Rahman Eqram, Rao Parinitha, Sayed Karim, Garcia Patricia E, Ioannidis Sotirios, Yu Nanze, Sadeghi-Esfahlani Shabnam, Nassif Alexander D, Webb William Richard, Rahman Zakia, Peng Hsien-Li Peter, Goodman Greg J
Research and Innovation Hub, Innovation Aesthetics, London, WC2H 9JQ, UK.
The Skin Address, Aesthetic Dermatology Practice, Bangalore, India.
Aesthetic Plast Surg. 2025 Jul 1. doi: 10.1007/s00266-025-05007-3.
Non-surgical aesthetic treatments (NSATs) have gained significant traction over the past two decades, prized for their minimally invasive nature, cost-effectiveness, and rapid outcomes. Yet complications associated with these procedures remain underreported, inadequately studied, and inconsistently regulated, compromising patient safety.
This mixed-methods study synthesised global data from 457 peer-reviewed studies, 37,250 media articles, 2.28 million social media posts, and regulatory databases, encompassing 231,475 documented complications. Statistical methodologies, including Cox proportional hazards models, Bayesian hierarchical modelling, and geospatial mapping, were employed to evaluate risk trends. Machine learning algorithms forecasted emerging risks, while sensitivity analyses addressed potential data biases.
Dermal fillers accounted for 42% of complications, chiefly granulomas, vascular occlusions, and delayed hypersensitivity reactions. Botulinum toxin A contributed 15% of cases, predominantly mild adverse effects such as headache, ptosis, and bruising. Thread lift procedures were marred by frequent extrusion and infection rates. The safest products were identified as Prabotulinumtoxin A, Juvéderm high-viscosity fillers, Profhilo, APTOS Light Lift, microneedling radiofrequency devices, Ultherapy, and EMFACE, each demonstrating > 85% safety probability. Predictive models highlighted escalating risks linked to unregulated therapies (e.g. exosomes), while geospatial analysis revealed stark regional disparities, with Asia reporting 34% of complications-attributed to medical tourism and variable oversight.
While advancements like standardised complication registries and ultrasound-guided techniques herald progress, transformative measures are imperative. These include mandating adverse event reporting, harmonising global regulatory frameworks, and integrating AI-driven surveillance systems. The field must prioritise transparency, rigorous credentialling, and patient-centred ethics to ensure its evolution aligns with uncompromising safety standards.
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在过去二十年中，非手术美容治疗（NSATs）获得了显著的关注，因其微创性、成本效益和快速见效而备受青睐。然而，与这些治疗相关的并发症仍然报告不足、研究不充分且监管不一致，危及患者安全。
这项混合方法研究综合了来自457篇同行评审研究、37250篇媒体文章、228万条社交媒体帖子和监管数据库的全球数据，涵盖231475例记录在案的并发症。采用包括Cox比例风险模型、贝叶斯分层模型和地理空间映射在内的统计方法来评估风险趋势。机器学习算法预测新出现的风险，而敏感性分析则解决潜在的数据偏差问题。
真皮填充剂导致的并发症占42%，主要是肉芽肿、血管阻塞和迟发型超敏反应。A型肉毒杆菌毒素导致的病例占15%，主要是头痛、上睑下垂和瘀伤等轻度不良反应。线雕手术常出现线材外露和感染率高的问题。最安全的产品被确定为帕拉肉毒杆菌毒素A、乔雅登高粘度填充剂、芙媄登、APTOS轻提升、微针射频设备、超声刀和EMFACE，每种产品的安全概率均>85%。预测模型突出了与不受监管的疗法（如外泌体）相关的风险不断上升，而地理空间分析揭示了明显的地区差异，亚洲报告的并发症中有34%归因于医疗旅游和监管不一。
虽然标准化并发症登记和超声引导技术等进展预示着进步，但变革性措施势在必行。这些措施包括强制报告不良事件、统一全球监管框架以及整合人工智能驱动的监测系统。该领域必须优先考虑透明度、严格的资质认证和以患者为中心的伦理道德，以确保其发展符合毫不妥协的安全标准。
证据水平IV：本刊要求作者为每篇文章指定证据水平。有关这些循证医学评级的完整描述，请参阅目录或作者在线指南www.springer.com/00266 。
