Mortality and Safety in Aesthetic Plastic Surgery: An Italian Analysis

Elective aesthetic surgery has grown substantially in Italy, from 262,556 procedures in 2022 to 480,047 in 2024. Despite this, mortality data are scarce and fragmented. International studies confirm low but non-negligible risk, particularly for high-impact procedures such as liposuction and combined surgeries. To quantify fatal events following elective aesthetic surgery in Italy (2010-2025), characterize patient, procedural, and facility-related factors, compare findings with international data, and propose preliminary safety recommendations. A retrospective review was performed using medico-legal reports, clinical documentation, surgeon interviews, court records, and public archives. All intra- or postoperative deaths following elective aesthetic surgery were included. Data collected included demographics, comorbidities, procedure type, surgical setting, anesthetic management, timing, and cause of death. Twenty deaths following elective aesthetic surgery in Italy (2010-2025) were identified. Liposuction accounted for 45% of cases ( ≈ 0.02% of total procedures), breast surgery 25% ( ≈ 0.01%), and abdominoplasty 10% ( ≈ 0.004%). Ten procedures (25%) occurred in non-compliant facilities. Leading causes were cardiac arrest or anesthesia-related complications (45%), thromboembolic events (15%), and sepsis/multiorgan failure (20%). Fifty-five percent of deaths occurred days to weeks postoperatively. These findings are consistent with international literature, highlighting high-risk procedures, anesthesia-related complications, and thromboembolism. Although rare relative to procedure volume, fatal events are often preventable. Key risk-reduction strategies include rigorous patient selection, structured VTE prophylaxis, anesthetic safety standards, accredited surgical facilities, and structured postoperative follow-up. This journal requires that authors assign a level of evidence to each article. For a full descrip tion of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .