Blackwater Law medical negligence solicitors successfully represented Mrs Lockey in her claim against University Hospitals of North Midlands NHS Trust.
Posted on 23rd December 2025
Co-written by Rick Miller, BSc., MSc., RD Principal Dietitian and CEO at Miller Health, Mr Kamil Asaad Consultant Plastic Surgeon and Chloe Canham, Clinical Negligence Solicitor with a key interest in Cosmetic Surgery Claims.
Cosmetic surgery in the UK is growing at pace. BAAPS reported 31,057 procedures in 2022, a 102% increase on the previous year and wider industry estimates suggest over 500,000 procedures annually across the private sector. While demand accelerates, elements of the law and regulatory sector are lagging behind:
A key element being the failure to perform adequate pre-operative risk assessment, particularly when it comes to nutritional status, dieting behaviour and GLP-1 use, leaving patients medically underprepared and clinicians legally exposed. Another key element is that despite the aesthetic industry seeing explosive growth, the industry is largely unregulated with little surrounding legislation resulting in many clinics offering high-risk treatments without adequate medical training.
Cosmetic Surgery Litigation in the UK Is Increasing
Cosmetic surgery activity has increased significantly, but the safety infrastructure has not kept pace. ISAPS reports continuing global growth (40% increase since 2020) and the UK private sector remains variably regulated with UK government continue to address measures to improve regulation.
In the non-surgical sphere, there were 931 adverse incidents involving injectable treatments in 2017, 83% of which were performed by non-healthcare professionals; illustrating how cosmetic demand often outpaces clinical oversight.
Across invasive and non-invasive procedures, common themes in UK litigation include:
- inconsistent pre-operative assessment
- failure to explore lifestyle factors
- failure to explain all the risks and potential complications resulting in incomplete consent
- inadequate postoperative follow-up
- patients undergoing surgery while physiologically unstable
- Inadequate or careless surgical technique
- Use of unsafe or unapproved products
As patient expectations rise and risk profiles become more complex, these issues are increasingly visible in medico-legal claims. In response to growing concerns over patient safety the UK government are proposing new licensing rules for non-surgical procedures to raise standards across the industry and enhance patient protection.
However, issues surrounding dieting, GLP-1s and nutritional risk are still key areas that require redress to make sure patients are protected from harm.
Hidden Nutritional Vulnerability Is Overlooked And Often Foreseeable
Cosmetic surgery patients, even those with a normal BMI frequently engage in behaviours that elevate surgical risk. Research in Aesthetic Plastic Surgery Journal in 2024 show cosmetic surgery motivated individuals may have:
- restrictive dieting patterns
- cycles of weight loss and regain
- frequent pre-operative “leaning out”
- low protein intake
- unverified supplement routines
- increasing use of GLP-1 agents (Wegovy, Mounjaro)
Further, nutrition-linked complications frequently appear in claims such as:
- delayed wound healing
- surgical-site infection
- implant visibility/rippling in low-fat states
- dissatisfaction following rapid weight change.
The complications below are not readily blamed on nutrition, but can have an impact:
- anaesthetic difficulty (especially with GLP-1 use)
- seroma or haematoma
- poor scarring
Some of these complications could be predicted, or the patient could have been counselled more thoroughly about them. Liability will sit with duty of care and foreseeable risk. GMC Good Medical Practice particularly highlights:
- paragraphs 10–11 – adequate assessment
- paragraphs 30–34 – informed consent
- paragraph 61 – referral where appropriate
- paragraphs 39–40 – documentation
Surgeons are expected to identify behaviours or medications that materially influence surgical risk. This is reinforced by the Royal College of Surgeons’ Professional Standards for Cosmetic Surgery
- Standard 2.1 – full pre-operative lifestyle assessment
- Standard 1.6 – responsible decision-making
- Standard 3.1 – risk-based, patient-specific consent
- Standard 3.4 – ensuring patients are clinically optimised before elective surgery
However, a cosmetic surgeon in the UK is not required to conduct a full nutritional assessment or nutrition-related blood work, but part of the medical assessment must:
- identify behaviours that materially affect surgical risk
- ask appropriate pre-operative questions
- recognise when recent dieting or medication use increases risk
- advise the patient accordingly
- document the conversation
- delay or refer if risk remains significant
These factors fall under foreseeable medical risk, meaning they must be discussed as part of informed consent (Montgomery v Lanarkshire, 2015) and ignoring them exposes both the patient and the clinician.
GLP-1 Medications: The New Blind Spot in Cosmetic Surgery
Cosmetic-motivated use of Wegovy and Mounjaro has surged and many patients simply do not disclose them, believing they are “just for weight loss.” This can also be seen with other supplements, medications and alcohol intake.
Another factor seen with non-surgical treatments is that not all medications supplied are necessarily from reputable suppliers. As such the dosage, quality control or even the active ingredients may not be as stated on packaging. This risk will be increased by the recent price rise of Mounjaro, The list price increased by up to 170%, with the highest monthly dose rising from approximately £122 to £330. This will fuel a market for cheaper alternatives and potentially counterfeit medication.
Some published anaesthetic and endocrine guidance highlights:
- Delayed gastric emptying from the medications may increase pulmonary aspiration risk where patients may require a longer period of pre-operative fasting prior to general anaesthetic. This may be as much the anaesthetist’s responsibility as it is the surgeon’s. But this could be picked up by specific questioning in pre-anaesthetic assessment which is not always done by a doctor in some clinics.
- Rapid weight loss may involve lean-mass depletion and hence poorer surgical recovery.
- Altered nutrient handling may lead to vitamin B12, vitamin D and iron vulnerability.
- Unpredictable anaesthetic responses.
Not asking specifically about GLP-1’s now represents a clear medico-legal vulnerability.
High-Profile UK Cases Illustrate These Gaps
Karen Turner v Mr Nigel Carver
A breast augmentation consent case examining whether the surgeon fully disclosed material risks — including those linked to tissue quality and physiological variation. Reinforces the requirement for personalised consent and thorough documentation.
UK Patient v Dr Kalecinski (Poland)
A British patient developed sepsis after cosmetic surgery abroad. The High Court found inadequate assessment and aftercare. Although the surgery was performed abroad, the principle applies apply equally in the UK that failure to evaluate modifiable risk factors increases postoperative complications.
Final Word
Cosmetic surgery can achieve excellent outcomes but only when pre-operative preparation matches the complexity of modern patients.
The UK government is taking action in attempt to transform the aesthetic landscape and address some of the current shortfalls within the law and industry which have unsurprisingly resulted in a surge of cosmetic surgery claims.
The industry remains hopeful that the new regulations will improve clinical standards and increase patient protection. However, dieting behaviour, GLP-1 medication use, supplement routines and metabolic vulnerabilities continue to be increasingly common features in aesthetic practice. While surgeons are not expected to perform full nutritional assessments, they are expected to identify and address behaviours that carry material surgical or anaesthetic risk.
Patients deserve safe preparation. Clinicians deserve proper protection. And the sector deserves a more honest discussion about risks that have been overlooked for too long.
Is regulatory reform needed to address the industry’s shortcomings in inadequate pre-operative assessments, or can these issues be resolved instead through improved patient-clinician transparency and more rigorous risk assessment and management practices?
