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CC BY 4.0 · Indian J Plast Surg
DOI: 10.1055/s-0045-1814163
Letter to the Editor

The Diamond Route to Safer Aesthetic Surgery

Authors

  • Nandini Singh Tanwar 

    1   Department of Plastic Reconstructive and Burns Surgery, All India Institute of Medical Sciences, New Delhi, India

  • Raunak Goyal

    2   Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States

  • Rajat Gupta 

    3   Department of Plastic and Reconstructive Surgery, RG Aesthetics, Excel Hospital, New Delhi, India
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Introduction

From Plato's time to contemporary neurological research, the concept of beauty has consistently sparked intense debate and profound reflection. The definition of beauty remains ambiguous, varying across individuals and history. It is a growing pursuit, amplified by social media, that highlights its influence on self-esteem and quality of life.[1] Nonetheless, this progress is accompanied by the paramount responsibility to ensure patient safety, which remains the fundamental principle of ethical and effective surgical practice.

Every year, September 17th is celebrated as World Patient Safety Day, which was commenced in the year 2019 by the World Health Organization to recognize patient safety as a global health priority.[2] Patient safety emerged due to the growing complexity of health care systems and the increasing number of patient-related complications. The slogan of the 2024 World Safety Day was “Get it right, make it safe,” highlighting the importance of correct and timely diagnosis to ensure patient safety and improve health outcomes.[3]

Globally, India ranks seventh in the number of surgical and nonsurgical aesthetic procedures performed. According to the 2024 global surgery survey performed by the International Society of Aesthetic Plastic Surgeons (ISAPS), the total number of aesthetic procedures performed in India was 12,88,840 cases, with 6,77,040 surgical and 6,11,800 nonsurgical procedures.[4] In comparison with the 2023 global ISAPS survey, there was an increase of 2,60,117 procedures.[5] Aesthetic procedures pose distinct challenges due to the diversity of health care infrastructure and the increasing demand for aesthetic procedures. Although technological advancements and enhanced surgical techniques have contributed to improved outcomes, deficiencies in preoperative evaluation, perioperative protocols, or postoperative care may result in preventable complications. To overcome this, the Indian Society of Anaesthesiologists has laid down preoperative guidelines.[6] While perioperative protocols may vary based on individual cases and institutional practices, strict adherence to standardized guidelines is essential.

Quoting the most recent incident on social media, where a 31-year-old singer and influencer travelled with her husband for her cosmetic surgery to Türkiye in June 2025. There was a commercial agreement to offer her surgery at no cost for promoting the clinic. She underwent breast augmentation, liposuction, and rhinoplasty on Sunday, which was 2 days ahead of the scheduled date of surgery. Hours after her surgery, she had bradycardia followed by cardiac arrest, and even with the best efforts by the anesthesiology team, she could not be revived.[7] There are many such incidents reported every other day, but no conclusive statistics are available in India. Avoid exorbitant or aggressive commercialization of aesthetic procedures. Centers offering freebies, free surgery for free promotions, or overtly cheap procedures should raise suspicion. Surgical practices should run on a strong ethical foundation.

The surge of complications and incidents, such as surgical site infections, thromboembolic events, anesthetic mishaps, or inadequately managed patient expectations, can compromise the credibility of the specialty.[8] Just as a “diamond” traffic sign warns drivers to anticipate and avoid hazards ahead, the Four Diamond Factors ([Fig. 1]) in aesthetic surgery established by ISAPS serve as critical safety signals—guiding surgeons and patients to navigate potential risks and ensure a smooth, complication-free journey[9]:

  • Procedure: Select procedures appropriate to your goals, supported by thorough research and realistic expectations. Total surgical duration should be within safe limits.

  • Patient: A comprehensive medical evaluation is essential to assess risks and overall suitability for aesthetic surgery. Full disclosure of medical history and prior procedures is critical.

  • Surgeon: Opt for a board-certified plastic surgeon with proven expertise in your desired procedure and a strong safety track record. Credentials should be verifiable through relevant national medical boards.

  • Surgical setting: Every country has a different set of standards. Always ensure the facility is accredited or certified. Hospitals should have recognized certification, and national accrediting bodies should accredit outpatient.

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Fig. 1 The four diamond factors of patient safety laid down by ISAPS. ISAPS, International Society of Aesthetic Plastic Surgeons.

Further disclosure, research, and policy initiatives on patient safety are essential to upholding the standards of our profession and to protect patient welfare.



Conflict of Interest

None declared.


Address for correspondence

Nandini Singh Tanwar, MBBS, MS, MCh (Plastic Surgery)
Department of Plastic Reconstructive and Burns Surgery, All India Institute of Medical Sciences
New Delhi 110029
India   

Publication History

Article published online:
05 January 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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Fig. 1 The four diamond factors of patient safety laid down by ISAPS. ISAPS, International Society of Aesthetic Plastic Surgeons.