The causal link and aesthetic damage

This article examines the role of causation in medical liability for aesthetic damage, arguing that compensation cannot be based solely on a patient's dissatisfaction with the outcome of cosmetic treatment. Instead, recovery requires proof of three cumulative elements: actual damage, professional negligence, and a causal link between the healthcare provider's conduct and the alleged injury. By analysing the evolution of Italian case law, the framework introduced by Law No. 24/2017 (the Gelli-Bianco Act), the Italian Supreme Court's Order No. 28120/2025, and the judgment of the Court of Salerno No. 6134/2024, the paper shows a clear judicial trend rejecting any presumption of liability based on an unfavourable aesthetic result. Particular attention is devoted to the evidentiary function of expert medical testimony and to the distinction between subjective disappointment and legally compensable harm. The study concludes that Italian medical liability is centred on the lawfulness of the clinical decision-making process and compliance with professional standards, rather than on guaranteeing a specific aesthetic outcome, thereby reaffirming causation as the indispensable cornerstone of civil liability.