The maintenance of patient safety in the operating room is one of the main concerns of surgeons, hospitals and surgical centers. Avoiding preventable complications is essential, and the pressure to avoid these complications in cosmetic surgery is increasing. Traditionally, nursing and anesthesia personnel have achieved positioning and patient safety issues in the operating room.As the number of office-based procedures in cosmetic surgery practices increases, understanding and applying patient safety guidelines by the plastic surgeon is of increasing importance. A review of the most important aspects of the universal protocol and established requirements to prevent perioperative complications has been made. In the present work, the importance of the application of these guidelines in the practice of cosmetic surgery is reviewed. The key aspects of patient safety in the operating room are described, including patient positioning, eye protection and other essential issues for the minimization of postoperative morbidity. In addition, as the demand for cosmetic contour surgery in cosmetic practice continues to increase, paying special attention to specific safety considerations for obese patients of massive weight loss.After reviewing this document, the reader should be able to introduce universal protocol of the Joint Commission in their daily practice. The reader will understand key aspects of patient positioning, administration of the airway and eye protection in cosmetic surgery. Finally, the reader will have a better understanding of the perioperative care of unique populations, including patients, massive weight loss with morbid obesity and the elderly. Attention to detail in these aspects of patient safety can help avoid unnecessary complications and significantly improve patient experience and surgical outcomes.