Sao Paulo, Brazil- At age 15, Brazilian psychologist Alexandre Yomatsu de Paula Okumoto began suffering from severe acne, which severely affected his self-esteem. He tried treatments using creams, lasers, pulsed light, and even antibiotics, but even when he managed to control his acne, he still struggled with scarring.
So he began trying cosmetic treatments like diamond and Mediterranean peels, as well as microneedling with hyaluronic acid. Although these treatments helped reduce the scarring, Auburn’s skin never returned to its original state, and he believes he will need to undergo these treatments repeatedly throughout his life.
Okumoto admits that his decision to undergo cosmetic treatments was heavily influenced by self-esteem and societal pressure. “There’s so much pressure to live up to certain beauty standards, especially in the LGBTQIA+ community, that you need to have a perfect body, perfect teeth, perfect skin. But we almost never live up to those standards,” he told Brazil Report.
Seeking approval from himself and others fueled his desire to improve his appearance. “When we look in the mirror and see imperfections, it’s very painful. Today, the reason I get cosmetic surgery is to feel better in my skin and not see imperfections when I look in the mirror. It’s something that’s very deep in my heart and it’s hard to break.”
Like Okumoto, thousands of Brazilians are seeking cosmetic treatments to correct perceived flaws in their appearance. Brazil is the second-most plastic surgery country in the world, after the United States. According to the data From the International Society of Aesthetic Plastic Surgeons (ISAPS).
At least 1.5 million plastic surgeries are performed in Brazil each year, of which 57% are cosmetic and 43% are reconstructive. according to The Brazilian Society of Plastic Surgery (SBCP) says that the Brazilian market is very active and hundreds of foreigners come to Brazil just for plastic surgery: At least 7% More than 100,000 immigration cases are filed against foreign nationals each year.
As for non-surgical cosmetic treatments, the growth rate is even higher: 56% between 2020 and 2022, which would also make Brazil the second largest World Ranking Non-invasive treatment. Among the most popular treatments, According to ISAPSThese include Botox, hyaluronic acid-based facial fillers, laser hair removal, collagen biostimulators, and fat reduction treatments via freezing of adipose tissue cells.
But the need is so great, and the risks to patients are increasing.
The death of a young man in Sao Paulo earlier this month after undergoing plastic surgery has reignited discussions about booking treatments by unqualified professionals, who often have no medical training, or in clinics that lack the structure to handle emergencies.
Carolina Marçon, a dermatologist at the Brazilian Society of Dermatology (SBD), says that all invasive procedures or those that cause any physiological or anatomical changes in the characteristics of the skin must be performed by a doctor. This is because a thorough and rigorous initial evaluation is very important, and only a doctor is qualified to deal with potential complications.
“The process is not just about injecting or applying the product, but also includes pre- and post-treatment evaluations as well as follow-up. It is very important to seek help from a dermatologist who knows how to treat skin changes,” she told Brazil Report.
A death occurred at a high-end beauty clinic in Sao Paulo
On June 3, 27-year-old businessman Enrique Silva Chagas died after undergoing a phenol peel at a beauty clinic in an upscale neighborhood of São Paulo. He had booked a 4,500 Brazilian reals ($900) treatment with Natalia Fabiana de Freitas Antônio, a beautician and influencer with more than 200,000 followers on social media, and the treatment cost him 4,500 reais ($900).
Phenol peels are the recommended treatment for severe facial aging. If performed correctly according to the guidelines, they can boost collagen production and significantly reduce wrinkles and spots, completely rejuvenating the skin.
However, since this is an invasive procedure involving toxic substances, complications such as severe pain, skin color changes, and even unpredictable heart problems may occur regardless of the concentration of phenol, the method of application, and the depth of penetration into the skin.
In Chagas’ case, he collapsed minutes after the skinning procedure. He reported shortness of breath and tremors, according to his boyfriend, Marcelo Camargo, who accompanied him. The clinic called an ambulance, but when the medical team arrived, they confirmed he was dead.
The same day, police began an investigation and closed Natalia Becker’s clinic for allegedly performing phenol peels without authorization. Investigators’ hypothesis was that the Chagas disease patient may have had an allergic reaction and died of “anaphylactic shock.”
In an interview with police, the beautician called the case a “tragedy.”
“I feel really bad about what happened. I’m really sorry. This has ruined my life. I never meant to hurt him,” Becker said after leaving the police station. So far, she has not been arrested.
Police are considering filing charges for intentional homicide, which under Brazilian law occurs when a person does not intend to kill someone but takes the risk, as the suspected influencer lacked proper training in using phenol.
Her lawyer, Tatiana Forte, said Becker took an online course in late 2023 to learn how to use phenol. “It was a free course, organized by a pharmacist, which explained in detail the dosage of phenol and how to use it. So, it was a simple process,” the lawyer said.
However, medical associations disagree, arguing that only doctors should use phenol because it is an invasive procedure that carries the risk of causing a serious reaction.
São Paulo Regional Medical Council (Cremesp) statement Invasive procedures such as phenol peels “should only be performed by a doctor” and non-medical personnel would “pose an unacceptable risk to public health”.
Brazilian Society of Dermatology (SBD) statement Phenol peels require extreme caution. “The procedure must be performed by a qualified physician, preferably in a hospital setting, and the patient must be properly anesthetized and on cardiac monitoring.”
What can patients do?
Marçon stresses that it is important to consult a dermatologist before undergoing any cosmetic procedure, no matter how simple it may seem. She also recommends verifying that the doctor is a specialist: “As with all invasive procedures involving injectables, which have a more aggressive effect, it is best for the patient to be guided by a specialist.”
Given that the number of people seeking cosmetic treatments in Brazil is getting younger and younger, guidance is even more important. Market analysis company HSRThe data shows that 80% of people aged 18 to 25 want some kind of treatment. That number drops to 60% for those in their 40s and 40% for those over 60.
It is the younger generations who are most keen to seek information on social media, and they are easily attracted by professionals with poor qualifications. According to Marçon, social media often displays misleading information, where people claim to be experts but do not actually have relevant qualifications, as is the case with influencer Natalia Becker.
“This allows people without proper training to position themselves as authorities and use many manipulated before-and-after images to show unreal results. This creates desire and need in the person who sees the content. But if the person lacks discernment, they may fall into the trap and endanger their health and life,” the doctor said.
It’s also important to research the clinic before scheduling any procedure. That’s what instructor Luzicleia de Azevedo Chaves did before getting a crystal peel to reduce freckles and spots on her face. “I checked to see if other patients were satisfied and if the clinic was authorized. I loved the results, and there were no complications,” she told Brazil Report.
Lawyer Scindia Moraka underwent micro-focused ultrasound treatment at a clinic recommended by a friend to stimulate collagen and reduce facial sagging. However, she was not completely satisfied with the service and information after the treatment, as a spot appeared on her face and she began to feel discomfort in her cheeks.
“I had to see a dermatologist who specializes in aesthetics to evaluate the lesions. I ended up having other collagen-stimulating treatments and feel my skin has improved,” she told Brazil Report“But these surgeries are very expensive and we end up spending money out of anxiety and desire for results. Everything I do is out of excitement.”
The high cost of surgery is one of the reasons why many patients choose to seek help from less qualified professionals instead of specialists. “Price is a decisive factor, but it should also be a reason for skepticism. Surgery involves a lot of costs, depending on the professional’s training, the products or equipment used. If the price is too low, patients need to be warned,” added Marcon.
