Cosmetic surgery is generally safe when performed by a qualified, board-certified plastic surgeon in an accredited facility. The overall complication rate for outpatient cosmetic procedures is around 0.7%, and the mortality rate is extremely low at roughly 0.002%. But those numbers reflect ideal conditions. Your actual risk depends on the specific procedure, your health profile, where you have surgery, and who performs it.
How Common Are Complications?
Most cosmetic procedures go smoothly, but no surgery is risk-free. The most frequent complications are bleeding-related issues and infections. In a study of over 1,100 breast augmentation patients, 2.7% developed a postoperative hematoma (a collection of blood under the skin), typically within the first 14 hours after surgery. Deep surgical site infections occurred in just 0.5% of patients, usually appearing about two weeks later.
These numbers are representative of what you’d expect from common procedures performed in good conditions. Less common but more serious risks include blood clots, nerve damage, poor wound healing, and adverse reactions to anesthesia. Combined procedures (having more than one surgery at the same time) carry higher complication rates than single procedures because they mean longer time under anesthesia and more tissue disruption.
Some Procedures Carry More Risk Than Others
Not all cosmetic surgeries have the same safety profile. Minimally invasive procedures like liposuction have a complication rate around 0.9%, while more extensive operations like lower body lifts carry rates closer to 8.8%. Abdominoplasty (tummy tuck) falls in between at about 3.5%. Combining breast and body procedures pushes the rate to around 4.2%.
The Brazilian Butt Lift stands out as the highest-risk cosmetic procedure. About 1 death occurs for every 3,000 BBLs, a mortality rate far exceeding other elective cosmetic surgeries. The danger comes from fat accidentally being injected into or below the muscle, where it can enter large blood vessels and travel to the lungs. A multi-society task force now advises surgeons to inject fat only above the muscle and to use ultrasound guidance during the procedure, both of which have been shown to reduce fatal complications. If you’re considering a BBL, asking your surgeon whether they follow these specific protocols is one of the most important questions you can ask.
Your Health Profile Changes the Equation
Your body mass index is one of the strongest predictors of how likely you are to experience a complication. A large analysis of nearly 128,000 cosmetic surgery patients found that complication rates rise steadily with weight: 1.6% for patients at a normal weight, 2.3% for those who are overweight, 3.1% for those with obesity, and 4.2% for those with a BMI of 40 or higher.
The biggest increases show up in two areas. Infection risk roughly doubles for patients with obesity compared to those at a normal weight. Blood clot risk follows a similar pattern, increasing about 2.5 times. For patients with both obesity and diabetes, the complication rate climbs to 5.2%, compared to 3.1% for patients with obesity alone. These are not reasons surgery is impossible at higher weights, but they do mean your surgeon should discuss the added risks honestly and may recommend weight loss before operating.
Smoking, uncontrolled diabetes, and certain medications that affect blood clotting also increase surgical risk. Most surgeons require patients to stop smoking at least several weeks before and after surgery because nicotine restricts blood flow and impairs wound healing.
Anesthesia: General vs. Sedation
More than 80% of cosmetic surgeries happen on an outpatient basis, and about 60% take place in office-based surgical facilities rather than hospitals. The type of anesthesia you receive matters more than you might expect.
General anesthesia, where you’re fully unconscious, avoids some of the unpredictability of sedation. A review of over 23,000 patients who underwent cosmetic surgery under general anesthesia in office settings found no major cardiovascular complications. Sedation (sometimes called “twilight anesthesia”) eliminates the risks of invasive airway management and reduces postoperative nausea, but it introduces its own hazard: the anesthesia provider doesn’t have direct control of your airway. Respiratory depression from sedative drugs was the leading cause of oxygen-related injuries and death in sedation malpractice claims, accounting for 21% of cases.
For facial cosmetic surgery specifically, the data is sobering. In a three-year audit of office-based surgical incidents in Florida, every death among facial cosmetic surgery patients was related to sedation anesthesia. This doesn’t mean sedation is inherently dangerous, but it does mean the skill and vigilance of the person managing your anesthesia is critical regardless of the setting.
Why Your Surgeon’s Credentials Matter
Here’s something many people don’t realize: any licensed physician can legally call themselves a cosmetic surgeon or aesthetic surgeon in the United States. There is no government requirement that a doctor advertising cosmetic surgery has completed any formal plastic surgery training. A dermatologist, an emergency medicine doctor, or a general practitioner could legally perform a facelift.
A surgeon certified by the American Board of Plastic Surgery has completed a very different path. After medical school, they complete at least six years of surgical training, including a minimum of three years focused specifically on plastic surgery. They must pass both written and oral board exams and complete continuing education every year. Integrated plastic surgery residency programs run six to eight years total.
This gap in training is one of the most controllable risk factors in cosmetic surgery. Checking that your surgeon is board-certified by the American Board of Plastic Surgery (not just any board with “cosmetic” in the name) is a straightforward step that meaningfully reduces your risk.
Where You Have Surgery
Cosmetic procedures are performed in hospitals, ambulatory surgery centers, and office-based surgical suites. Accreditation from organizations like the Joint Commission or AAAHC means a facility has met specific safety standards for equipment, staffing, and emergency protocols.
The data on whether accreditation alone improves outcomes is mixed. A large study comparing accredited and non-accredited ambulatory surgery centers in Florida found that, for most procedures, there were no systematic differences in quality of care. Patients at Joint Commission-accredited facilities were about 10% less likely to be hospitalized within a week of their procedure for one specific surgery studied, but this difference didn’t hold across other procedures.
What matters more than the accreditation sticker on the wall is whether the facility has the right monitoring equipment, emergency protocols, and trained staff to handle complications if they arise. If you’re having surgery under sedation or general anesthesia in an office setting, ask whether the facility has emergency airway equipment, a crash cart, and a plan for transferring you to a hospital if needed.
The Added Risks of Surgery Abroad
Medical tourism for cosmetic surgery, particularly to countries where procedures cost a fraction of domestic prices, introduces risks that are harder to evaluate and control. The CDC identifies infection as the most common complication among medical tourists. Beyond standard surgical site infections, patients face exposure to drug-resistant bacteria and fungi that may be more prevalent in certain countries. Some of these organisms, like carbapenem-resistant bacteria and Candida auris, are extremely difficult to treat and may not respond to standard antibiotics.
There are also practical problems. Complications that develop after you return home require treatment by a new doctor who wasn’t part of the original surgery and may not have access to your operative records. Revision surgeries to correct unsatisfactory results or address complications can end up exceeding the cost savings that motivated the trip abroad. Blood clot risk is also elevated by long flights shortly after surgery, when you’re already in a period of higher clotting risk from the procedure itself.
How to Reduce Your Risk
The safety of cosmetic surgery isn’t a fixed number. It’s a range, and where you fall on that range depends largely on decisions you can make before the procedure:
- Choose a board-certified plastic surgeon. Verify certification through the American Board of Plastic Surgery, not just a clinic’s website.
- Have surgery in an accredited facility with proper monitoring and emergency equipment.
- Be honest about your health. Disclose your full medical history, medications, and supplements. Conditions like diabetes and obesity measurably increase complication rates.
- Avoid combining too many procedures. Each additional procedure adds operative time, anesthesia exposure, and recovery burden.
- Stop smoking well before surgery and don’t restart during recovery.
- Ask specific safety questions. For high-risk procedures like BBLs, ask about injection technique and ultrasound guidance. For any procedure under sedation, ask about airway monitoring protocols.
Cosmetic surgery has become remarkably safe in controlled conditions, but “elective” doesn’t mean “trivial.” The procedures involve real surgical risks, and the single biggest factor in your safety is making informed choices about who operates on you, where, and whether your body is in the best possible condition going in.