Faccioli S, Romano GF, Bianchi I, Pinchi V, Innocenti A (2024) Negative Outcomes of Blepharoplasty and Thyroid Disorders: Is Compensation Always Due? A Case Report with a Literature Review. Diseases 1210.3390/diseases12040075. Gilardi R, Galassi L, Del Bene M, Firmani G, Parisi P (2023) Infective complications of cosmetic tourism: A systematic literature review. Journal of Plastic, Reconstructive & Aesthetic Surgery 84: 9-29. Villegas-Alzate FJ, María A (2025) How to Prevent and Solve Complications of Previous Abdominoplasties and Liposuction With TULUA In: TULUA Abdominoplasty Elsevier, pp 205-221 McAuliffe PB, Muss TE, Desai AA, Talwar AA, Broach RB, Fischer JP (2023) Complications of aesthetic surgical tourism treated in the USA: a systematic review. Aesthetic Plastic Surgery 47: 455-464. Wue BLC, P’ng Hon Shen MB, Quan ES, Wee EL, Jin G, Yi M, Shalene Palansamy M, Fu Mei Sian M (2024) Acute kidney injury after breast augmentation using hyaluronic acid injection–A case series and review of literature. MJM Case Reports 1: 119. Wagner N (2024) Contact allergy to medical devices. Allergo Journal International 33: 54 - 59. DOI:10.1007/s40629-023-00276-3. Aljerian A, Abi-Rafeh J, Hemmerling T, Gilardino MS (2024) Complications of aesthetic liposuction performed in isolation: a systematic literature review and meta-analysis. Plastic Surgery 32: 19-32. Blugerman G (2023) Complications in Body Contouring In: Manual of Cosmetic Surgery and Medicine: Volume 1-Body Contouring Procedures Springer, pp 193-205 Souza GMCD, Costa SMDA, Resende MHL, Sobral CS, Ferreira LM (2018) Liposuction Practices among Brazilian Surgeons. Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery 33: 181-186. DOI:10.5935/2177-1235.2018rbcp0093. Kanapathy M, Pacifico M, Yassin AM, Bollen E, Mosahebi A (2021) Safety of Large-Volume Liposuction in Aesthetic Surgery: A Systematic Review and Meta-Analysis. Aesthet Surg J 41: 1040-1053. DOI:10.1093/asj/sjaa338. Koshkinbayeva AR, Yutskovskaya YA, Omarkulov BK, Ponamareva OA, Ogizbayeva AV (2025) The opportunities and effectiveness of the use of autologous platelet-rich plasma in plastic surgery, anti-age medicine and dermatology. Medicine and ecology 4: 17-28. DOI:10.59598/me-2305-6045-2024-113-4-17-28. Troell RJ (2025) Aesthetic Primary and Secondary Breast Augmentation: Proposed Algorithm for Optimal Cosmetic Outcomes While Minimizing Complications. The American Journal of Cosmetic Surgery: 07488068251314535. de Menezes JA, Gomes HFC, Martins RAC, Ferreira LM (2020) Legal disputes involving plastic surgeries in Brazil: Main causes of patients 'complaints, trial outcomes, and influence of the expert report on the results of appellate courts. Journal of Plastic, Reconstructive and Aesthetic Surgery 73: 1174 - 1205. DOI:10.1016/j.bjps.2020.01.035. Monib S (2022) Clinical importance of the informed consent process in breast surgery. The Pan African medical journal 41: 188. DOI:10.11604/pamj.2022.41.188.28872. Manahan MA (2021) Adjunctive Procedures and Informed Consent with Breast Implant Explantation. Plastic and reconstructive surgery 147: 51S-57S. DOI:10.1097/PRS.0000000000008046. Maroon J, Hossain SZ, Mackenzie L (2024) A systemic review of the “Informed consent” Process for aesthetic cosmetic surgery procedures. The American Journal of Cosmetic Surgery 41: 230-246. Ahmed MB, Almohannadi FS, Shraim BA, Aljassem G, Al-Lahham S, Alsherawi A (2024) Surgical Written Consent in Aesthetic Plastic Surgery: A Plastic Center Audit of Surgical Consent Standards. Cureus 16: e51701. DOI:10.7759/cureus.51701. Sherif RD, Lisiecki J, Gilman RH (2021) Perception of risk among aesthetic plastic surgeons. Aesthetic Surgery Journal 41: NP1218-NP1224. Chappell AG, Kane RL, Wood SM, Wescott AB, Chung KC (2021) Representation of Ethics in the Plastic Surgery Literature: A Systematic Review. Plast Reconstr Surg 148: 289e-298e. DOI:10.1097/PRS.0000000000008232. Santos NLD, Esteves-De-Oliveira IG, Tacani RE, Baldan CS, Masson IFB, Farcic TS, Machado AFP (2023) Perception of patients about professional performance and procedures performed in the pre, intra, and postoperative period of abdominoplasty. Revista Brasileira de Cirurgia Plástica 35: 189-197. Backman M, Fridblom K, Hassan- Nur M, Fredholm H, Fredriksson I (2022) CN60 OptiBra study: An RCT, optimal postoperative bra support after breast cancer surgery. Annals of Oncology 33: S1371.10.1016/j.annonc.2022.07.383. Salari N, Kazeminia M, Heydari M, Darvishi N, Ghasemi H, Shohaimi S, Mohammadi M (2022) Body dysmorphic disorder in individuals requesting cosmetic surgery: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 75: 2325-2336. DOI:10.1016/j.bjps.2022.04.098. Kaleeny JD, Janis JE (2024) Body Dysmorphic Disorder in Aesthetic and Reconstructive Plastic Surgery-A Systematic Review and Meta-Analysis. Healthcare (Basel) 1210.3390/healthcare12131333. Lee AD, Hale EW, Mundra L, Le E, Kaoutzanis C, Mathes DW (2023) The heart of it all: Body dysmorphic disorder in cosmetic surgery. J Plast Reconstr Aesthet Surg 87: 442-448. DOI:10.1016/j.bjps.2023.10.068. Davison SP, Evans G, Ball E, Newman A, Sotile W (2024) Control versus Choice in Deciding Career Pathway in Plastic Surgery: The Perfect Ratio. Plast Reconstr Surg Glob Open 12: e6240. DOI:10.1097/GOX.0000000000006240. Pandya S, Fedor CJ, Liu HY, Jeong T, Arellano JA, Bonetti MA, Nguyen VT, Gusenoff JA, Stofman GA, Egro FM (2025) A 10-Year Analysis of Resident Aesthetic Surgery Clinic: Abdominoplasty Performed by Residents Is Safe and Leads to Comparable Outcomes to Attending Surgeons. Annals of Plastic Surgery 94: S184-S187. Alkaelani MT, Koussayer B, Blount T, Amawi YA, Mahboob O, Le NK, Parus A, Troy J (2023) Complications of medical tourism in aesthetic surgery: a systematic review. Annals of Plastic Surgery 91: 668-673. Farouk M, Hegazy AM, Aziz WNT, Aziz MF, Shehata YNH (2021) Following ISAPS Recommendations, Does it Really Help? Aesthetic Plast Surg 45: 1888-1894. DOI:10.1007/s00266-021-02174-x. Álvarez LF, Urdaneta F (2024) Critical View of Aesthetic Surgical Tourism: A Perioperative Care Perspective. Trends in Anaesthesia and Critical Care: 101381. Morrissette A (2022) " I like Big Butts and I Cannot Lie"... but Am I Willing to Die? The Need to Regulate the Brazilian Butt Lift. J Health & Biomedical L 19: 112. Additional Declarations The authors declare no competing interests. Supplementary Files SupplementaryMaterialAppendix1.docx Supplementary material - appendix 1 Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6680003","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":457576319,"identity":"d7b76b35-ba3d-4a83-b4c5-132c0f5735ec","order_by":0,"name":"Saule A. Mussabekova","email":"","orcid":"","institution":"Karaganda Medical University","correspondingAuthor":false,"prefix":"","firstName":"Saule","middleName":"A.","lastName":"Mussabekova","suffix":""},{"id":457576320,"identity":"f2523930-1577-46b6-b20f-fa819f41034f","order_by":1,"name":"Yuliya Menchisheva","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0003-4141-3517","institution":"King's College London","correspondingAuthor":true,"prefix":"","firstName":"Yuliya","middleName":"","lastName":"Menchisheva","suffix":""},{"id":457576321,"identity":"645ddd0b-81b3-4f1f-bc38-8e636d6ed6a3","order_by":2,"name":"Álvaro Varela Morillas","email":"","orcid":"https://orcid.org/0000-0002-1224-5190","institution":"King's College London","correspondingAuthor":false,"prefix":"","firstName":"Álvaro","middleName":"Varela","lastName":"Morillas","suffix":""}],"badges":[],"createdAt":"2025-05-16 10:51:16","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6680003/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6680003/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83048764,"identity":"c39d9e11-6273-4caf-8772-2cb22d39a748","added_by":"auto","created_at":"2025-05-19 12:12:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":628784,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA Flow Diagram of the Study Selection Process Used in the Systematic Review. Created with PRISMA 2020 statement. https://estech.shinyapps.io/prisma_flowdiagram/\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6680003/v1/5524ca379848e884230ba905.png"},{"id":83048765,"identity":"5a9fcdd0-6a23-4c3d-bf1b-98baacbb5f6b","added_by":"auto","created_at":"2025-05-19 12:12:38","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":127342,"visible":true,"origin":"","legend":"\u003cp\u003eRadar chart: complication frequencies in aesthetic surgery. Created with Draxlr.com\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6680003/v1/78c7ed709440f0f4a6936b3a.png"},{"id":83048766,"identity":"5f6406e5-c43a-470f-a22a-db7d6578589a","added_by":"auto","created_at":"2025-05-19 12:12:39","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":253971,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of complications associated with aesthetic body surgery based on anatomical zones. Created with BioRender.com\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-6680003/v1/4740fe6a87738133e097970e.png"},{"id":83048775,"identity":"e1fc9828-b6dd-4bb1-a6a4-2b50b1e8070d","added_by":"auto","created_at":"2025-05-19 12:12:39","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":142290,"visible":true,"origin":"","legend":"\u003cp\u003eFunnel plot assessing publication bias in studies reporting legal outcomes in body plastic surgery. Created with MetaAnalysisOnline.com\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-6680003/v1/6ba2bd1771063b229f92de6c.png"},{"id":83048772,"identity":"385f1736-d8e3-4dab-88e2-d8b9c984a475","added_by":"auto","created_at":"2025-05-19 12:12:39","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":417797,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of legal outcomes decided in favor of surgeons in plastic surgery. Created with MetaAnalysisOnline.com\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-6680003/v1/ad5cdc8e67eb48b76e752376.png"},{"id":83050486,"identity":"c634e24d-558a-467c-aacb-d033240a9213","added_by":"auto","created_at":"2025-05-19 12:36:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2842832,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6680003/v1/f7c94584-2b6b-4044-8202-90777f728307.pdf"},{"id":83048972,"identity":"4a0aa40f-d36a-4932-ba64-d608cb9bdbe3","added_by":"auto","created_at":"2025-05-19 12:20:39","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":573968,"visible":true,"origin":"","legend":"\u003cp\u003eSupplementary material - appendix 1\u003c/p\u003e","description":"","filename":"SupplementaryMaterialAppendix1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6680003/v1/3f9fa3c106a89a636f065948.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eLitigation and Complications Arising From Aesthetic Body Surgery: a Systematic Review\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eAesthetic body surgery has witnessed a marked increase in global demand over recent decades [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Body contouring procedures now represent a substantial portion of elective surgeries worldwide, from liposuction and abdominoplasty to gluteal and breast augmentation [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This rise has been facilitated by the confluence of advanced surgical techniques, social media influence, and shifting ideals of beauty [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. While most of these procedures are elective and performed on otherwise healthy individuals, they are not without risk [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Postoperative complications, patient dissatisfaction, and failure to meet aesthetic expectations have given rise to a growing number of medico-legal disputes globally [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGiven the socio-economic and psychological implications of aesthetic procedures, legal scrutiny is increasing [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Surgeons and clinics face mounting pressure to align with medical, ethical, and legal standards [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Complication rates vary by procedure, practitioner experience, and setting, yet dissatisfaction - even with objectively satisfactory results-can prompt litigation [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. As elective interventions hinge on personal expectations, the discrepancy between perceived and actual outcomes remains a primary driver of complaints [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The global nature of aesthetic medical tourism, coupled with uneven regulatory frameworks, further complicates liability assessment [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e By consolidating international evidence on medico-legal risks in aesthetic body surgery, this review provides valuable insights into the risk factors, legal precedents, and preventative strategies. It serves as a resource for surgeons, policy-makers, and legal experts aiming to improve clinical practice, informed consent procedures, and patient safety. Ultimately, understanding the interplay between surgical outcomes and legal accountability can contribute to reducing preventable complications and minimizing litigation in body aesthetic surgery.\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cp\u003eThe protocol for this study was registered in PROSPERO (ID: CRD420251043585)(\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251043585\u003c/span\u003e\u003c/span\u003e) and compiled by the Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]. The study selection process is illustrated using the PRISMA flow chart [\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e]. Supplementary Material Appendix 1 (Tables\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;4) has more details on the search methodology.\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eEligibility criteria\u003c/h2\u003e\n \u003cp\u003eSpecific inclusion and exclusion criteria to ensure the selection of relevant studies were established (Supplementary Material, Appendix 1, Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). The inclusion criteria encompassed studies involving adult patients (aged\u0026thinsp;\u0026ge;\u0026thinsp;18) of any gender who underwent elective body aesthetic surgeries. Procedures considered included liposuction, abdominoplasty, breast augmentation, gluteoplasty, cruroplasty, and brachioplasty, as well as combinations thereof. Only studies that addressed postoperative complications, legal disputes, malpractice claims, or forensic evaluations in the context of these procedures were included. All eligible studies were published from 1 January 2020, in English, and had full-text availability. Retrospective, prospective, cross-sectional studies, case series, and case reports were included. The exclusion criteria involved studies focusing on non-body anatomical regions (e.g., facial surgery) and non-surgical procedures (injectable procedures - injection of hyaluronic acids, botox, hydroxyapatites, laser ablations, tattoo).\u003c/p\u003e\n \u003cp\u003eUltimately, non-English articles, those published prior to 2020, and publications categorised as comments, editorials, letters, reviews (both systematic and otherwise), guidelines, position papers, as well as in vitro and animal research were removed.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eInformation sources\u003c/h3\u003e\n\u003cp\u003eA comprehensive literature search was conducted across seven electronic databases (MEDLINE (Ovid), EMBASE (Ovid), Cochrane Library, PubMed, Web of Science (Clarivate Analytics), SCOPUS (Elsevier), and Google Scholar); two registers (ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP)). Additional sources were also searched from platforms, including WorldCat, ProQuest Dissertations \u0026amp; Theses (PQDT), Open Access Theses and Dissertations (OATD), and the King\u0026apos;s College London Research Portal. The date range for all searches was from 1 January 2020 onwards. Citation searching yielded an additional 12 records. Conference proceedings were searched through SCOPUS and Web of Science, while preprints were checked from SSRN and F1000Research Preprints. Supplementary Material Appendix 1 (Table\u0026nbsp;5) provides detailed information pertaining to the supplemental search strategies. The last update on searches occurred on 18 May 2025.\u003c/p\u003e\n\u003ch3\u003eSearch strategy\u003c/h3\u003e\n\u003cp\u003eA comprehensive literature search strategy was created in collaboration with a seasoned research librarian to ensure the exhaustive inclusion of all pertinent studies, irrespective of language, study type, or publication status, covering published, unpublished, in-press, and ongoing research [\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eThe Population, Intervention, Comparison, Outcome (PICO) framework was utilised to establish an organised and systematic methodology for formulating the research question and directing the literature review (Supplementary Material, Appendix 1, Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe following research question was formulated: In patients who experienced complications after body surgery (P), how does the occurrence of medico-legal litigation (I) influence clinical and legal risk management strategies (O)?\u003c/p\u003e\n\u003cp\u003ePICO Framework:\u003c/p\u003e\n\u003cp\u003e\u0026bull; Population (P): Individuals who underwent body aesthetic surgery.\u003c/p\u003e\n\u003cp\u003e\u0026bull; Intervention (I): Evaluation of postoperative complications and medico-legal disputes.\u003c/p\u003e\n\u003cp\u003e\u0026bull; Comparison (C): Not applicable\u003c/p\u003e\n\u003cp\u003e\u0026bull; Outcome (O): Identification of causes of medico-legal challenges, common complications, and proposed solutions.\u003c/p\u003e\n\u003cp\u003eThe following combinations of Medical Subject Headings, entry terms and keywords were used in the electronic search: \u0026ldquo;human\u0026rdquo;, \u0026ldquo;body surgery\u0026rdquo;, \u0026ldquo;liposuction\u0026rdquo;, \u0026ldquo;lipectomy\u0026rdquo;, \u0026ldquo;body contouring\u0026rdquo;, \u0026ldquo;embolism, fat\u0026rdquo;, \u0026ldquo;abdominoplasty\u0026rdquo;, \u0026ldquo;gluteoplasty\u0026rdquo;, \u0026ldquo;cruroplasty\u0026rdquo;, \u0026ldquo;brachioplasty\u0026rdquo;, \u0026ldquo;breast augmentation\u0026rdquo;, \u0026ldquo;mammoplasty\u0026rdquo;, \u0026ldquo;buttock augmentation\u0026rdquo;, \u0026ldquo;liability\u0026rdquo;, \u0026ldquo;legal\u0026rdquo;, \u0026ldquo;malpractice\u0026rdquo;, \u0026ldquo;forensic medicine\u0026rdquo;, and \u0026ldquo;court\u0026rdquo;. Boolean operators (AND/OR) were used to maximize relevance.\u003c/p\u003e\n\u003ch3\u003eSelection process\u003c/h3\u003e\n\u003cp\u003eThe selection process used the automated screening technology Rayyan AI, developed by the Qatar Computing Research Institute. All retrieved studies were subjected to a two-phase screening process conducted independently by two reviewers (SM and YM) to ascertain their eligibility at each stage of the selection process. Included and excluded studies are presented in Supplementary Material Appendix 1 (Tables\u0026nbsp;6 and 7).\u003c/p\u003e\n\u003ch3\u003eData collection process\u003c/h3\u003e\n\u003cp\u003eEndNote, a reference management program, was employed to optimise the data collection and organisation process. Duplicate articles were eliminated. The articles were chosen based on their titles and abstracts for relevancy, adhering to the inclusion and exclusion criteria given below (Supplementary Material, Appendix 1, Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). All abstracts underwent independent evaluation. Any disagreements were settled through the intervention of the third author (AVM) [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]. Google Scholar Alerts was utilised to update citations until the 18 May 2025, ensuring the incorporation of the most recent and pertinent publications.\u003c/p\u003e\n\u003cp\u003eArticles meeting the criteria for full-text review were extracted. A standardised data extraction form was utilised to gather information regarding study characteristics (author, year, country, study type), total cases analysed, types of body plastic surgery procedures involved, primary medico-legal allegations and legal outcomes, prevalent postoperative complications, and litigation risk factors.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy risk of bias assessment\u003c/h2\u003e\n \u003cp\u003eThe assessment of bias risk was performed utilising two validated instruments according to the study design. The Joanna Briggs Institute (JBI) critical assessment checklist (Australia, JBI) was utilised for case reports and case series [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]. The Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) (UK, Cochrane) was used to evaluate potential biases in both retrospective and prospective studies [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]. Two independent evaluators (SM and YM) performed a risk of bias evaluation. Supplementary Material Appendix 1, Tables\u0026nbsp;8\u0026ndash;10, provide comprehensive evidence of the evaluation process.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 41 studies met the inclusion criteria and were analyzed in this systematic review (Supplementary Material, Appendix 1, Table\u0026nbsp;6). The excluded studies are listed in Supplementary Material Appendix 1 (Table\u0026nbsp;7). The PRISMA flow diagram (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) delineates the methodical selection process for research inclusion.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThese studies were geographically distributed as follows: USA (17) \u0026minus;\u0026thinsp;41,5%, Italy (4) \u0026ndash; 9.6%, Canada (3) \u0026ndash; 7.3%, Brazil (3) \u0026ndash; 7.3%, UK (3) \u0026ndash; 7.3%, Egypt (2) \u0026ndash; 4.9%, others (South Korea, China, Germany, Kuwait, Romania, Peru, Vietnam, France, Switzerland): 1 study each (total 9 studies, 21.9% of total). Most studies were published between 2021 and 2024, with a noticeable peak in 2021 (14 studies) \u0026minus;\u0026thinsp;34.1%. Other annual distributions were: 2020 (4 studies) -9.75%, 2022 (5 studies)- 12.2%, 2023 (7 studies) -17%, 2024 (9 studies) \u0026minus;\u0026thinsp;21.9%, and 2025 (2 studies) \u0026ndash; 4.8%. The characteristics of the studies assessing the legal landscape of aesthetic body surgery are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, while a comparative analysis trends and outcomes in plastic surgery malpractice litigation are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The key characteristics of the cases and case series are described in detail in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssessment of the legal landscape of aesthetic body surgery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e№\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst author,\u003c/p\u003e \u003cp\u003eYear,\u003c/p\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDatabase Used, Time Frame of Analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal Cases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTypes\u003c/p\u003e \u003cp\u003eof surgeries\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMain\u003c/p\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMain\u003c/p\u003e \u003cp\u003eAllegations\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLegal outcomes.\u003c/p\u003e \u003cp\u003eCases Won by Surgeons\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFan et al., 2020,\u003c/p\u003e \u003cp\u003eUSA\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCRICO Benchmarking System,\u003c/p\u003e \u003cp\u003e2008\u0026ndash;2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast reconstruction, breast augmentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInfection, emotional trauma, cosmetic injury, scarring, wound dehiscence, skin necrosis, hematoma, rupture, implant displacement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eImproper performance, mismanagement, informed consent failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e41 cases paid; avg. payout \u003cspan\u003e$\u003c/span\u003e130,422\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoyd et al., 2021,\u003c/p\u003e \u003cp\u003eUSA\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMPLA, AMS, 1991\u0026ndash;2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast augmentation, reduction, breast surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUnhappy results (20%), infection (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eImproper performance, lack of follow-up, infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e761 paid claims, \u003cspan\u003e$\u003c/span\u003e141\u0026nbsp;361\u0026nbsp;756 total\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGibstein et al.,\u003c/p\u003e \u003cp\u003e2023,\u003c/p\u003e \u003cp\u003eUSA\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLexisNexis, 1988\u0026ndash;2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast surgery and reconstruction, abdominoplasty, liposuction, skin debridement and grafting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eProcedural error (52.4%), lack of consent (52.4%), supervision failure (52.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInadequate supervision, resident inexperience, consent failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e38.1% defense verdicts, 28.6% plaintiff, 33.3% settled; median payout \u003cspan\u003e$\u003c/span\u003e5.1M\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRemington et al.,\u003c/p\u003e \u003cp\u003e2024,\u003c/p\u003e \u003cp\u003eUSA\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCandello database, 2009\u0026ndash;2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2674\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast surgeries, body-contouring, face-lift, eyelid surgeries, nasal surgeries.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEmotional trauma (20.9%), infection (9.7%), scarring (8.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePoor technique, communication failures, documentation issues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e26.8% paid claims; avg. payment \u003cspan\u003e$\u003c/span\u003e204,121\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReese et al., 2024,\u003c/p\u003e \u003cp\u003eUSA\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWestlaw Campus, 2013\u0026ndash;2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAbdominoplasty, liposuction, buttock augmentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInfection (40.6%), scarring (31.3%), emotional distress (31.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNegligent technique (71.9%), poor postoperative care (62.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eOnly 1 plaintiff verdict; 56.3% for defense; few settlements\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRawash et al.,\u003c/p\u003e \u003cp\u003e2025, Egypt\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCairo Medicolegal Area,\u003c/p\u003e \u003cp\u003e2016\u0026ndash;2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLiposuction, abdominoplasty, buttock augmentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDehiscence, mortality (3.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDisfigurement, dissatisfaction, burns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e44.9% positive for plaintiff; death in 3 cases; liposuction most litigated\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFacchin et al.,\u003c/p\u003e \u003cp\u003e2023,\u003c/p\u003e \u003cp\u003eItaly\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHospital database, 2015\u0026ndash;2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e788 procedures, 8 legal cases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAbdominoplasties,\u003c/p\u003e \u003cp\u003etorsoplasties,\u003c/p\u003e \u003cp\u003ebreast surgeries, brachioplasties,\u003c/p\u003e \u003cp\u003ethighplasties,\u003c/p\u003e \u003cp\u003eliposuctions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e46% total (19% major, 27% minor); highest in thighplasty (63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCosmetic dissatisfaction, consent misinterpretation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eOnly 1 payout; rest dismissed or surgeon won\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eElHawary et al., 2021, Canada\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLexisNexis, Westlaw, 1990\u0026ndash;2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLiposuction, fat grafting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDeath (42%), nerve or organ damage, scarring, unsatisfactory aesthetic results.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNegligence, lack of consent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e64% surgeon wins; avg. payout \u003cspan\u003e$\u003c/span\u003e1.45M\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eZhang et al., 2021, Canada\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCMPA,\u003c/p\u003e \u003cp\u003e2013\u0026ndash;2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e414\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast augmentation, abdominoplasty, body contouring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eScarring (16.6%), deformity (15.9%), mental health (6.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePoor communication, consent, diagnosis failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e47.8% unfavorable; 43.4% compensated\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSarmiento et al.,\u003c/p\u003e \u003cp\u003e2020,\u003c/p\u003e \u003cp\u003eUSA\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWestlaw, 2000\u0026ndash;2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAbdominoplasty,\u003c/p\u003e \u003cp\u003eGender affirmation surgery, breast reconstruction, liposuction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDisfigurement (42%), injury (24%), psychological distress (9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGross negligence, informed consent, surgical error\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e60% surgeon wins; payouts median \u003cspan\u003e$\u003c/span\u003e600,000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFeola et al., 2021,\u003c/p\u003e \u003cp\u003eItaly\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eORMe (Civil Court of Rome),\u003c/p\u003e \u003cp\u003e2012\u0026ndash;2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast augmentation,\u003c/p\u003e \u003cp\u003ebreast reconstruction, liposuction, body lifts (arm lift, buttock enhancement, thigh lift, and tummy tuck)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNon-fatal injuries (97.9%), fatal (2.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInformed consent violations, procedural errors, unsatisfactory results\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e70.14% defendants were found liable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMoura et al.,\u003c/p\u003e \u003cp\u003e2023,\u003c/p\u003e \u003cp\u003eUSA\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWestlaw, 1979\u0026ndash;2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast surgery, fat reduction, body lift, aesthetic genital surgery, aesthetic face and neck surgeries.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePermanent injury (21.4%), poor outcomes, death (3.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOut-of-scope practice (55.7%), informed consent, standard breaches\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e60.9% surgeon wins, 34.4% plaintiff, avg. payout \u003cspan\u003e$\u003c/span\u003e340,520\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eElHawary et al.,\u003c/p\u003e \u003cp\u003e2023, Canada\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLexisNexis, Westlaw, 1970\u0026ndash;2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast surgeries, abdominoplasty,\u003c/p\u003e \u003cp\u003eliposuction,\u003c/p\u003e \u003cp\u003eblepharoplasty, rhinoplasty, face lifting, upper and lower extremity surgeries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMost linked to informed consent issues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLack of informed consent, surgical error, unmet expectations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e64.2% in favor of surgeon; avg. payout \u003cspan\u003e$\u003c/span\u003e61,076\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGong et al., 2023,\u003c/p\u003e \u003cp\u003eUSA\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWestlaw, 1990\u0026ndash;2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast reduction surgeries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNipple malpositioning (14.6%), disfigurement (46.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSurgical negligence, poor planning, consent issues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e67.7% defense verdicts, median payouts \u003cspan\u003e$\u003c/span\u003e221K\u0026ndash;\u003cspan\u003e$\u003c/span\u003e650K\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKang et al., 2024,\u003c/p\u003e \u003cp\u003eSouth Korea\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective analysis, 2006\u0026ndash;2012, 2017\u0026ndash;2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (2006\u0026ndash;2012)\u003c/p\u003e \u003cp\u003e75 (2017\u0026ndash;2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLiposuction, mammoplasty, breast reconstruction, blepharoplasty, rhinoplasty, face and neck lift, orthognathic surgeries.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBreach of duty, dissatisfaction, medical malpractice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e86.95% positive for plaintiff (2006\u0026ndash;2012),\u003c/p\u003e \u003cp\u003e81.33% (2017\u0026ndash;2021)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eNote*: not applicable, not available, not assessed, and/or no answer - N/A\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTrends and outcomes in plastic surgery malpractice litigation: a comparative analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e№\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst author,\u003c/p\u003e \u003cp\u003eYear,\u003c/p\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMethodology \u0026amp; Time Frame\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal Cases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eType of Surgery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eComplication Types\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStudy Focus\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eKey Findings\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eConclusion\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eO\u0026rsquo;Connell et al., 2021,\u003c/p\u003e \u003cp\u003eUK\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReview of litigation claims,\u003c/p\u003e \u003cp\u003e2012\u0026ndash;2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e449\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast surgeries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInfection (9.4%), hematoma, skin necrosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAnalysis of claims related to breast surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMost claims due to delays in diagnosis and dissatisfaction with outcomes; annual litigation cost estimated at \u0026pound;5.57 to \u0026pound;9.59\u0026nbsp;million.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNeed for improved consent processes and addressing patient expectations to reduce litigation risks.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHenry et al.,\u003c/p\u003e \u003cp\u003e2021,\u003c/p\u003e \u003cp\u003eUK\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eObservational study;\u003c/p\u003e \u003cp\u003e2015\u0026ndash;2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAbdominoplasty, gluteal enhancement, breast augmentation and reduction, genioplasty, thigh lift.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWound infection (50%), wound dehiscence (42%), fat necrosis (12%).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEvaluation of complications from cosmetic surgery tourism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMajority of patients were female with mean age 35.1 years; NHS cost totalled \u0026pound;152,946, average \u0026pound;5,882.54.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ePatients seeking cosmetic surgery abroad face significant risks; the NHS bears the financial burden of these complications, needing better patient education.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSantis et al.,\u003c/p\u003e \u003cp\u003e2022,\u003c/p\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReview of literature and legislative proposal, 2018\u0026ndash;2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLiposuction, Mammoplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIntraoperative complications, infections, allergic reactions, death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eExamination of the underreport-ting of complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSignificant disparity between reported complications and some procedures performed.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCompulsory notification is proposed to improve data collection and patient safety.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSchafer et al.,\u003c/p\u003e \u003cp\u003e2023,\u003c/p\u003e \u003cp\u003eUSA\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective cohort analysis,\u003c/p\u003e \u003cp\u003e2016\u0026ndash;2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28,171\u003c/p\u003e \u003cp\u003e(1400 complications)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAugmentation mammaplasty, Reduction mammaplasty, Trunk liposuction, Mastopexy, Abdominoplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSuperficial wound disruption, hematoma, seroma, pulmonary embolism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eComparison of 30-day complication rates\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eOverall complication rate was 5.0%; combined procedures had a higher complication rate (7.6%) compared to the index (4.2%).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIncreased risk noted for trunk liposuction and augmentation mammaplasty necessitates careful patient evaluation and shared decision-making.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWeidmanet al., 2024,\u003c/p\u003e \u003cp\u003eUSA\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective analysis; QUAD A database, 2019\u0026ndash;2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46,244 cases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFat grafting (gluteal augmentation) \u0026ndash; 436 cases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWound infection, wound disruption, hematoma, seroma, thromboembolism, death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAnalysis of complications related to fat grafting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eOverall complication rate of 0.94%; gluteal augmentation accounted for 37.6% of complications; 4 deaths reported.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIncreased reporting requirements are essential for enhancing patient safety and understanding the complication profile of these procedures.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eValentine et al., 2024,\u003c/p\u003e \u003cp\u003eUSA\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional study,\u003c/p\u003e \u003cp\u003e2019\u0026ndash;2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e246,119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLiposuction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUnplanned hospital presentation, wound disruption, venous thromboembolism, infection, death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAnalysis of outpatient liposuction complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eThe complication rate was 0.40%; the most common complication was unplanned hospital presentation (24%); the Southeast region had the highest incidence.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eLiposuction associated with serious complications in outpatient settings, highlighting the need for enhanced safety measures.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDyer et al.,\u003c/p\u003e \u003cp\u003e2021,\u003c/p\u003e \u003cp\u003eFrance\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCourt ruling; analysis of litigation claims,\u003c/p\u003e \u003cp\u003e2010\u0026ndash;2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast surgeries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRupture, inflammation due to industrial silicone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInvestigation of compensation claims related to PIP implants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTUV Rhineland found negligent; PIP implants made with industrial-grade silicone.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eRuling emphasises the need for stringent safety regulations in medical device certification.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDi Santis et al., 2020,\u003c/p\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDocumentary study; media reports and death certificates, 1987\u0026ndash;2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLiposuction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePulmonary thromboembolism, infection, perforation, hemorrhage, fat embolism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInvestigation of deaths related to liposuction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e17.44% deaths due to pulmonary thromboembolism; 45% died on the day of surgery; 98.04% were women.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCompulsory notification of complications should be established to develop preventive guidelines.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComplications and allegations in aesthetic body surgery: a review of case reports\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e№\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst author,\u003c/p\u003e \u003cp\u003eYear,\u003c/p\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePatient Characteris\u003c/p\u003e \u003cp\u003etics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurgery Type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMedical Complications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMain Allegations\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConclusion\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVenditto et al.,\u003c/p\u003e \u003cp\u003e2020, USA\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.7 years, female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBrazilian butt lift (BBL), liposuction, abdominoplasty, breast augmentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInfection, wound breakdown, hematoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInadequate preoperative counselling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCosmetic surgery tourism leads to significant complications.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eShrestha et al., 2022, USA\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48 years, female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLipoabdominoplasty, ventral hernia repair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNecrotizing soft tissue infection, bowel perforation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLack of postoperative monitoring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSignificant risks from medical tourism necessitate safety standards.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCabar et al., 2022, Brazil\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAges N/A, 4 females, 1 male\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMultiple procedures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNecrotizing soft tissue infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInadequate informed consent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eComprehensive patient information is crucial.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBudini et al., 2024, Italy\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 to 40 years\u003c/p\u003e \u003cp\u003e(mean 28.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMultiple procedures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSurgical complications, infections\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInadequate preoperative counselling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSurgical tourism poses significant risks.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKoussayer et al.,\u003c/p\u003e \u003cp\u003e2024, USA\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 to 48 years, female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMastopexy, liposuction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNontuberculous mycobacteria infections\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInadequate postoperative care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMedical tourism poses risks for infections.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eShaffrey et al., 2024, USA\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52 years, female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAbdominoplasty, umbilical hernia repair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained surgical sponge, abscess formation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInadequate postoperative care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eImproved patient education and continuity of care are needed.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrignano et al., 2021,\u003c/p\u003e \u003cp\u003eItaly\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 years, female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast augmentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIsolated subcutaneous emphysema, infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInadequate surgical technique and preoperative planning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCompliance with guidelines is essential to prevent complications.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWang et al.,\u003c/p\u003e \u003cp\u003e2020, China\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39 years, female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAutologous fat grafting (vaginal tightening, breast augmentation)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSevere fat embolism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInadvertent injection of fat into vessels\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSevere fat embolism post-surgery; anatomical research required.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScarlat et al., 2021, Romania\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 years, female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAbdominal liposuction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMassive fat pulmonary embolism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLack of medical indication for surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFat embolism is a severe complication of liposuction.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eZamora-Mostacero et al., 2021, Peru\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43 years, female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLiposuction, autologous fat transfer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMassive hemoperitoneum, mixed pulmonary embolism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInadequate surgical technique\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMixed pulmonary embolism necessitates careful procedural technique.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePham,\u003c/p\u003e \u003cp\u003e2022, Vietnam\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 years, female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast augmentation, abdominoplasty, liposuction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFat embolism, respiratory distress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInadequate monitoring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTimely diagnosis of fat embolism is crucial.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWolfe et al., 2022, USA\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 years, female;\u003c/p\u003e \u003cp\u003e26 years, female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGluteal fat grafting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMacro-fat embolism, respiratory distress, stroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLethal complications from fat embolism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEarly recognition and management are crucial.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eShaheen et al., 2023, Egypt\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 years, female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eInjectable gluteal filler\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFatal pulmonary embolism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIllegal procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInjectable fillers pose significant risks.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRogers et al., 2024, USA\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 to 57 years (mean 43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLiposuction, buttock lift\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFatal pulmonary embolism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInadequate adherence to safety protocols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAdherence to guidelines is crucial to prevent fatalities.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJorge et al., 2021, Germany\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 years, male\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePower-assisted liposuction, subcutaneous mastectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUnilateral hematoma, von Willebrand Disease (vWD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOmission of medical history in self-assessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eStructured self-assessment questionnaires enhance patient safety.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIbrahim et al., 2021, Kuwait\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39 years, female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBilateral breast reduction mammoplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTotal loss of nipple-areola complex, necrosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFaulty surgical decision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eProper preoperative planning can prevent severe complications.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDyer,\u003c/p\u003e \u003cp\u003e2024, UK\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 to 57 years\u003c/p\u003e \u003cp\u003e(mean 43.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLiposuction, buttock lift\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eScarring, complications from inadequate consent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInadequate surgical practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eProper consent and care standards are essential.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerrin et al., 2025, Switzerland\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 years, female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBilateral subpectoral breast augmentation, extended lipoabdominoplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained surgical sponge, hypovolemic shock\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInadequate postoperative care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSpecialist oversight is critical in cosmetic procedures.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eComplication frequencies\u003c/h2\u003e \u003cp\u003eAmong the complications described across all reviewed articles, infection wad the most frequently reported, appearing in 48.7% (n\u0026thinsp;=\u0026thinsp;20) of the studies [\u003cspan additionalcitationids=\"CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31 CR32 CR33 CR34 CR35 CR36 CR37 CR38 CR39 CR40 CR41\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLiposuction-related complications were the second most prevalent, occurring in 26.8% (n\u0026thinsp;=\u0026thinsp;11) of the studies [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan additionalcitationids=\"CR44 CR45 CR46 CR47 CR48 CR49\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. These complications included fat and thromboembolism. This finding aligns with the broader clinical concern over gluteal fat grafting, commonly known as the Brazilian Butt Lift (BBL), which has gained attention for its elevated mortality risk compared to other procedures [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Fat embolism was consistently associated with intramuscular fat injection and improper technique, particularly in unregulated facilities or those lacking intraoperative ultrasound guidance.\u003c/p\u003e \u003cp\u003eHemorrhage and hematoma formation were reported in 21.9% (n\u0026thinsp;=\u0026thinsp;9) of the studies [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan additionalcitationids=\"CR32 CR33\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWound dehiscence was identified in 21.9% (n\u0026thinsp;=\u0026thinsp;9) of studies, predominantly in patients with comorbidities or who had undergone multiple simultaneous procedures [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Skin necrosis in 19.5% (n\u0026thinsp;=\u0026thinsp;8) of studies [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eScarring was reported in 17% (n\u0026thinsp;=\u0026thinsp;7) of the studies, mostly in the context of breast surgery [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e] as well as implant rupture which identified in 9.7% (n\u0026thinsp;=\u0026thinsp;4) of the studies [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. These ruptures often occurred due to trauma, inadequate implant quality, or technical failure during insertion. Complication Frequencies in Aesthetic Surgery are presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eAnatomical Distribution of Complications\u003c/h2\u003e \u003cp\u003eBased on the review and quantitative extraction from 41 articles on aesthetic surgery complications, a more precise anatomical and procedural analysis reveals important distinctions in both the frequency and severity of postoperative complications. Using the exact case numbers from the studies, a better understanding can be gained regarding which regions and procedures pose the highest risk to patients (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eGluteal region: The gluteal region, predominantly involving gluteal fat grafting (e.g., the BBL), revealed the highest proportion of fat embolism cases, with 40 cases out of 515, equating to a 7.77% incidence rate. While this percentage might appear modest, it reflects the most severe and often fatal complication across all regions analyzed. The danger lies in accidental intramuscular or intravascular fat injection, leading to embolic events in the lungs or brain. These findings strongly advocate for intraoperative ultrasound guidance, limited injection volume, and strict adherence to gluteal safety guidelines.\u003c/p\u003e \u003cp\u003eAbdominal region: The abdominal area was associated with multiple complication types, particularly due to the popularity of liposuction and abdominoplasty procedures. Infection was the most commonly reported complication, with 50 out of 650 cases (7.69%). This was followed by hematoma (30/650, or 4.62%) and wound dehiscence (20/650, or 3.08%). These complications were often linked to high body mass index, poor hygiene, large resection zones, or concurrent surgeries. Cases with poor postoperative surveillance or surgery in uncertified settings were particularly vulnerable to infection and healing issues.\u003c/p\u003e \u003cp\u003eBreast region: Among breast procedures such as augmentation, reduction, and reconstruction, several complications stood out. Implant rupture occurred in 30 of 400 cases (7.5%), largely due to long-term wear, trauma, or technical failure during surgery. Capsular contracture was noted in 25 cases (6.25%), often associated with chronic inflammation or subglandular implant placement. A unique complication in this region\u0026mdash;nipple malposition - was found in 14 of 96 breast reduction cases (14.6%), which had the highest litigation success rate when not included in informed consent. Scarring, both hypertrophic and keloidal, was also common, reported in 46.9% of breast-related claims, underscoring the aesthetic and psychological sensitivity of breast outcomes.\u003c/p\u003e \u003cp\u003eThighs and flanks: Liposuction-related complications in the thigh and flank regions were reported in 45 of 300 cases (15%), reflecting a higher complication rate than the abdominal region. These included contour irregularities, skin laxity, and post-liposuction hematoma. High complication frequency in this area was attributed to the anatomical challenge of fat distribution and the technical complexity of creating smooth contours.\u003c/p\u003e \u003cp\u003eComplication frequency varies substantially across anatomical zones, with some complications (e.g., fat embolism in gluteal and abdominal areas, nipple malposition in breast surgery) being more likely to lead to severe morbidity or litigation. Understanding these risks at a granular level allows for targeted risk-reduction strategies, including enhanced surgical training, certified facility use, patient education, and procedure-specific informed consent. The anatomical distribution of complications correlated closely with procedure type. Gluteal region complications - especially fat embolism - were the most lethal and the most likely to lead to litigation. Abdominal complications, primarily related to abdominoplasty and liposuction, often manifest as hematomas, infections, or flap necrosis. Breast surgeries were associated primarily with implant rupture and capsular contracture, with a smaller number involving asymmetry and scarring.\u003c/p\u003e \u003cp\u003eThighs and flanks were affected mainly in liposuction cases, particularly in medical tourism settings. Infections and wound dehiscence in these zones were often attributed to inadequate postoperative care or uncredentialed providers.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eRisk of bias in studies\u003c/h2\u003e \u003cp\u003eThe appropriate checklist was selected based on the research design: the JBI Critical Appraisal Checklist for case reports [\u003cspan additionalcitationids=\"CR67 CR68\" citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e] was applied to 18 studies, while the ROBINS-I checklist for observational cohort and cross-sectional studies [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] was used for the remaining 23 studies. Each study was meticulously reviewed against the specified criteria. A summary of these assessments is provided in Supplemental Tables\u0026nbsp;8, 9, and 10. An overarching appraisal was derived: case reports led to straightforward inclusion or exclusion decisions, while observational studies were rated for bias as 'Low,' 'Moderate,' 'High,' or 'Unclear' based on the criteria met. The overall risk-of-bias assessments indicated that the majority of studies exhibit a moderate risk across various domains, thereby contributing to the internal validity of the systematic review findings.\u003c/p\u003e \u003cp\u003eThe funnel plot showed noticeable asymmetry, particularly with a lack of studies on the left side of the plot, where smaller studies with lower favorable verdict rates would typically appear. This asymmetry suggested that such studies may be underrepresented or unpublished, possibly due to selective reporting favoring studies with more defendant-friendly outcomes. Furthermore, the clustering of points toward the right side\u0026mdash;indicating higher favorable verdict rates\u0026mdash;implies a tendency to publish studies with more positive outcomes for defendants. The forest plot supported this observation, as it displayed substantial heterogeneity (I\u0026sup2; \u0026gt; 90%), with favorable verdict rates ranging widely across studies. Taken together, the asymmetrical funnel plot and heterogeneity in the forest plot suggest a likely presence of publication bias, potentially overestimating the true average rate of favorable verdicts for defendants. The funnel plot assessing publication bias in studies reporting legal outcomes in body plastic surgery is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eCommon allegations and legal outcomes\u003c/h2\u003e \u003cp\u003eFrequent allegations in litigation related to body aesthetic surgeries included: poor cosmetic outcomes, inadequate informed consent, procedural errors, surgical site infections, delayed diagnosis of complications, and permanent injuries such as fat embolism, nerve damage, or scarring. Informed consent deficiencies were cited in over 50% of the reviewed cases. Among the legal outcomes, approximately 45\u0026ndash;76% of claims were dismissed, while 20\u0026ndash;40% resulted in settlements or compensation. Lawsuits with evidence of inadequate documentation or absent informed consent were more likely to result in plaintiff victories.\u003c/p\u003e \u003cp\u003eAcross the studies, the primary causes of medico-legal issues included:\u003c/p\u003e\u003cp\u003e- Inadequate or absent informed consent\u003c/p\u003e\n\u003cp\u003e- Procedural errors and technical complications\u003c/p\u003e\n\u003cp\u003e- Failure to diagnose or manage postoperative complications\u003c/p\u003e\n\u003cp\u003e- Poor patient selection, including patients with unrealistic aesthetic expectations\u003c/p\u003e\n\u003cp\u003e- Lack of postoperative follow-up\u003c/p\u003e\n\u003cp\u003e- Out-of-scope practice by non-plastic surgeons performing high-risk procedures\u003c/p\u003e\n\u003cp\u003e- Communication failures between healthcare providers and patients\u003c/p\u003e\n\u003cp\u003eThe legal outcome of malpractice claims in facial plastic surgery varied considerably across studies. Case dismissals were the most common result, ranging from 45\u0026ndash;76%, indicating that many claims may lack sufficient legal basis. However, in 20\u0026ndash;40% of cases, settlements were reached, reflecting instances where some level of responsibility or compromise was acknowledged. Notably, the highest financial compensations were awarded in cases involving severe functional impairments, as opposed to those based solely on aesthetic dissatisfaction, highlighting the greater legal weight assigned to objective physical harm over subjective concerns.\u003c/p\u003e\n\u003cp\u003eThe legal outcomes varied, but the majority of cases favoured the defense (surgeons), especially when documentation was comprehensive. Still, 20\u0026ndash;40% of the cases resulted in either a settlement or a verdict favouring the plaintiff, particularly in the context of catastrophic outcomes (e.g., death, embolism, or long-term disfigurement). Claims lacking adequate preoperative documentation were significantly more likely to result in compensation for patients.\u003c/p\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical findings\u003c/h2\u003e\n \u003cp\u003eOut of the studies providing complete legal outcome data, the average rate of favourable verdicts for defendants (surgeons) was approximately 54.3% (95% CI: 49\u0026ndash;59%). Statistical analysis revealed a significant correlation between inadequate informed consent and litigation loss. High case volumes were also linked to increased complication and death rates in outpatient centres. Fat embolism, particularly in gluteal fat grafting, was one of the most fatal complications, especially when performed by underqualified providers. A forest plot of the legal outcomes decided in favour of surgeons in plastic surgery is presented in Fig. \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003eLimitations\u003c/h2\u003e\n \u003cp\u003eSeveral limitations were identified in the reviewed studies: inconsistencies in reporting, variations in legal systems, exclusion of confidential settlements, underrepresentation of low- and middle-income countries, and a lack of longitudinal follow-up. Many cases that were resolved through arbitration or pre-court settlements were not captured in formal databases, potentially underestimating the total litigation burden.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis systematic review aimed to identify, categorise, and synthesise the existing evidence on the postoperative complications and medico-legal disputes associated with aesthetic surgeries of the body. The findings provide substantial insight into the types of complications most often associated with litigation, the legal context in which these cases unfold, and the systemic vulnerabilities in current surgical practice that contribute to adverse medico-legal outcomes.\u003c/p\u003e \u003cp\u003eThe overwhelming representation of studies from the United States underscores the highly litigious environment of American healthcare, where malpractice claims are systematically tracked and publicly recorded. This contrasts with countries that may experience underreporting due to limited access to legal representation, weaker regulatory oversight, or cultural barriers to litigation. Nevertheless, the presence of cases from Brazil, Canada, the UK, and Italy illustrates that litigation in aesthetic medicine is a global concern, with rising case volumes and increasing awareness among patients of their legal rights.\u003c/p\u003e \u003cp\u003eThe majority of the reviewed studies employed retrospective methodologies, relying heavily on legal database searches (e.g., Westlaw, LexisNexis, CMPA) or national court archives. This methodological choice provides robust data for understanding past litigation but is limited in predicting future trends. Moreover, the retrospective nature makes it challenging to capture informal dispute resolutions and pre-trial settlements, which are common in aesthetic surgery malpractice claims. Future research could benefit from incorporating prospective registries and hospital-based litigation tracking systems [\u003cspan additionalcitationids=\"CR71\" citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eComplications leading to legal claims were often preventable, including infection, wound dehiscence, and thromboembolic events [\u003cspan additionalcitationids=\"CR71 CR72 CR73\" citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e]. The particularly high number of claims involving embolism, especially in liposuction and fat grafting procedures, signals a need for increased vigilance [\u003cspan additionalcitationids=\"CR76 CR77\" citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e]. Despite improvements in surgical technique, these complications remain prevalent and are frequently lethal [\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan additionalcitationids=\"CR80\" citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e]. Notably, a subset of fatal complications occurred in high-volume ambulatory centers, especially in regions with less stringent oversight, such as South Florida in the USА [\u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e]. This emphasises the need for regulatory reforms and uniform safety protocols for outpatient cosmetic surgery facilities.\u003c/p\u003e \u003cp\u003eThe consistent theme across the studies was the central role of informed consent. More than one-third of claims were rooted in allegations of inadequate consent [\u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e]. The nature of aesthetic surgery, where subjective patient expectations play a significant role in satisfaction, elevates the importance of a comprehensive consent process [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e]. Surgeons who thoroughly documented the discussion of aesthetic procedure risks, benefits, alternatives, and limitations were more likely to avoid legal liability. This supports the implementation of standardised consent protocols, including visual tools and psychological screening for patients with unrealistic expectations or suspected body dysmorphic disorder (BDD) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR89 CR90 CR91\" citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe review also revealed procedural errors as another frequent allegation, often stemming from improper technique, unqualified operators (e.g., general practitioners performing aesthetic surgeries), or inadequate supervision in training settings. Cases involving non-specialists or surgeries performed outside their scope of certification had higher rates of adverse outcomes and successful patient claims [\u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e, \u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e94\u003c/span\u003e]. Legal literature supports restricting certain procedures to board-certified plastic surgeons and mandating continued education in patient safety [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSurprisingly, few studies addressed the role of postoperative follow-up in litigation risk [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e]. However, missed and poor communication during recovery were highlighted in qualitative reviews [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]. This indicates that improving continuity of care and establishing reliable communication channels may reduce dissatisfaction and prevent legal escalation [\u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e]. Additionally, in the context of medical tourism - another rising trend - patients treated abroad often lacked access to follow-up care, further compounding risks and legal ambiguity [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFinancially, the data demonstrated that claims involving functional impairment (e.g., embolism, necrosis, chronic pain) resulted in higher compensation compared to claims driven purely by aesthetic dissatisfaction [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. This suggests that courts give greater weight to objective injuries than to subjective appearance-related grievances, even in aesthetic surgery. Still, settlements were not uncommon even in subjective cases, particularly when documentation was vague or surgeons were unable to prove proper consent or protocol adherence.\u003c/p\u003e \u003cp\u003eThe results presented in this study support previous findings in facial aesthetic surgery litigation, indicating that the underlying drivers of lawsuits, such as unmet expectations, inadequate, and poor communication, transcend anatomical regions[ 11, 16, 18, 32]. Body aesthetic surgeries may be uniquely vulnerable due to the scale and invasiveness of procedures such as BBL, abdominoplasty, or high-volume [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR98\" class=\"CitationRef\"\u003e98\u003c/span\u003e]. These are also increasingly performed in outpatient settings, where emergency preparedness and monitoring may be compromised.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis systematic review highlights the complex interplay between aesthetic body surgery, patient outcomes, and medico-legal accountability. The findings reveal that inadequate informed consent, procedural errors, poor communication, and insufficient postoperative care remain the most common drivers of litigation.\u003c/p\u003e \u003cp\u003eLiposuction, abdominoplasty, gluteoplasty, and breast augmentation were the most litigated procedures, with complications such as infections, embolism, scarring, wound dehiscence, skin necrosis, hemorrage/hamatoma, and implant rupture frequently leading to legal claims. Gluteal fat grafting was associated with the highest mortality and legal risk. Across most countries studied, especially in the U.S. and Brazil, litigation was more likely to be successful for plaintiffs when documentation was lacking, or complications were not adequately communicated.\u003c/p\u003e \u003cp\u003eFrom a legal standpoint, the role of informed consent emerged as central. Surgeons who failed to document risk discussions or who operated on patients with unrealistic expectations faced a significantly higher probability of losing in court. In contrast, those who provided comprehensive preoperative counselling and maintained detailed records were generally better protected legally.\u003c/p\u003e \u003cp\u003e To mitigate these risks, several strategies are recommended: standardized, detailed informed consent protocols; adherence to procedural scope and guidelines; enhanced training in risk communication and medico-legal education; and incorporation of psychological screening for patients seeking body aesthetic procedures. Additionally, regulators should consider mandatory complication reporting systems and certification requirements for outpatient aesthetic practices. By implementing these strategies, the medical community can improve outcomes while minimizing the legal and ethical risks inherent to aesthetic practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAcknowledgement:\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eThawanyarat K, Hinson C, Gomez DA, Rowley M, Navarro Y, Johnson C, Venditto CM (2023) #PRS: A Study of Plastic Surgery Trends With the Rise of Instagram. Aesthet Surg J Open Forum 5: DOI: ojad004.10.1093/asjof/ojad004.\u003c/li\u003e\n\u003cli\u003eGutowski KS, Chwa ES, Weissman JP, Garg SP, Simmons CJ, Brandt KE, Gosain AK (2023) Practice Profile of Practicing Plastic Surgeons: A 20-year Review of Plastic Surgery Statistics. Plast Reconstr Surg Glob Open 11: e5486. DOI:10.1097/GOX.0000000000005486.\u003c/li\u003e\n\u003cli\u003eBezzini DR, Washington GN, Abiodun O, Olufajo OA, Jones I, Butts DM, Ortega G, Paul H (2021) The Potential Impact of Plastic Surgery Expertise on Body Contouring Procedure Outcomes. Aesthet Surg J 41: 47-55. DOI: 10.1093/asj/sjaa056.\u003c/li\u003e\n\u003cli\u003eNguyen L, Afshari A, Grotting JC, Perdikis G, Kye Higdon K (2022) Preoperative Risk Factors and Complication Rates of Breast Augmentation With Fat Grafting. Aesthet Surg J 42: 749-757. DOI:10.1093/asj/sjac061.\u003c/li\u003e\n\u003cli\u003eRudy H, Lu YH, Rothchild E, Chernovolenko D, Ricci JA (2025) Marijuana Use Increases the Risk of Postoperative Bleeding in Patients Undergoing Abdominal Body Contouring. Aesthetic Plast Surg 49: 1410-1417. DOI:10.1007/s00266-024-04651-5.\u003c/li\u003e\n\u003cli\u003eComerci AJ, Arellano JA, Alessandri-Bonetti M, Mocharnuk JW, Marangi GF, Persichetti P, Rubin JP, Egro FM (2024) Risks and Complications Rate in Liposuction: A Systematic Review and Meta-Analysis. Aesthet Surg J 44: NP454-NP463. DOI: 10.1093/asj/sjae074.\u003c/li\u003e\n\u003cli\u003eReisman NR (2024) Medico-Legal Pitfalls Associated with the Male Aesthetic Patient In: A Comprehensive Guide to Male Aesthetic and Reconstructive Plastic Surgery. Springer. DOI: 10.1007/978-3-031-48503-9_8. \u003c/li\u003e\n\u003cli\u003eDalmar M, El Sheikh M, Baker R, Uppal R (2024) Managing complications following cosmetic surgery after the COVID pandemic: A study of a year at an NHS plastic surgery unit. Journal of Plastic, Reconstructive and Aesthetic Surgery 88: 47- 50. DOI:10.1016/j.bjps.2023.10.135.\u003c/li\u003e\n\u003cli\u003eWang H, Liu J, Bordes MC, Chopra D, Reece GP, Markey MK, Hoffman AS (2022) When discussing breast reconstruction, do psychosocial characteristics influence which surgical options patients remember? Cancer Research 82: P4-09-04.\u003c/li\u003e\n\u003cli\u003eFeldman D, Grenon V (2022) Malpractice claims in plastic surgery: descriptive-comparative-predictive. Plastic and Reconstructive Surgery\u0026ndash;Global Open 10: 37-38.\u003c/li\u003e\n\u003cli\u003eHibler BP, Eliades PJ, Kagha KC, Avram MM (2021) Litigation Arising From Minimally Invasive Cosmetic Procedures: A Review of the Literature. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al] 47: 1606-1613. DOI:10.1097/DSS.0000000000003202.\u003c/li\u003e\n\u003cli\u003eAbdel-Hamid M (2023) Liposuction - Current legal situation. Vasomed 35: 164.\u003c/li\u003e\n\u003cli\u003eMontrief T, Bornstein K, Ramzy M, Koyfman A, Long BJ (2020) Plastic Surgery Complications: A Review for Emergency Clinicians. West J Emerg Med 21: 179-189. DOI:10.5811/westjem.2020.6.46415.\u003c/li\u003e\n\u003cli\u003eArbaje AI, Werner NE, Kasda EM, Wu AW, Locke CFS, Aboumatar H, Paine LA, Leff B, Davis RO, Boonyasai R (2020) Learning From Lawsuits: Using Malpractice Claims Data to Develop Care Transitions Planning Tools. J Patient Saf 16: 52-57. DOI:10.1097/PTS.0000000000000238.\u003c/li\u003e\n\u003cli\u003eElshama SS (2024) How to Investigate Legal and Professional Liability in Cosmetic Intervention Issues. Available at SSRN 4984253 \u003c/li\u003e\n\u003cli\u003eSvider PF, Keeley BR, Zumba O, Mauro AC, Setzen M, Eloy JA (2013) From the operating room to the courtroom: a comprehensive characterization of litigation related to facial plastic surgery procedures. Laryngoscope 123: 1849-1853. DOI:10.1002/lary.23905.\u003c/li\u003e\n\u003cli\u003ePage MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hrobjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372: n71. DOI:10.1136/bmj.n71.\u003c/li\u003e\n\u003cli\u003eHaddaway NR, Page MJ, Pritchard CC, McGuinness LA (2022) PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis. Campbell Syst Rev 18: e1230. DOI:10.1002/cl2.1230.\u003c/li\u003e\n\u003cli\u003eMcGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C (2016) PRESS Peer Review of Electronic Search Strategies: 2015 Guideline Statement. J Clin Epidemiol 75: 40-46. DOI:10.1016/j.jclinepi.2016.01.021.\u003c/li\u003e\n\u003cli\u003ede Vet HCW, Dikmans RE, Eekhout I (2017) Specific agreement on dichotomous outcomes can be calculated for more than two raters. J Clin Epidemiol 83: 85-89. DOI:10.1016/j.jclinepi.2016.12.007.\u003c/li\u003e\n\u003cli\u003eMoola S, Munn Z, Sears K, Sfetcu R, Currie M, Lisy K, Tufanaru C, Qureshi R, Mattis P, Mu P (2015) Conducting systematic reviews of association (etiology): The Joanna Briggs Institute\u0026apos;s approach. Int J Evid Based Healthc 13: 163-169. DOI:10.1097/XEB.0000000000000064.\u003c/li\u003e\n\u003cli\u003eSterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hrobjartsson A, Kirkham J, Juni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schunemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JP (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355: i4919. DOI:10.1136/bmj.i4919.\u003c/li\u003e\n\u003cli\u003eFan B, Pardo J, Yu W, Janes M, James T (2020) Society of Surgical Oncology SSO 2020 - International Conference on Surgical Cancer Care. Ann Surg Oncol 27: 1-230. DOI:10.1245/s10434-020-08278-z.\u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Connell RL, Patani N, Machin JT, Briggs TWR, Irvine T, MacNeill FA (2021) Litigation in breast surgery: unique insights from the English National Health Service experience. BJS Open 5: zraa068. DOI:10.1093/bjsopen/zraa068.\u003c/li\u003e\n\u003cli\u003eHenry N, Abed H, Warner R (2021) The ever-present costs of cosmetic surgery tourism: a 5-year observational study. Aesthetic plastic surgery 45: 1912-1919.\u003c/li\u003e\n\u003cli\u003eBoyd JB, Moon HK, Martin S, Mastrogiovanni DB (2021) Plastic Surgery and the Malpractice Industry. Plast Reconstr Surg 147: 239-247. DOI:10.1097/PRS.0000000000007497.\u003c/li\u003e\n\u003cli\u003eSantis \u0026Eacute;PD, Yarak S, Martins MR, Hirata SH (2022) Compulsory notification of injuries in aesthetic procedures. Impact on patient safety. Anais Brasileiros de Dermatologia 97: 491-497.\u003c/li\u003e\n\u003cli\u003eGibstein AR, Jabori SK, Watane A, Slavin BR, Elabd R, Singh D (2023) Do plastic surgery residents get sued? An analysis of malpractice lawsuits. Plastic and Reconstructive Surgery\u0026ndash;Global Open 11: e4721.\u003c/li\u003e\n\u003cli\u003eSchafer RE, Blazel MM, Nowacki AS, Schwarz GS (2023) Risk of Complications in Combined Plastic Surgery Procedures Using the Tracking Operations and Outcomes for Plastic Surgeons Database. Aesthet Surg J 43: 1384-1392. DOI:10.1093/asj/sjad124.\u003c/li\u003e\n\u003cli\u003eRemington AC, Schaffer A, Hespe GE, Yugar CJ, Sherif R, Vercler CJ (2024) Understanding Factors Associated with Paid Malpractice Claims in Plastic Surgery. Plast Reconstr Surg 153: 644e-649e. DOI:10.1097/PRS.0000000000010593.\u003c/li\u003e\n\u003cli\u003eWeidman AA, Foppiani J, Valentine L, Hernandez Alvarez A, Elmer N, Hassell N, Seyidova N, Hwang P, Paul M, Arguello A (2024) Complications from fat grafting and gluteal augmentation in outpatient plastic surgery: an analysis of American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF, QUAD A) data. Aesthetic surgery journal 44: 722-730.\u003c/li\u003e\n\u003cli\u003eReese A, Navarro A, Kozlowski K, Singh S, Vu G, Neimanis S, Burke M, Morrison C (2024) An Updated Analysis of Body Contouring Malpractice Cases. Ann Plast Surg 92: S275-S278. DOI:10.1097/SAP.0000000000003870.\u003c/li\u003e\n\u003cli\u003eValentine L, Alvarez AH, Weidman AA, Foppiani J, Hassell NE, Elmer N, Hwang P, Kaul S, Rosenblatt W, Lin SJ (2024) Liposuction complications in the outpatient setting: a national analysis of 246,119 cases in accredited ambulatory surgery facilities In: Aesthet Surg J Open Forum 6:ojad107. DOI: 10.1093/asjof/ojad107. \u003c/li\u003e\n\u003cli\u003eRawash GA, Ibrahim NA, Farrag IM, Mostafa SY (2025) Medicolegal aspects of medical malpractice claims following aesthetic interventions in Cairo, Egypt. Egyptian Journal of Forensic Sciences 1510.1186/s41935-024-00419-9.\u003c/li\u003e\n\u003cli\u003eVenditto C, Gallagher M, Hettinger P, Havlik R, Zarb R, Argenta A, Doren E, Sanger J, Klement K, Dzwierzynski W, LoGiudice J, Jensen J (2021) Complications of Cosmetic Surgery Tourism: Case Series and Cost Analysis. Aesthet Surg J 41: 627-634. DOI:10.1093/asj/sjaa092.\u003c/li\u003e\n\u003cli\u003eShrestha S, Lue M, Wang HT (2022) Necrotizing Soft Tissue Infection of Abdominal Wall after Lipoabdominoplasty: Complication following Medical Tourism. Plast Reconstr Surg Glob Open 10: e4416. DOI:10.1097/GOX.0000000000004416.\u003c/li\u003e\n\u003cli\u003eCabar FR, Ribeiro AEA, Gorga ML (2022) Civil sentencing in health care and their relation with blanket consent in rulings from the Court of Appeals of the State of Sao Paulo. Revista da Associacao Medica Brasileira 68: 422 - 425. DOI: 10.1590/1806-9282.20211298.\u003c/li\u003e\n\u003cli\u003eBudini V, Zanettin C, Brambullo T, Bassetto F, Vindigni V (2024) Aesthetic Surgery Tourism: An Opportunity or a Danger? Aesthetic Plast Surg 48: 3914-3920. DOI:10.1007/s00266-024-04117-8.\u003c/li\u003e\n\u003cli\u003eKoussayer B, Blount T, Alkaelani MT, Le NK, Al Bayati MJ, Moffitt J, Troy J (2024) Medical Tourism in Plastic Surgery: A Case Series of Complications. Eplasty 24: e10.\u003c/li\u003e\n\u003cli\u003eShaffrey EC, Larson JD (2024) Unintended Souvenirs: Case Report of a Retained Foreign Body During Cosmetic Surgery Tourism. Aesthet Surg J Open Forum 6: ojae070. DOI:10.1093/asjof/ojae070.\u003c/li\u003e\n\u003cli\u003eTrignano E TC, Baccari M, Serra PL, Pili N, Mazzeo E, Rubino C. (2021) Iatrogenic subcutaneous emphysema in aesthetic breast augmentation Medicolegal aspects. . Ann Ital Chir: 131-134.\u003c/li\u003e\n\u003cli\u003eDyer C (2021) Women harmed by faulty breast implants should be compensated, says French court. BMJ 373: n1307.10.1136/bmj.n1307.\u003c/li\u003e\n\u003cli\u003eDi Santis \u0026Eacute;P, Yarak S, Martins MR, Hirata SH (2020) Deaths related to liposuction in Brazil. Surgical \u0026amp; Cosmetic Dermatology 12: 320-325.\u003c/li\u003e\n\u003cli\u003eWang C, Wang X, Huang J, Yu N, Long X (2020) Severe fat embolism after autologous fat grafting in vaginal tightening and breast augmentation surgery. J Int Med Res 48: 300060520949109. DOI:10.1177/0300060520949109.\u003c/li\u003e\n\u003cli\u003eScarlat MS, Poll IA, Capatina CO (2021) Massive Fat Pulmonary Embolism due to Liposuction. A Case Report. Romanian Journal of Legal Medicine 29: 360-364. DOI:10.4323/rjlm.2021.360.\u003c/li\u003e\n\u003cli\u003eZamora-Mostacero VE, Vargas-Ferrer JE, Paredes-Julca AA, Vasquez-Montoya AT (2021) Skeletal muscle and fatty tissue in mixed pulmonary embolism associated with liposuction: An incidental autopsy finding. Forensic Sci Med Pathol 17: 312-316. DOI:10.1007/s12024-020-00353-x.\u003c/li\u003e\n\u003cli\u003ePham MQ (2022) Fat Embolism After Plastic Surgery: A Case Report. Plast Aesthet Nurs (Phila) 42: 27-30. DOI:10.1097/PSN.0000000000000414.\u003c/li\u003e\n\u003cli\u003eWolfe EM, Weber LE, Wo LM, Samaha MJ, Mathew P, Garcia O, Singh D (2022) Two Cases Surviving Macro Fat Emboli Complications Following Gluteal Fat Grafting. Aesthet Surg J 42: 902-906. DOI:10.1093/asj/sjac063.\u003c/li\u003e\n\u003cli\u003eShaheen S, Al-Habbaa A, Riad MS, Mandour AS, Elzeny MA, Alnady K (2023) Fatal pulmonary embolism following injectable gluteal filler usage: a case report. Egypt Heart J 75: 83. DOI:10.1186/s43044-023-00415-9.\u003c/li\u003e\n\u003cli\u003eRogers C, Astarita D, Sathyavagiswaran L, Pazmino P, Ramirez-Montanana A (2025) Fat Embolism Fatalities Following Liposuction/Injection in Los Angeles County (2010-2018). Am J Forensic Med Pathol 46: 48-54. DOI:10.1097/PAF.0000000000000993.\u003c/li\u003e\n\u003cli\u003eKalaaji A, J\u0026ouml;nsson V, Haukeb\u0026oslash;e TH (2022) Gluteal augmentation with fat: patient assessment, operative technique, and safety guidelines In: Plastic and Aesthetic Regenerative Surgery and Fat Grafting: Clinical Application and Operative Techniques Springer, pp 1307-1326\u003c/li\u003e\n\u003cli\u003eTillo O, Nassab R, Pacifico MD (2023) The British Association of Aesthetic Plastic Surgeons (BAAPS) gluteal fat grafting safety review and recommendations. Aesthetic Surgery Journal 43: 675-682.\u003c/li\u003e\n\u003cli\u003eJorge ACSRG, Estler A, Stahl AS, Daigeler A, Stahl S (2021) Incidental Detection of Von Willebrand Disease: Can A Self-Assessment Anamnesis Questionnaire Protect From litigation And Minimize Complications? DOI:10.21203/rs.3.rs-955319/v1.\u003c/li\u003e\n\u003cli\u003eFacchin F, Pagani A, Perozzo FAG, Scarpa C, Bassetto F, Vindigni V (2023) Litigation Cases After Post-Bariatric Surgery: Lesson from the Past. Aesthetic plastic surgery 47: 2479-2485. DOI:10.1007/s00266-023-03287-1.\u003c/li\u003e\n\u003cli\u003eIbrahim D, Abdel-satar M, Gaballah I (2021) A Case Report of Bilateral Breast Reduction Mammoplasty Crisis in Kuwait: Medical Malpractice or Postoperative Complication. The Egyptian Journal of Forensic Sciences and Applied Toxicology 21: 11-18. DOI:10.21608/ejfsat.2020.32900.1152.\u003c/li\u003e\n\u003cli\u003eElHawary H, Saed Aldien A, Alam P, Janis JE (2021) When Liposuction Goes Wrong: An Analysis of Medical Litigation. Aesthet Surg J 41: NP1337-NP1338. DOI:10.1093/asj/sjab156.\u003c/li\u003e\n\u003cli\u003eZhang Z, Calder L, Finestone PJ, Liu R, Bucevska M, Arneja JS (2021) Medico-legal Closed Case Trends in Canadian Plastic Surgery: A Retrospective Descriptive Study. Plast Reconstr Surg Glob Open 9: e3754. DOI:10.1097/GOX.0000000000003754.\u003c/li\u003e\n\u003cli\u003ePerrin M, Schweizer T, Oetliker C, Reuthebuch OT, Babst D, Schaefer DJ (2025) From Aesthetic Breast Augmentation to Extracorporeal Membrane Oxygenation Escaping Death: Why Plastic Surgery Specialty Training and an Ideal Setting Matter. Plast Reconstr Surg Glob Open 13: e6592. DOI:10.1097/GOX.0000000000006592.\u003c/li\u003e\n\u003cli\u003eSarmiento S, Wen C, Cheah MA, Lee S, Rosson GD (2020) Malpractice litigation in plastic surgery: can we identify patterns? Aesthetic surgery journal 40: NP394-NP401.\u003c/li\u003e\n\u003cli\u003eFeola A, Minotti C, Marchetti D, Caricato M, Capolupo GT, Marsella LT, La Monaca G (2021) A five-year survey for plastic surgery malpractice claims in Rome, Italy. Medicina 57: 571.\u003c/li\u003e\n\u003cli\u003eMoura SP, Shaffrey EC, Lam CS, Wirth PJ, Attaluri PK, Rao VK (2023) Out-of-scope Cosmetic Surgery: A Review of Malpractice Lawsuits against Nonplastic Surgeons. Plast Reconstr Surg Glob Open 11: e4873. DOI:10.1097/GOX.0000000000004873.\u003c/li\u003e\n\u003cli\u003eElHawary H, Aldien AS, Gorgy A, Salimi A, Gilardino MS (2023) Dissecting medical litigation: an analysis of Canadian legal cases in plastic surgery. Plastic Surgery 31: 161-167.\u003c/li\u003e\n\u003cli\u003eGong JH, Kim DD, King VA, Mehrzad R (2023) Factors Associated with Court Outcomes of Medical Malpractice Litigations Involving Breast Reductions: 1990 to 2020. Plastic and reconstructive surgery 152: 985e-992e. DOI:10.1097/PRS.0000000000010471.\u003c/li\u003e\n\u003cli\u003eKang D, Hong SE (2024) Impact of Legal Education Reform on Plastic and Reconstructive Procedure-Related Malpractice Litigation in South Korea. \u003c/li\u003e\n\u003cli\u003eDyer C (2024) Breast surgeon who left patients scarred, in pain, and unable to wear prostheses is struck off. BMJ (Clinical research ed) 385: q1030. DOI:10.1136/bmj.q1030.\u003c/li\u003e\n\u003cli\u003eNagano S, Unuma K, Makino Y, Mori H, Uemura K (2024) Acute upper airway obstruction due to cervical hematoma after cervicofacial liposuction. J Forensic Leg Med 104: 102697. DOI:10.1016/j.jflm.2024.102697.\u003c/li\u003e\n\u003cli\u003eDhooghe NS, Maes S, Depypere B, Claes KEY, Coopman R, Kubat B, Piette MH, Monstrey S (2022) Fat Embolism After Autologous Facial Fat Grafting. Aesthet Surg J 42: 231-238. DOI:10.1093/asj/sjab252.\u003c/li\u003e\n\u003cli\u003eVenditto CM, Grotting JC, Auersvald A, Johnson DJ, Labbe D, Hodgkinson D, Barrera A, Warren RJ, Botti G, Von Laeken N, Bald M (2024) Complete Hemifacial Paralysis Post-facelift: Making Sense of a Plastic Surgeon\u0026apos;s Worst Nightmare. Aesthet Surg J 44: 256-264. DOI:10.1093/asj/sjad337.\u003c/li\u003e\n\u003cli\u003eDefraia B, Focardi M, Grassi S, Chiavacci G, Faccioli S, Romano GF, Bianchi I, Pinchi V, Innocenti A (2024) Negative Outcomes of Blepharoplasty and Thyroid Disorders: Is Compensation Always Due? A Case Report with a Literature Review. Diseases 1210.3390/diseases12040075.\u003c/li\u003e\n\u003cli\u003eGilardi R, Galassi L, Del Bene M, Firmani G, Parisi P (2023) Infective complications of cosmetic tourism: A systematic literature review. Journal of Plastic, Reconstructive \u0026amp; Aesthetic Surgery 84: 9-29.\u003c/li\u003e\n\u003cli\u003eVillegas-Alzate FJ, Mar\u0026iacute;a A (2025) How to Prevent and Solve Complications of Previous Abdominoplasties and Liposuction With TULUA In: TULUA Abdominoplasty Elsevier, pp 205-221\u003c/li\u003e\n\u003cli\u003eMcAuliffe PB, Muss TE, Desai AA, Talwar AA, Broach RB, Fischer JP (2023) Complications of aesthetic surgical tourism treated in the USA: a systematic review. Aesthetic Plastic Surgery 47: 455-464.\u003c/li\u003e\n\u003cli\u003eWue BLC, P\u0026rsquo;ng Hon Shen MB, Quan ES, Wee EL, Jin G, Yi M, Shalene Palansamy M, Fu Mei Sian M (2024) Acute kidney injury after breast augmentation using hyaluronic acid injection\u0026ndash;A case series and review of literature. MJM Case Reports 1: 119.\u003c/li\u003e\n\u003cli\u003eWagner N (2024) Contact allergy to medical devices. Allergo Journal International 33: 54 - 59. DOI:10.1007/s40629-023-00276-3.\u003c/li\u003e\n\u003cli\u003eAljerian A, Abi-Rafeh J, Hemmerling T, Gilardino MS (2024) Complications of aesthetic liposuction performed in isolation: a systematic literature review and meta-analysis. Plastic Surgery 32: 19-32.\u003c/li\u003e\n\u003cli\u003eBlugerman G (2023) Complications in Body Contouring In: Manual of Cosmetic Surgery and Medicine: Volume 1-Body Contouring Procedures Springer, pp 193-205\u003c/li\u003e\n\u003cli\u003eSouza GMCD, Costa SMDA, Resende MHL, Sobral CS, Ferreira LM (2018) Liposuction Practices among Brazilian Surgeons. Revista Brasileira de Cirurgia Pl\u0026aacute;stica (RBCP) \u0026ndash; Brazilian Journal of Plastic Sugery 33: 181-186. DOI:10.5935/2177-1235.2018rbcp0093.\u003c/li\u003e\n\u003cli\u003eKanapathy M, Pacifico M, Yassin AM, Bollen E, Mosahebi A (2021) Safety of Large-Volume Liposuction in Aesthetic Surgery: A Systematic Review and Meta-Analysis. Aesthet Surg J 41: 1040-1053. DOI:10.1093/asj/sjaa338.\u003c/li\u003e\n\u003cli\u003eKoshkinbayeva AR, Yutskovskaya YA, Omarkulov BK, Ponamareva OA, Ogizbayeva AV (2025) The opportunities and effectiveness of the use of autologous platelet-rich plasma in plastic surgery, anti-age medicine and dermatology. Medicine and ecology 4: 17-28. DOI:10.59598/me-2305-6045-2024-113-4-17-28.\u003c/li\u003e\n\u003cli\u003eTroell RJ (2025) Aesthetic Primary and Secondary Breast Augmentation: Proposed Algorithm for Optimal Cosmetic Outcomes While Minimizing Complications. The American Journal of Cosmetic Surgery: 07488068251314535.\u003c/li\u003e\n\u003cli\u003ede Menezes JA, Gomes HFC, Martins RAC, Ferreira LM (2020) Legal disputes involving plastic surgeries in Brazil: Main causes of patients \u0026apos;complaints, trial outcomes, and influence of the expert report on the results of appellate courts. Journal of Plastic, Reconstructive and Aesthetic Surgery 73: 1174 - 1205. DOI:10.1016/j.bjps.2020.01.035.\u003c/li\u003e\n\u003cli\u003eMonib S (2022) Clinical importance of the informed consent process in breast surgery. The Pan African medical journal 41: 188. DOI:10.11604/pamj.2022.41.188.28872.\u003c/li\u003e\n\u003cli\u003eManahan MA (2021) Adjunctive Procedures and Informed Consent with Breast Implant Explantation. Plastic and reconstructive surgery 147: 51S-57S. DOI:10.1097/PRS.0000000000008046.\u003c/li\u003e\n\u003cli\u003eMaroon J, Hossain SZ, Mackenzie L (2024) A systemic review of the \u0026ldquo;Informed consent\u0026rdquo; Process for aesthetic cosmetic surgery procedures. The American Journal of Cosmetic Surgery 41: 230-246.\u003c/li\u003e\n\u003cli\u003eAhmed MB, Almohannadi FS, Shraim BA, Aljassem G, Al-Lahham S, Alsherawi A (2024) Surgical Written Consent in Aesthetic Plastic Surgery: A Plastic Center Audit of Surgical Consent Standards. Cureus 16: e51701. DOI:10.7759/cureus.51701.\u003c/li\u003e\n\u003cli\u003eSherif RD, Lisiecki J, Gilman RH (2021) Perception of risk among aesthetic plastic surgeons. Aesthetic Surgery Journal 41: NP1218-NP1224.\u003c/li\u003e\n\u003cli\u003eChappell AG, Kane RL, Wood SM, Wescott AB, Chung KC (2021) Representation of Ethics in the Plastic Surgery Literature: A Systematic Review. Plast Reconstr Surg 148: 289e-298e. DOI:10.1097/PRS.0000000000008232.\u003c/li\u003e\n\u003cli\u003eSantos NLD, Esteves-De-Oliveira IG, Tacani RE, Baldan CS, Masson IFB, Farcic TS, Machado AFP (2023) Perception of patients about professional performance and procedures performed in the pre, intra, and postoperative period of abdominoplasty. Revista Brasileira de Cirurgia Pl\u0026aacute;stica 35: 189-197.\u003c/li\u003e\n\u003cli\u003eBackman M, Fridblom K, Hassan- Nur M, Fredholm H, Fredriksson I (2022) CN60 OptiBra study: An RCT, optimal postoperative bra support after breast cancer surgery. Annals of Oncology 33: S1371.10.1016/j.annonc.2022.07.383.\u003c/li\u003e\n\u003cli\u003eSalari N, Kazeminia M, Heydari M, Darvishi N, Ghasemi H, Shohaimi S, Mohammadi M (2022) Body dysmorphic disorder in individuals requesting cosmetic surgery: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 75: 2325-2336. DOI:10.1016/j.bjps.2022.04.098.\u003c/li\u003e\n\u003cli\u003eKaleeny JD, Janis JE (2024) Body Dysmorphic Disorder in Aesthetic and Reconstructive Plastic Surgery-A Systematic Review and Meta-Analysis. Healthcare (Basel) 1210.3390/healthcare12131333.\u003c/li\u003e\n\u003cli\u003eLee AD, Hale EW, Mundra L, Le E, Kaoutzanis C, Mathes DW (2023) The heart of it all: Body dysmorphic disorder in cosmetic surgery. J Plast Reconstr Aesthet Surg 87: 442-448. DOI:10.1016/j.bjps.2023.10.068.\u003c/li\u003e\n\u003cli\u003eDavison SP, Evans G, Ball E, Newman A, Sotile W (2024) Control versus Choice in Deciding Career Pathway in Plastic Surgery: The Perfect Ratio. Plast Reconstr Surg Glob Open 12: e6240. DOI:10.1097/GOX.0000000000006240.\u003c/li\u003e\n\u003cli\u003ePandya S, Fedor CJ, Liu HY, Jeong T, Arellano JA, Bonetti MA, Nguyen VT, Gusenoff JA, Stofman GA, Egro FM (2025) A 10-Year Analysis of Resident Aesthetic Surgery Clinic: Abdominoplasty Performed by Residents Is Safe and Leads to Comparable Outcomes to Attending Surgeons. Annals of Plastic Surgery 94: S184-S187.\u003c/li\u003e\n\u003cli\u003eAlkaelani MT, Koussayer B, Blount T, Amawi YA, Mahboob O, Le NK, Parus A, Troy J (2023) Complications of medical tourism in aesthetic surgery: a systematic review. Annals of Plastic Surgery 91: 668-673.\u003c/li\u003e\n\u003cli\u003eFarouk M, Hegazy AM, Aziz WNT, Aziz MF, Shehata YNH (2021) Following ISAPS Recommendations, Does it Really Help? Aesthetic Plast Surg 45: 1888-1894. DOI:10.1007/s00266-021-02174-x.\u003c/li\u003e\n\u003cli\u003e\u0026Aacute;lvarez LF, Urdaneta F (2024) Critical View of Aesthetic Surgical Tourism: A Perioperative Care Perspective. Trends in Anaesthesia and Critical Care: 101381.\u003c/li\u003e\n\u003cli\u003eMorrissette A (2022) \u0026quot; I like Big Butts and I Cannot Lie\u0026quot;... but Am I Willing to Die? The Need to Regulate the Brazilian Butt Lift. J Health \u0026amp; Biomedical L 19: 112.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Aesthetic surgery, Medico-legal claims, Body contouring, Surgical complications, Litigation","lastPublishedDoi":"10.21203/rs.3.rs-6680003/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6680003/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAesthetic body surgeries are increasingly performed worldwide, often driven by social media, shifting beauty standards, and medical tourism. Despite being elective procedures, they carry significant risk for complications and medico-legal disputes. This systematic review explores litigation trends, common complications, and legal outcomes in body aesthetic surgeries.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA systematic review was conducted per PRISMA guidelines, with registration on PROSPERO (ID: CRD420251043585). Forty-one studies published since 1 January 2020 were included, sourced from 7 databases, 2 trial registries, and grey literature. Eligible studies reported on adult patients undergoing body aesthetic surgeries and subsequent medico-legal claims. Data were extracted regarding surgical procedures, complications, legal allegations, and verdicts. Risk of bias was assessed using JBI and ROBINS-I tools.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLiposuction, abdominoplasty, gluteoplasty, and breast augmentation were the most litigated procedures. Fat embolism, infection, and implant rupture were the most common complications cited in claims. Allegations frequently involved inadequate informed consent (over 50%), procedural errors, and insufficient follow-up. Plaintiff success rates ranged from 20–40%, especially when complications were severe or documentation was poor. Surgeon-favorable outcomes were more likely when thorough documentation and informed consent were evident.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLitigation in aesthetic body surgery is largely preventable and frequently associated with poor communication, inadequate consent, and procedural missteps. Standardizing informed consent, restricting high-risk procedures to certified specialists, and improving postoperative care may reduce litigation and improve patient safety.\u003c/p\u003e","manuscriptTitle":"Litigation and Complications Arising From Aesthetic Body Surgery: a Systematic Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-19 12:12:34","doi":"10.21203/rs.3.rs-6680003/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b23d8568-26e2-425e-94c3-7098e7f5d53f","owner":[],"postedDate":"May 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":48703729,"name":"Forensic Medicine"},{"id":48703730,"name":"Plastic \u0026 Reconstructive Surgery"}],"tags":[],"updatedAt":"2025-05-19T12:12:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-19 12:12:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6680003","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6680003","identity":"rs-6680003","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}