Medical Malpractice and Physicians'Legal Liability in Cosmetic Surgery

Publication Date: October 2026

Medical intervention refers to any procedure performed on a patient's body, directly or indirectly for therapeutic purposes, by a physician legally authorized to practise medicine. Within this framework, aesthetic surgical procedures are also regarded as medical interventions intended to correct congenital, acquired or externally caused physical deformities and to improve an individual's appearance.

Patients generally undergo cosmetic surgery to enhance their physical appearance rather than to address a medical necessity. This distinguishes aesthetic surgery from many other medical specialties and contributes to particularly high patient expectations. Nevertheless, as cosmetic procedures involve interventions on living human tissue, medical errors and malpractice may arise, as in other fields of medicine.

This article examines the concept of medical malpractice in cosmetic surgery and the legal liability of physicians under Turkish law, with particular emphasis on the nature of the physician–patient relationship and the applicable principles of contractual and non-contractual liability.

I. The Concept and Elements of Medical Malpractice

Medical malpractice may be defined as conduct by a healthcare professional that falls below the applicable professional standards of care during a medical intervention or treatment and causes harm to a patient through an error or omission.

Malpractice may arise from inappropriate or unethical conduct, insufficient professional knowledge, negligence, lack of experience, or the application of improper treatment methods.

For an incident to constitute medical malpractice, the following four fundamental elements must generally be established:

1. The physician or healthcare professional owed a duty of care in connection with the medical intervention.

2. The medical intervention or treatment failed to comply with applicable professional standards.

3. The patient suffered harm as a result of the intervention.

4. A causal relationship exists between the breach of duty and the harm suffered.

In cosmetic surgery, malpractice claims frequently arise from the use of inappropriate surgical techniques, incomplete or inaccurate information provided to patients, or failure to take necessary precautions against postoperative complications.

Given the outcome-oriented nature of cosmetic surgery and the high expectations of patients, such incidents may have significant consequences not only for the patient's physical health but also from psychological and legal perspectives.

II. Legal Nature of the Physician–Patient Relationship

Determining a physician's legal liability, including that of a plastic surgeon, requires an initial assessment of the legal nature of the relationship between the physician and the patient.

Different approaches have been advanced in Turkish legal doctrine concerning the classification of this relationship.

According to one view, the physician–patient relationship constitutes an atypical contract with characteristics specific to medical services. Another view considers it a form of contract for the performance of services, which may be classified under different contractual categories.

Among those adopting the latter approach, some characterize the relationship as an employment or service contract, while others classify it as a contract of mandate or a contract for work.

Under the generally accepted approach in Turkish legal doctrine and the case law of the Turkish Court of Cassation, the physician–patient relationship is ordinarily characterized as a contract of mandate.

However, the legal classification of agreements relating to cosmetic surgery remains subject to particular considerations.

The purpose of the medical intervention plays a decisive role in determining the nature of the contractual relationship and the applicable legal provisions.

Where the primary purpose of the procedure is therapeutic treatment or the correction of a physical impairment, the physician does not ordinarily undertake to achieve a specific result. Instead, the physician assumes a duty to exercise the required professional care and diligence. Such relationships are generally governed by the provisions applicable to contracts of mandate.

Conversely, where the principal purpose of the intervention is aesthetic enhancement and the physician undertakes to achieve a particular result, the Turkish Court of Cassation has recognized the applicability of the provisions governing contracts for work.

Under a contract for work, the contractor—in this context, the surgeon—undertakes to produce a specified result.

Accordingly, the purpose of the procedure and the nature of the result undertaken by the physician are of considerable importance when determining legal liability in cosmetic surgery.

III. Physicians’ Legal Liability

The contractual relationship arising from an aesthetic medical intervention may be classified as either a contract of mandate or a contract for work.

Regardless of the applicable contractual framework, physicians are required to fulfil their contractual obligations and comply with the professional standards governing medical practice.

Physicians must also exercise the appropriate degree of care and diligence in performing their duties.

Failure to comply with these obligations may give rise to contractual or non-contractual liability, depending on the circumstances of the case.

Where a breach of duty causes compensable harm to the patient, the physician may be required to compensate the resulting damage.

The principal grounds of liability in aesthetic medical interventions are examined below.

1. Liability under a Contract of Mandate

Where a physician does not guarantee a particular outcome, the legal relationship with the patient is generally assessed under the provisions governing contracts of mandate.

In such circumstances, the physician's liability primarily arises from a breach of the duty of care.

Article 506 of the Turkish Code of Obligations No. 6098 (“TCO”) regulates the duty of care owed by an agent.

Under this provision, the applicable standard of care is determined by reference to the diligence that a prudent person undertaking comparable services would be expected to exercise.

Accordingly, where a physician fails to exercise the required professional care during an aesthetic intervention and the patient suffers harm as a result, contractual liability may arise under the provisions governing contracts of mandate.

2. Liability under a Contract for Work

Where a physician undertakes to achieve a specific result, the provisions governing contracts for work may apply.

In particular, the Turkish Court of Cassation has classified certain medical interventions undertaken solely for cosmetic or aesthetic enhancement, rather than therapeutic purposes, within the framework of contracts for work.

The principal distinction between a contract of mandate and a contract for work lies in the undertaking to achieve a result.

Under a contract for work, the physician may be responsible not only for exercising professional care and diligence but also for fulfilling the contractual undertaking concerning the outcome of the intervention.

Article 475 of the TCO regulates the remedies available to a client where the work is defective.

Depending on the nature and severity of the defect and the applicable legal conditions, the client may be entitled to:

1. Request the rectification of the defective work without additional charge.

2. Request a reduction in the agreed contractual price proportionate to the defect.

3. Withdraw from the contract where the statutory conditions for such withdrawal are satisfied.

In the context of cosmetic surgery, patients may particularly seek corrective treatment where the outcome of the intervention does not comply with the physician's contractual obligations.

Revision surgery performed to remedy an unsatisfactory or defective result may, where medically appropriate and legally justified, constitute a form of corrective performance.

Nevertheless, the application of remedies designed for contracts for work must be assessed carefully in light of the particular characteristics of medical procedures and the protection of bodily integrity.

3. Liability Arising from the Management of Another's Affairs Without Authority

In certain circumstances, a physician may perform a medical intervention despite the absence of a valid contractual relationship with the patient.

Depending on the circumstances, such situations may fall within the legal framework of the management of another person's affairs without authority, commonly referred to as negotiorum gestio.

Article 526 of the TCO concerns the management of another person's affairs without having been authorized to do so.

Under Article 527 of the TCO, a person who undertakes the management of another's affairs may be held liable for negligence in performing those activities.

Accordingly, where a physician performs an intervention without an underlying contractual relationship or the patient's consent, the potential application of the provisions governing unauthorized management of affairs may arise, depending on the specific circumstances and the applicable rules concerning medical consent.

4. Tort Liability

A physician's liability is not limited to contractual obligations.

In certain circumstances, the physician's conduct may also give rise to liability in tort.

Even where a contractual relationship exists between the physician and the patient, a wrongful and negligent act causing harm may potentially constitute both a breach of contractual obligations and a tort.

Article 49 of the TCO establishes the general principles governing liability for wrongful acts.

For tort liability to arise, the following elements must be established:

1. An unlawful act: Conduct by the physician that is contrary to applicable legal obligations.

2. Damage: The patient must have suffered legally recognizable harm.

3. Causation: A causal relationship must exist between the unlawful act and the damage.

4. Fault: The physician must have acted intentionally or negligently, subject to the applicable legal framework.

Where these elements are established, the physician may be required to compensate the patient for the resulting damage under the principles of tort liability.

IV. Conclusion

The classification of the physician–patient relationship in aesthetic surgery as either a contract of mandate or a contract for work has important consequences for the rights and obligations of the parties and the scope of the physician's liability.

Under a contract of mandate, the physician is primarily required to exercise professional care and diligence, act loyally and protect the patient's interests, without ordinarily guaranteeing the outcome of the treatment.

By contrast, where the relationship is classified as a contract for work, the physician's obligations may extend beyond the duty of care to include responsibility for achieving the contractual result.

In such cases, complications arising from the patient's individual anatomical characteristics or unexpected bodily reactions may raise additional questions concerning the physician's contractual liability, even where those complications would not ordinarily constitute malpractice.

The extent of liability must nevertheless be assessed in light of the precise contractual undertaking, the nature of the medical complication, the applicable legal provisions and the circumstances of the individual case.

Where the provisions governing contracts for work apply, patients may also seek to exercise the remedies available under Article 475 of the TCO.

However, because aesthetic surgical procedures directly concern human bodily integrity, the practical availability of certain contractual remedies may be limited.

Consequently, claims concerning defective aesthetic procedures frequently focus on corrective treatment, where medically appropriate, or financial compensation.

The feasibility of revision surgery must be evaluated in each case, since a further surgical intervention may not always be medically possible, suitable or advisable.

Finally, circumstances such as force majeure, the serious fault of a third party or the serious fault of the injured person may, under the applicable general principles of law, limit or exclude liability.

The existence and extent of a physician's legal responsibility must therefore be determined through an individual assessment of the medical evidence, the contractual relationship, the applicable standard of care and the circumstances in which the alleged damage arose.

This article has been prepared for general informational purposes only and does not constitute legal advice. Legal assessments relating to specific circumstances should be conducted in accordance with applicable legislation and the particular facts of each case.

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