Background <p>Fear of malpractice can affect the psychological well-being and clinical decision-making processes of surgeons. This study aimed to evaluate fear of malpractice, generalized anxiety levels (GAD-7), and defensive medicine practices among rhinoplasty surgeons in Türkiye.</p> Methods <p>A cross-sectional online survey was conducted among ENT and plastic surgeons performing rhinoplasty between August and September 2025. The survey included the 6-item Fear of Malpractice Scale, Generalized Anxiety Disorder-7 (GAD-7), and the 18-item Defensive Medicine Practices Attitude Scale. Descriptive statistics, correlation analyses, and multiple linear regression were performed.</p> Results <p>A total of 188 surgeons participated. 17% of the participants were female, 83% were male, and their mean age was 40.8 ± 6.7 years. The mean fear of malpractice score was 21.28 ± 6.17 (range 6–30). The mean GAD-7 score was 8.38 ± 4.13 (range 0–21). Female surgeons had higher GAD-7 scores than males (9.84 ± 4.21 vs. 8.06 ± 4.07, <i>p</i> = 0.038). Fear of malpractice correlated positively with GAD-7 (<i>r</i> = 0.34, <i>p</i> &lt; 0.001) and defensive medicine scores (ρ = 0.32, <i>p</i> = 0.001). In multivariable regression analysis, higher malpractice fear (β = 0.29, <i>p</i> &lt; 0.001), younger age (β = -0.11, <i>p</i> = 0.002), female gender (β = 1.21, <i>p</i> = 0.031), and working in private institutions (β = 2.46, <i>p</i> &lt; 0.001) independently predicted higher anxiety levels (adjusted R² = 0.254).</p> Conclusions <p>Fear of malpractice is significantly associated with general anxiety and defensive medical practices among rhinoplasty surgeons. Balanced medico-legal training and institutional support can help reduce unnecessary defensiveness while protecting the patient’s best interests in decision-making.</p>