In Colombia, the growing interest in cosmetic procedures is overshadowed by an alarming increase in mortality rates and serious complications. ^1,2 National press reports reveal a disturbing reality: these tragic events are often the result of poor surgical techniques, inadequate patient selection, lack of professional training, and the choice of inappropriate facilities for such procedures. ³ It has been estimated that anesthesia-associated mortality worldwide is approximately one per every 100,000 to 200,000 patients. According to the International Society of Aesthetic plastic Surgery (ISApS), Colombia is ranked nineth in the world as a destination for medical tourism and is the third Latin American country after Brazil and Argentina. A total of 470,000 cosmetic surgeries were conducted in Colombia in 2022, and the media reported at least two deaths associated with these procedures in 2023. The frequency of these procedures is shown in Table 1, and the mortality rate in Colombia is around one per 20,000 patients. This alarming situation calls for a rapid and forceful response to improve patient safety.

The lack of reports and actions by healthcare organizations, health secretariats and departmental forensic institutes - with few exceptions - ^5,6 has hindered the availability of accurate statistics in the region. The inability to generate adverse event reports leaves us relying solely on information released by the national media. However, this information lacks the specifics about the frequency or incidence of mortality, although it does report the fatalities associated with cosmetic surgical procedures or its complications. ⁷

The prevention of complications in cosmetic surgery is based on a meticulous anesthesia. proper patient selection, comprehensive presurgical assessment, careful intraoperative monitoring and a rigorous postoperative follow-up are all essential components. Additionally, a synergistic relationship between the anesthesiologists and plastic surgeons is mandatory, in order to minimize risks, through an assertive communication among the team of practitioners and the patient.

The continuous advancement in anesthetic techniques and monitoring methods tailored to the specific needs of plastic surgery is vital, in addition to ongoing education, and the exchange of knowledge and best practices between anesthesiologists and plastic surgeons, for an enhanced level of care and improved patient safety.

The growing demand for cosmetic surgeries, driven by beauty ideals and economic factors, often gives rise to ethical dilemmas. ⁸ Such dilemmas may lead to inadequate patient selection which increases the risk of complications. Joint preoperative planning and fluid and constant communication during the procedure are essential for an effective response to any unexpected event, and significantly increase patient safety. ⁹

Reducing mortality and complications in cosmetic surgery in Colombia is a goal that requires a collective commitment of anesthesiologists and plastic surgeons who have already undertaken previous exercises, requiring an updating and commitment to implementation. ¹⁰ Ongoing education, the development of practice guidelines, the adoption of state-of-the-art technologies and effective collaboration, in addition to strengthened regulations by the corresponding authorities, will contribute to accomplishing the highest standards of safety, quality and patient satisfaction, in order to reduce the high level of mortality and the resulting significant consequences. ^11,12 The medical community must adopt concrete and lasting measures to regain and maintain the confidence of the general population in these procedures, thus ensuring the wellbeing and safety of all patients.