Table 1.
Litigation and complications in aesthetic body surgery: a comprehensive overview of 41 studies
| No. | First author, year, country, reference | Data Source/Methodology (time frame) | Cases analysed | Surgical procedures investigated | Reported complications (%) | Primary allegations/Study focus | Legal outcome/Key findings | Conclusion/Implications |
|---|---|---|---|---|---|---|---|---|
| 1 | Fan et al. 2020, USA [23] | CRICO Benchmarking System (2008-2019) | 174 cases | Breast reconstruction, augmentation | Infection, emotional trauma, scarring, wound dehiscence, necrosis, rupture, implant displacement | Technical negligence, mismanagement, inadequate informed consent | 41 paid claims; mean payout USD 130,422 | Improved consent and surgical technique may reduce claims |
| 2 | Boyd et al. 2021, USA [24] | MPLA, AMS (1991-2016) | 3008 cases | Breast augmentation, reduction, breast surgery | Dissatisfaction (20%), infection (10%) | Negligence in performance and follow-up | 761 paid claims; total payout USD 141.36M | Better postoperative care could reduce litigation |
| 3 | Gibstein et al. 2023, USA [25] | LexisNexis (1988-2020) | 21 cases | Breast surgery, reconstruction, abdominoplasty, liposuction, grafting | Procedural error (52.4%), lack of consent (52.4%), inadequate supervision (52.4%) | Resident inexperience, poor oversight, deficient consent | 38.1% defence verdicts, 28.6% plaintiff verdicts, 33.3% settled; median payout USD 5.1M | Adequate supervision and consent documentation are critical |
| 4 | Remington et al. 2024, USA [26] | Candello database (2009-2018) | 2674 cases | Breast surgery, body-contouring, facial procedures | Emotional trauma (20.9%), infection (9.7%), scarring (8.2%) | Poor technique, communication and documentation failures | 26.8% paid claims; mean payout USD 204,121 | Enhanced communication and documentation may reduce claims |
| 5 | Reese et al. 2024, USA [27] | Westlaw Campus (2013-2021) | 32 cases | Abdominoplasty, liposuction, buttock augmentation | Infection (40.6%), scarring (31.3%), emotional distress (31.3%) | Negligent technique (71.9%), poor postoperative care (62.5%) | 1 plaintiff verdict; 56.3% defence verdicts; few settlements | Strict adherence to perioperative care standards necessary |
| 6 | Rawash et al. 2025, Egypt [28] | Cairo Medicolegal Area (2016-2020) | 98 cases | Liposuction, abdominoplasty, buttock augmentation | Wound dehiscence, mortality (3.1%) | Disfigurement, dissatisfaction, burns | 44.9% plaintiff verdicts; 3 deaths recorded; liposuction most litigated | Stronger regulation of high-risk procedures needed |
| 7 | Facchin et al. 2023, Italy [29] | Hospital database (2015-2019) | 788 procedures, 8 legal cases | Abdominoplasty, torsoplasty, breast, brachioplasty, thighplasty, liposuction | 46% complications (19% major, 27% minor); highest in thighplasty (63%) | Cosmetic dissatisfaction, misinterpreted consent | Only 1 payout; others dismissed or defence wins | Better preoperative communication recommended |
| 8 | ElHawary et al. 2021, Canada [30] | LexisNexis, Westlaw (1990-2019) | 86 cases | Liposuction, fat grafting | Death (42%), nerve or organ damage, scarring, poor results | Negligence, lack of informed consent | 64% defence verdicts; mean payout USD 1.45M | Improved risk disclosure and patient selection advised |
| 9 | Zhang et al. 2021, Canada [31] | CMPA (2013-2017) | 414 cases | Breast augmentation, abdominoplasty, body contouring | Scarring (16.6%), deformity (15.9%), psychological impact (6.9%) | Poor communication, consent failure, misdiagnosis | 47.8% unfavourable to surgeon; 43.4% compensated | Enhanced patient communication protocols needed |
| 10 | Sarmiento et al. 2020, USA [32] | Westlaw (2000-2017) | 165 cases | Abdominoplasty, gender affirmation surgery, breast reconstruction, liposuction | Disfigurement (42%), injury (24%), psychological distress (9%) | Gross negligence, informed consent, operative error | 60% defence verdicts; median payout USD 600,000 | Enhanced training and consent may prevent claims |
| 11 | Feola et al. 2021, Italy [33] | ORMe Civil Court of Rome (2012-2016) | 144 cases | Breast augmentation, reconstruction, liposuction, body lifts | Non-fatal injuries (97.9%), fatalities (2.1%) | Procedural errors, consent violations, unsatisfactory outcomes | 70.14% defendants liable | Clearer risk disclosure and adherence to guidelines advised |
| 12 | Moura et al. 2023, USA [34] | Westlaw (1979-2022) | 64 cases | Breast, fat reduction, body lift, genital, facial surgeries | Permanent injury (21.4%), poor outcome, death (3.1%) | Out-of-scope practice (55.7%), consent issues, standard breaches | 60.9% defence verdicts; 34.4% plaintiff verdicts; mean payout USD 340,520 | Surgeons must operate within their competence |
| 13 | ElHawary et al. 2023, Canada [35] | LexisNexis, Westlaw (1970-2020) | 105 cases | Breast, abdominoplasty, liposuction, blepharoplasty, rhinoplasty, face lifts, limb surgeries | Claims mostly linked to consent issues | Inadequate consent, surgical errors, unmet expectations | 64.2% defence verdicts; mean payout USD 61,076 | Robust consent process crucial |
| 14 | Gong et al. 2023, USA [36] | Westlaw (1990-2020) | 96 cases | Breast reduction | Nipple malposition (14.6%), disfigurement (46.9%) | Negligence, poor planning, consent failures | 67.7% defence verdicts; median payout USD 221K-650K | Improved operative planning and communication advised |
| 15 | Kang et al. 2024, South Korea [37] | Retrospective analysis (2006-2012; 2017-2021) | 23 cases (2006-2012), 75 cases (2017-2021) | Liposuction, mammoplasty, breast reconstruction, blepharoplasty, rhinoplasty, face/neck lifts, orthognathic surgeries | N/A | Breach of duty, dissatisfaction, malpractice | Plaintiff verdicts: 86.95% (2006-2012), 81.33% (2017-2021) | Litigation frequency increased despite legal reforms |
| 16 | O’Connell et al. 2021, UK [38] | Litigation claims review (2012-2018) | 449 cases | Breast surgery | Infection (9.4%), haematoma, skin necrosis | Delayed diagnosis, dissatisfaction | Estimated annual cost £5.57-£9.59M | Improved consent and management protocols advised |
| 17 | Henry et al. 2021, UK [39] | Observational study (2015-2020) | 26 patients (mean age 35.1 years; mostly female) | Abdominoplasty, gluteal enhancement, breast augmentation and reduction, genioplasty, thigh lift | Wound infection (50%), wound dehiscence (42%), fat necrosis (12%) | Complications following cosmetic surgery tourism | NHS costs £152,946 total; average £5,882.54 per patient | Better patient education and regulation of medical tourism are required |
| 18 | Santis et al. 2022, Brazil [40] | Literature review and legislative proposal (2018-2021) | Not applicable | Liposuction, mammoplasty | Intraoperative complications, infections, allergic reactions, death | Under-reporting of complications in cosmetic surgery | Significant disparity noted between reported complications and procedures performed | Compulsory notification is proposed to enhance patient safety |
| 19 | Schafer et al. 2023, USA [41] | Retrospective cohort analysis (2016-2020) | 28,171 procedures (1,400 complications) | Augmentation mammaplasty, reduction mammaplasty, trunk liposuction, mastopexy, abdominoplasty | Superficial wound disruption, haematoma, seroma, pulmonary embolism | Comparison of 30-day complication rates | Combined procedures had higher complication rate (7.6%) compared to index (4.2%) | Careful patient evaluation and shared decision-making are recommended |
| 20 | Weidman et al. 2024, USA [42] | Retrospective analysis, QUAD A database (2019-2021) | 46,244 cases; 436 fat grafting procedures | Fat grafting (gluteal augmentation) | Wound infection, wound disruption, haematoma, seroma, thromboembolism, death | Complications related to fat grafting | Complication rate 0.94%; gluteal augmentation accounted for 37.6% of complications; 4 deaths | Enhanced reporting requirements are crucial to improve patient safety |
| 21 | Valentine et al. 2024, USA [43] | Cross-sectional study (2019-2021) | 246,119 cases | Liposuction | Unplanned hospital presentation (24%), wound disruption, venous thromboembolism, infection, death | Outpatient liposuction complications | Overall complication rate 0.40%; Southeast region highest incidence | Additional safety measures recommended in outpatient settings |
| 22 | Dyer et al. 2021, France [44] | Court ruling and litigation analysis (2010-2021) | 2,700 claims | Breast surgeries (PIP implants) | Implant rupture, inflammation due to industrial silicone | Defective implants and medical device negligence | TUV Rhineland found negligent for certifying defective implants | Stricter safety regulations for medical devices are essential |
| 23 | Di Santis et al. 2020, Brazil [45] | Documentary study; media reports and death certificates (1987-2015) | 102 deaths | Liposuction | Pulmonary thromboembolism (17.44%), infection, perforation, haemorrhage, fat embolism | Deaths related to liposuction procedures | 45% died on the day of surgery; 98.04% were women | Compulsory reporting and preventive guidelines are necessary |
| 24 | Venditto et al. 2020, USA [46] | Case series | 16 patients (mean age 32.7 years, female) | Brazilian butt lift, liposuction, abdominoplasty, breast augmentation | Infection, wound breakdown, haematoma | Inadequate preoperative counselling (medical tourism) | Multiple severe complications observed | Cosmetic tourism leads to increased risk of complications |
| 25 | Shrestha et al. 2022, USA [47] | Case report | 48-year-old female | Lipoabdominoplasty, ventral hernia repair | Necrotising soft tissue infection, bowel perforation | Lack of postoperative monitoring | Life-threatening complication observed | Stricter safety standards for postoperative care are essential |
| 26 | Cabar et al. 2022, Brazil [48] | Case series | 5 patients (4 females, 1 male) | Multiple procedures | Necrotising soft tissue infection | Inadequate informed consent | Severe infection cases reported | Comprehensive patient information is crucial |
| 27 | Budini et al. 2024, Italy [49] | Case series | 13 patients aged 18-40 years (mean 28.8) | Multiple procedures | Surgical complications, infections | Inadequate preoperative counselling (tourism) | High complication rate among medical tourism patients | Better regulation of cross-border cosmetic surgery is needed |
| 28 | Koussayer et al. 2024, USA [50] | Case series | 3 females aged 26-48 years | Mastopexy, liposuction | Nontuberculous mycobacterial infections | Inadequate postoperative care (tourism) | Persistent infections requiring multiple treatments | Patient follow-up and hygiene standards must be improved |
| 29 | Shaffrey et al. 2024, USA [51] | Case report | 52-year-old female | Abdominoplasty, umbilical hernia repair | Retained surgical sponge, abscess formation | Inadequate postoperative care | Serious preventable complication observed | Enhanced perioperative protocols are recommended |
| 30 | Trignano et al. 2021, Italy [52] | Case report | 28-year-old female | Breast augmentation | Isolated subcutaneous emphysema, infection | Inadequate surgical technique and preoperative planning | Severe avoidable complication observed | Compliance with guidelines is essential to reduce risk |
| 31 | Wang et al. 2020, China [53] | Case report | 39-year-old female | Autologous fat grafting (vaginal tightening, breast augmentation) | Severe fat embolism | Accidental injection of fat into blood vessels | Life-threatening complication occurred | Enhanced anatomical understanding required for safer techniques |
| 32 | Scarlat et al. 2021, Romania [54] | Case report | 30-year-old female | Abdominal liposuction | Massive fat pulmonary embolism | Lack of proper medical indication for surgery | Fatal embolism reported | Strict patient selection criteria advised |
| 33 | Zamora-Mostacero et al. 2021, Peru [55] | Case report | 43-year-old female | Liposuction, autologous fat transfer | Massive haemoperitoneum, mixed pulmonary embolism | Inadequate surgical technique | Severe multi-system complications observed | Careful procedural technique is critical |
| 34 | Pham, 2022, Vietnam [56] | Case report | 37-year-old female | Breast augmentation, abdominoplasty, liposuction | Fat embolism, respiratory distress | Inadequate monitoring | Severe postoperative complication observed | Timely diagnosis and monitoring are crucial |
| 35 | Wolfe et al. 2022, USA [57] | Case series | 2 females aged 26 and 28 years | Gluteal fat grafting | Macro-fat embolism, respiratory distress, stroke | Lethal fat embolism complications | Serious life-threatening events observed | Early recognition and management of fat embolism are vital |
| 36 | Shaheen et al. 2023, Egypt [58] | Case report | 26-year-old female | Injectable gluteal filler | Fatal pulmonary embolism | Illegal procedure | Death following unlicensed filler injection | Strict enforcement against illegal cosmetic procedures is essential |
| 37 | Rogers et al. 2024, USA [59] | Case series | 7 patients aged 29-57 years (mean 43) | Liposuction, buttock lift | Fatal pulmonary embolism | Inadequate adherence to safety protocols | Multiple deaths reported | Mandatory adherence to safety guidelines is necessary |
| 38 | Jorge et al. 2021, Germany [60] | Case report | 22-year-old male with von Willebrand Disease | Power-assisted liposuction, subcutaneous mastectomy | Unilateral haematoma | Omission of relevant medical history | Bleeding complication observed | Structured preoperative self-assessment is essential |
| 39 | Ibrahim et al. 2021, Kuwait [61] | Case report | 39-year-old female | Bilateral breast reduction mammoplasty | Total loss of nipple-areola complex, necrosis | Faulty surgical decision-making | Severe avoidable complication observed | Better preoperative planning is critical |
| 40 | Dyer, 2024, UK [62] | Case series | 6 patients aged 29-57 years (mean 43.7) | Liposuction, buttock lift | Scarring, complications from inadequate consent | Inadequate surgical practice and poor consent processes | Multiple adverse events reported | Proper consent and higher standards of care are essential |
| 41 | Perrin et al. 2025, Switzerland [63] | Case report | 22-year-old female | Bilateral subpectoral breast augmentation, extended lipoabdominoplasty | Retained surgical sponge, hypovolaemic shock | Inadequate postoperative care | Serious life-threatening complication observed | Specialist oversight and robust safety protocols are crucial |