Abstract
BACKGROUND: Aesthetic body surgeries such as liposuction, abdominoplasty, gluteoplasty, and breast augmentation have seen a global rise. However, the growing popularity of these procedures has led to increased reports of postoperative complications and medico-legal disputes. OBJECTIVE: To systematically review complications and litigation outcomes associated with aesthetic body surgeries and identify the most common risk factors contributing to legal claims. METHODS: A systematic review was conducted in accordance with PRISMA guidelines (registration on PROSPERO ID: CRD420251043585). Forty-one studies published since between 2020 and 2025 were included. Complications, allegations, and legal outcomes were extracted and analysed. Risk of bias was assessed using JBI and ROBINS-I tools. RESULTS: Infection (48.7%), fat embolism (26.8%), and hematoma (21.9%) were the most frequent complications. Gluteal fat grafting had the highest mortality and legal risk, with a 7.77% incidence of fat embolism. Inadequate informed consent was a leading allegation in over 50% of cases. Claims most often resulted in dismissal (45-76%), but 20-40% led to settlements or plaintiff verdicts, especially in cases of severe complications such as embolism or disfigurement. The pooled average of favourable verdicts for surgeons was 54.3% (95% CI: 49-59%). Publication bias was suggested by asymmetrical funnel plot distribution and high heterogeneity (I(2) > 90%). CONCLUSION: Medico-legal disputes in aesthetic body surgery commonly arise from preventable complications, especially when informed consent is inadequate or postoperative care is substandard. Standardised consent process, improved documentation, procedure-specific risk communication, and regulation of outpatient practices are critical to reducing litigation risk. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .