Abstract
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.