# Personalized Damage Assessment in Aesthetic Surgery: Current Trends and the Italian Scenario

## TL;DR

This paper explores how to assess and manage risks in aesthetic surgery, focusing on legal and psychological factors in Italy.

## Contribution

The paper introduces a 'mixed obligation' model for aesthetic surgery, emphasizing the need for personalized consent and psychological evaluation.

## Key findings

- Fully elective procedures like liposuction and breast augmentation have the highest litigation risk.
- Inadequate informed consent and mismatched patient expectations are common legal claims.
- Italian courts increasingly require detailed, individualized consent and psychological assessments.

## Abstract

Introduction: Aesthetic surgery addresses subjective desires for morphological enhancement and differs from reconstructive surgery due to its elective, non-therapeutic nature. This distinction introduces complex medico-legal challenges, particularly concerning informed consent, patient expectations, and the legal evaluation of aesthetic damage. Materials and Methods: A narrative review was conducted using national legislation, Italian and international clinical guidelines, peer-reviewed literature from PubMed, Scopus, and Web of Science, and Italian Supreme Court rulings. Eight commonly litigated aesthetic procedures were analyzed in terms of clinical indications, public reimbursement criteria, and medico-legal risk. Results: Findings revealed significant variability in medico-legal exposure among procedures. Fully elective interventions such as liposuction and breast augmentation carried the highest litigation risk. Common legal claims included inadequate informed consent, poor psychological assessment, and mismatched expectations. The review emphasizes the need for personalized consent processes and comprehensive preoperative evaluations. Discussion: Italian case law increasingly adopts a “mixed obligation” model for aesthetic surgery, requiring not only technical skill but also a prognostic and relational evaluation of the intervention. Informed consent must be detailed, individualized, and well-documented, as it holds greater legal weight than in therapeutic procedures. Predictive medico-legal tools such as psychological profiling and structured consent protocols are essential for risk mitigation. Conclusions: Modern aesthetic surgery requires a redefined approach to damage assessment that incorporates psychological, relational, and identity factors. In both clinical and surgical practice, an approach tailored to the patient’s psychological profile must be increasingly taken into consideration, both when proposing and carrying out treatments and in medical-legal assessments. A legally and ethically sound practice depends on transparency, documentation, and patient-centered care, especially in the absence of therapeutic indications.