Safety Profile of Facial Cosmetic Surgery Under Local Anesthesia, with or without Sedation: A Systematic Review and...

Facial aesthetic surgery is increasingly performed under local anesthesia, with or without sedation, in office-based settings. This systematic review and meta-analysis aimed to determine the safety profile of such procedures by measuring the incidence of complications following facial cosmetic surgery under local anesthesia, with or without sedation.

A systematic review of the literature was performed in line with the PRISMA guidelines. The databases PubMed, Embase, Scopus, CINAHL, and Web of Science were searched. Studies reporting on complications following facial cosmetic surgery performed in outpatient settings under local anesthesia, with or without sedation, were included. The pooled weighted incidence of complications was calculated using a random-effects inverse variance model with Freeman-Tukey transformation.

Twelve studies were included, with a procedure pool of 3283. The incidence of total complications was 5.6%, 95% CI [2.8, 9.3]. The incidence of major complications was 1.6%, 95% CI [0.1, 4.3], while minor complications occurred in 3.7%, 95% CI [2.0, 5.7], of cases. Combined facial aesthetic procedures were uncommon, with 9% of patients undergoing multiple procedures in the same operative setting.

Facial cosmetic surgery under local anesthesia, with or without sedation, appears to be associated with a low incidence of complications. Combined procedures were uncommon, indicating that operative scope in these settings is generally limited. Substantial heterogeneity among studies underscores the need for standardized definitions of complications, anesthetic protocols, and evidence-based patient selection criteria. Future research should focus on developing these frameworks and incorporating validated outcome measures to further optimize safety and patient satisfaction.

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .