Sao Paulo, Brazil – Brazilian psychologist Alexandre Yomatsu de Paula Okumoto began suffering from severe acne when he was 15, which had a huge impact on his self-esteem. He tried treatments including creams, lasers, pulsed light and even antibiotics, but despite controlling the blemishes, he continued to struggle with scarring.
As a result, he turned to cosmetic treatments such as diamond peels and Mediterranean peels, in addition to microneedling sessions with hyaluronic acid. Although this helped reduce scarring, Okumoto's skin never returned to its original state and he believes he will need to undergo these procedures repeatedly throughout his life.
Okumoto admits that her decision to undergo beauty treatments was heavily influenced by self-esteem issues and social pressure. “There is tremendous aesthetic pressure to meet certain beauty standards, especially in the LGBTQIA+ community, where we need to have the perfect body, perfect teeth, and perfect skin. But we hardly meet these standards,” he said. brazil report.
Striving for approval from yourself and others creates a desire to improve your appearance. “It’s very painful to look in the mirror and see your flaws. Today, the reason I get cosmetic procedures is to feel better about my skin and not see imperfections when I look in the mirror. It’s something that’s so internalized in me that it’s hard to break.”
Like Okumoto, thousands of Brazilians are receiving cosmetic treatments to correct imperfections in their appearance. According to data from the International Society of Aesthetic Plastic Surgery (ISAPS), Brazil has the second highest number of plastic surgeries in the world after the United States.
According to the Brazilian Society of Plastic Surgery (SBCP), at least 1.5 million plastic surgeries are performed in Brazil every year, of which 57% are cosmetic and 43% are reconstructive. The Brazilian market is very active, with hundreds of foreigners visiting Brazil solely for cosmetic surgery. At least 7% (over 100,000) of annual procedures are performed on foreigners.
For non-surgical aesthetic treatments, the growth rate is even higher at 56% between 2020 and 2022. This also makes Brazil the second country in the world rankings for non-invasive treatments. According to ISAPS, the most popular procedures include Botox, hyaluronic acid-based facial fillers, laser hair removal, collagen biostimulators, and fat reduction treatments by freezing adipose tissue cells.
But as demand grows so much, so does the risk to patients.
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The death of a young man in Sao Paulo earlier this month after undergoing a cosmetic procedure has reignited discussion about booking treatment with unqualified professionals or in clinics that lack medical training or the structures to deal with emergencies.
According to dermatologist Carolina Marçon of the Brazilian Society of Dermatology (SBD), all invasive procedures or procedures that cause physiological or anatomical changes in skin characteristics should be performed only by doctors. This is due to the importance of a thorough and rigorous pre-evaluation and the potential complications that only a physician is qualified to handle.
“The procedure is not simply the act of injecting or applying a product, but includes both pre- and post-assessment and follow-up. “It is very important to find a dermatologist with the knowledge to treat skin changes,” she said. brazil report.
Death at luxury beauty clinic in Sao Paulo
On June 3, 27-year-old businessman Henrique Silva Chagas died after receiving a phenol peeling procedure at a beauty clinic in an upscale area of Sao Paulo. He booked a treatment costing R$ 4,500 (USD $900) from Natalia Fabiana de Freitas Antônio, known as Natalia Becker, a hairdresser and influencer with more than 200,000 followers on social media.
Phenol peeling is a recommended procedure to treat severe facial aging. If done correctly and as directed, you will achieve results that will completely rejuvenate your skin, boosting collagen production and significantly reducing the appearance of wrinkles and spots.
However, because it is an invasive procedure containing toxic substances, complications such as severe pain, changes in skin color, and even unpredictable heart problems can occur regardless of the concentration of phenol, application method, and depth of skin reach.
In Chagas' case, he felt sick minutes after receiving the peel. He complained of difficulty breathing and tremors, according to his boyfriend, Marcelo Camargo, who accompanied him. He called an ambulance at the hospital, but he was pronounced dead when medics arrived.
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On the same day, the police launched an investigation and closed Natalia Becker's clinic on suspicion of unauthorized phenol peeling procedures. Investigators' hypothesis is that Chagas may have had an allergic reaction and died of “anaphylactic shock.”
The hairdresser called the incident a 'tragedy' after hearing police statements.
“I was very saddened by what happened. It's really unfortunate. It destroyed my life. I had no intention of harming him,” Becker said after leaving the police station. So far she has not been arrested.
Police are considering the possibility of charging the influencer with murder with ultimate intent, which, according to Brazilian law, is a case of taking a risk but not intending to kill, considering that he did not receive proper training in the use of phenol.
Her lawyer Tatiana Forte said Becker took an online course in late 2023 to learn how to apply phenol. “It was a free course led by a pharmacist, and it specifically listed the amount of phenol and how to use it,” she said. So the procedure is simple,” the lawyer said.
However, medical associations have different opinions that only doctors should perform phenol because it is an invasive procedure with a risk of causing serious reactions.
The Regional Medical Council of São Paulo (Cremesp) said invasive procedures such as phenol peeling “should only be performed by doctors” and that performing them by non-medical personnel represented an “unacceptable risk to public health.”
The Brazilian Society of Dermatology (SBD) states that extreme caution is required with phenol peeling. “It is important that this procedure is performed by a qualified physician and, if possible, in a hospital setting with the patient appropriately anesthetized and with cardiac monitoring.”
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What can patients do?
Marçon emphasizes the importance of consulting a dermatologist before undergoing any cosmetic procedure, no matter how simple it may seem. She also advised checking to see if your doctor is board-certified. She says, “For any invasive procedure, including injectables, where we take more aggressive measures, it's ideal for patients to be under the guidance of a specialist.”
The guidelines are even more important considering that the public seeking cosmetic procedures in Brazil is becoming younger and younger. According to market analysis firm HSR, 80% of people between the ages of 18 and 25 would like to receive treatment. This figure decreases to 60% in those in their 40s and to 40% in those over 60.
And it is the younger generation that is most likely to seek information on social media, and may be attracted to less qualified professionals. According to Marçon, social media often displays misleading information, with people presenting themselves as experts without proper credentials, as in the case of influencer Natalia Becker.
“This allows people without proper training to position themselves as authorities and use numerous fabricated before and after images to show results that are not real. This creates desire and desire in those who view the content. However, if you lack discernment, you can fall into a trap and put your health and life at risk,” he said.
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It is also important to research the clinic before scheduling a procedure. This is exactly what instructor Luzicleia de Azevedo Chaves did to reduce the freckles and spots on her face before getting a crystal peel. “She made sure other patients were satisfied and that it was approved by the hospital,” she said. “I liked the results and there were no complications,” she said. brazil report.
Attorney Cyndia Moraca received microfocus ultrasound treatment to stimulate collagen and reduce facial sagging at a clinic recommended by a friend. However, she was not completely satisfied with the services and information provided after the procedure and then started to develop spots on her face and discomfort in her cheeks.
“I had to see a cosmetic dermatologist to evaluate the lesion. I ended up using a different collagen stimulating application and felt like my skin was already improving,” she said. brazil report. “But the cost of the procedure is too expensive, and anxiety and greed about the results end up overspending. “Everything I did was motivated by excitement.”
The high cost of the procedure is one of the reasons why many patients turn to less qualified specialists rather than specialists. “While price is a determining factor, it should also be a reason for suspicion. The cost of the procedure can be high, depending on the training of the professional and the products or equipment used. If the price is too low, it should be a warning sign for patients,” Marçon added.