When Beauty Turns Litigious: What Do We Know About Complications and Legal Disputes in Nonsurgical Facial Aesthetics: A Systematic Review.

BACKGROUND

Nonsurgical facial aesthetic procedures including fillers, botulinum toxin, and energy-based devices are increasingly common worldwide. Although typically safe, serious complications such as vascular occlusion, necrosis, blindness, burns, and granulomas can lead to dissatisfaction and litigation.

OBJECTIVE

To systematically evaluate clinical complications and medico-legal disputes associated with nonsurgical facial procedures.

METHODS

A systematic review was conducted in accordance with PRISMA 2020 guidelines. Six databases and gray literature were searched (January 2020-March 2025). Eligible studies reported adverse outcomes or litigation after nonsurgical facial procedures. Risk of bias was assessed using ROBINS-I and JBI, certainty with GRADE. Random-effects meta-analysis was performed where appropriate.

RESULTS

Twenty-one studies were included, mainly retrospective cohorts and medico-legal database analyses. Frequent complications were blindness, necrosis, burns, granulomas, and pigmentary changes. Litigation was most often linked to injectables and energy-based devices, commonly driven by procedural errors, inadequate informed consent, and incomplete documentation. Pooled analysis of 14 studies (1,409 cases) showed 45% of claims favored plaintiffs (95% CI: 0.35-0.56; I 2 = 92%).

CONCLUSION

Litigation after nonsurgical facial procedures is frequent and often successful for plaintiffs. Strengthened consent, documentation, and practitioner regulation are critical to reducing medico-legal risk.