The Impact of Obesity on Plastic Surgery Outcomes: A Systematic Review and Meta-analysis

Aesthet Surg J. 2022 Jun 20;42(7):795-807. doi: 10.1093/asj/sjab397.


Background: Obesity is a potential risk factor for complications in plastic surgeries. However, the data presented by primary studies are contradictory.

Objectives: The aim of this study was to summarize and clarify the divergences in the literature to provide a better understanding of the impact of obesity in different plastic surgery procedures.

Methods: We conducted a systematic review and meta-analysis of the impact of obesity on plastic surgery outcomes. Searches were conducted in MEDLINE, LILACS, SciELO, Scopus, Embase, Web of Science,, and the Cochrane Database of Systematic Reviews. The primary outcomes assessed were surgical complications, medical complications, and reoperation rates. The secondary outcome assessed was patient satisfaction. Subgroup analysis was performed to investigate the impact of each BMI category on the outcomes.

Results: Ninety-three articles were included in the qualitative synthesis, and 91 were used in the meta-analysis. Obese participants were 1.62 times more likely to present any of the primary outcomes (95% CI, 1.48-1.77; P < 0.00001). The highest increase in risk among plastic surgery types was observed in cosmetic procedures (risk ratio [RR], 1.80; 95% CI, 1.43-2.32; P < 0.00001). Compared with normal-weight participants, overweight participants presented a significantly increased RR for complications (RR, 1.16; 95% CI, 1.07-1.27; P = 0.0004). Most authors found no relation between BMI and overall patient satisfaction.

Conclusions: Obesity leads to more complications and greater incidence of reoperation compared with nonobese patients undergoing plastic surgeries. However, this effect is not evident in reconstructive surgeries in areas of the body other than the breast.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Humans
  • Obesity / complications
  • Overweight
  • Plastic Surgery Procedures* / adverse effects
  • Reoperation
  • Surgery, Plastic*