Objective To investigate the current status of pharmacovigilance in medical aesthetic institutions in some provinces of China, analyze existing problems and put forward targeted improvement suggestions. Methods The study was conducted from January to June 2024. A multi-stage non-probability convenience sampling method was used to select 537 medical aesthetic institutions (accounting for 5% of the national total of 10 736) as the research subjects. Questionnaire surveys were administered to the management personnel and medical staff of these institutions, covering the organizational structure of pharmacovigilance, personnel training, equipment and resources, adverse drug reaction (ADR) report submission, institutional regulations and procedures, as well as the occurrence of ADRs. Results A total of 653 valid questionnaires were collected, with an effective recovery rate of 100.00%. Only 40.00% of institutions set up full-time departments for pharmacovigilance, and 77.29% had no designated person in charge of pharmacovigilance. 77.30% of institutions did not report ADRs through the National Adverse Drug Reaction Monitoring System. Only 38.92% formulated emergency plans for safety emergencies, 39.46% clarified ADR reporting procedures, and 16.76% had not established a pharmacovigilance monitoring system. Only 49.19% of medical staff hadparticipated in pharmacovigilance-related training, 60.50% were unfamiliar with ADR reporting procedures, and 34.60% considered themselves insufficient in ADR judgment ability. The most common type of ADR was skin and subcutaneous tissue diseases (88.17%), and 70.81% of institutions regarded patients’ insufffcient awareness of ADRs as the main difffculty in pharmacovigilance work. Conclusion The construction of pharmacovigilance system in medical aesthetic institutions in some provinces of China is imperfect, with problems such as lack of full-time departments and incomplete ADR reporting mechanisms. Medical staff have obvious shortcomings in pharmacovigilance awareness and implementation capacity. Targeted measures should be improved to enhance the level of pharmacovigilance management in medical aesthetic institutions.