Beauty and Fatality: A Forensic Perspective on Periprocedural Deaths after Aesthetic Procedures, and Insights for Death Investigation and Public Health Safety

Aesthetic procedures are widely performed in Korea, reflecting strong societal demand and accessibility. However, their exact numbers are not systematically recorded, and reliable mortality data remain unavailable. The absence of comprehensive statistics limits our understanding of the risks and hinders evidence-based safety policies. In this context, death investigation and forensic autopsy provide valuable insights into the circumstances and causes of such deaths. This study analyzed 50 forensic autopsy cases of aesthetic procedurerelated fatalities referred to the National Forensic Service between 2016 and 2024. Clinical information and postmortem findings, including histopathological examination and ancillary testing, were reviewed. Demographics, procedural and anesthesia types, and facility characteristics were also examined. The causes of death were classified as anesthesia–related, procedural complications, diseases, or others. Most decedents were women in their 20s-40s (30/50), and 64% of cases occurred in Seoul Metropolitan area. Most cases involved face and neck procedures (52%), followed by liposuction (22%) and vaginal rejuvenation (12%). Anesthesia–related deaths predominated in face and neck procedures and other groups, whereas liposuction fatalities were mainly due to procedural complications. Vaginal rejuvenation was most often associated with fatal pulmonary embolism from filler materials. Overall, anesthesia–related deaths constituted the largest single category across all procedural types. These findings emphasize anesthesia–related mortality as the key cause of death in aesthetic medicine and highlight the essential role of forensic autopsy in accurate death certification and prevention of premature. Strengthened management, adherence to safety guidelines, and improved awareness of procedural safety, efficacy, and necessity are crucial for preventing fatal outcomes.