BMC Health Serv Res. 2026 Jun 27. doi: 10.1186/s12913-026-15042-8. Online ahead of print.
ABSTRACT
BACKGROUND: The global surge in cosmetic procedures has been accompanied by a rise in medical malpractice litigation. Cosmetic services differ fundamentally from therapeutic medicine in their elective nature, heightened patient expectations, and the growing participation of unlicensed providers, each contributing to distinct patterns of adverse outcomes and varying levels of judicial accountability. Therefore, clarifying the distinct risk patterns and legal consequences between medically qualified professionals and unauthorized providers is of critical importance; this research gap has been addressed in the present study.
METHODS: This retrospective cross-sectional study reviewed 525 medical malpractice complaint records registered at the Shahid Ghodosi Judicial Complex in Shiraz, Iran, between 2021 and 2023. Records were screened according to predefined inclusion and exclusion criteria. Data were extracted from judicial case files using a structured checklist including demographic, clinical, forensic, and legal variables. Descriptive statistics and the Fisher-Freeman-Halton Exact Test were performed using SPSS version 25.
RESULTS: Of the 525 medical malpractice records reviewed, 253 (48.1%) met the eligibility criteria and were included in the final analysis. Statistically significant differences were observed between licensed and unlicensed providers across clinical outcomes, service settings, and judicial penalties (p < 0.001). Licensed providers were involved in 74.3% of cases and were primarily associated with technical complications in surgical procedures, particularly rhinoplasty (27.1%), leading mainly to structural deformities (86.4%) and dissatisfaction with aesthetic outcomes. In these cases, “Diyah” (financial compensation) alone was the predominant judicial outcome (96.8%). In contrast, unlicensed providers (25.7%) were significantly associated with minimally invasive procedures such as fillers and Botox (40.0%), frequently performed in informal settings including private homes (53.8%). These interventions were mainly linked to infections and tissue necrosis (62.2%) and resulted in significantly harsher judicial penalties, including imprisonment (52.3%) (p < 0.001).
CONCLUSIONS: Licensed and unlicensed providers exhibited distinct malpractice patterns and judicial outcomes. Licensed providers were primarily associated with technical complications resulting in Diyah penalties, whereas unlicensed providers were linked to severe adverse events in informal settings and harsher sanctions, including imprisonment. These findings highlight the need for targeted regulatory and patient-safety interventions.
TRIAL REGISTRATION: Not applicable.
PMID:42365359 | DOI:10.1186/s12913-026-15042-8
