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Bill intends to require communication of complications after phenol peeling

A bill (PL 9602/2018) that makes the reporting of complications in aesthetic procedures mandatory is awaiting consideration by the Senate after being approved by the Chamber of Deputies in December last year.

According to the text, the objective is to improve the quality of information, facilitating access to data to prevent these cases. The death of a 27-year-old businessman in São Paulo, on June 3, after undergoing a phenol peel, raised an alert about the risks of this technique.

An article published in the Brazilian Annals of Dermatology highlights that there is a lack of publications showing the real dimension of these adverse events, which are often restricted to medical confidentiality or are not exposed out of shame. This includes problems in complex procedures, such as plastic surgery, but also those arising from fillers, straightening and even tattoos and piercings, which can range from poisoning and infections to cases of blindness, for example.

According to the authors, it is necessary to know what is behind these incidents, which often affect young and healthy people, as well as poor quality products and interventions that can put the health of the population at risk.

According to investigations into the death of businessman Henrique Silva Chagas, he died approximately two hours after carrying out the procedure known as phenol peeling (find out more below), at a beautician’s clinic. Chagas suffered serious injuries to his face and throat, and the suspicion is that he suffered an allergic reaction, which would have triggered anaphylactic shock. According to preliminary information, he had not undergone previous examinations.

After the case, the Brazilian Society of Dermatology (SBD) released a technical note clarifying that phenol peeling has existed for many years and, as it is an aggressive and invasive procedure, it is essential to be carried out by qualified doctors, preferably in a hospital environment.

According to the SBD, the professional must be trained and specialized, capable of carrying out a complete medical assessment of the patient, taking into account their risk factors and possible adverse effects. “As with many procedures, we see a trivialization and every time this occurs the risks are underestimated and cases of complications appear”, observes dermatologist Barbara Miguel, from Hospital Israelita Albert Einstein.

“Unfortunately, people choose professionals based on the number of followers, the ‘before and after’ photos whose results do not always represent reality. In the same way that the internet brought access to information, it also makes everything seem very easy.”

Therefore, before any clinical or cosmetic intervention, SBD recommends always seeking guidance from a dermatologist, who can adequately assess the conditions and indicate the best approach. Also try to make sure that the professional is properly qualified, has the necessary credentials and is registered with regulatory bodies, and has a CRM and RQE (Specialist Qualification Register) to work in the area.

“Medical procedures always present potential risks and complications, sometimes irreversible, which can be worsened when there is no complete assessment of the patient’s health and expectations”, emphasizes the dermatologist.

What is phenol peeling?

Peelings are procedures that promote skin peeling and can be superficial, medium or deep. They are used to treat problems such as photoaging, wrinkles and scars. In the case of phenol, it is a deep, extremely aggressive peeling, which completely removes the epidermis, the most superficial layer, reaching the dermis. The objective is to promote complete tissue regeneration, eliminating wrinkles and marks, and – when well indicated and conducted – can provide excellent results.

What are the risks and precautions when applying?

Phenol is a compound absorbed through the skin and enters the bloodstream, so it can have a toxic effect on the heart, kidneys and liver. It can also lead to serious arrhythmias and even cardiac arrest. Therefore, the procedure is contraindicated in patients with problems in these organs. Furthermore, it cannot be done by those with dark skin and should be avoided in smokers. Before recommending it, it is essential to carry out tests for a complete assessment of the patient and their comorbidities.

The use of phenol to treat scars was developed in World War I (1914-1918). But in the 1960s, peelings began to be perfected and became more popular. Today, with changes to the formula, it is no longer a procedure restricted to the hospital environment, and it is possible to perform it in the office. However, there must be cardiac monitoring, and the medical team must be prepared to deal with complications.

“It’s not a procedure that anyone can do,” emphasizes the Einstein specialist. For SBD, phenol peeling must be carried out “preferably in a hospital environment, with the patient properly anesthetized and under cardiac monitoring.”

What is recovery like and what are the possible complications?

Typically, after the procedure there is pain, swelling and the formation of thick crusts. Complete recovery may take up to three months. Still, there are risks of hyperpigmentation or hypopigmentation, scar formation, persistent erythema (redness) and allergic reactions, as well as infections and even unpredictable heart problems.

According to SBD, there are risks regardless of the concentration, application method and depth reached into the skin.

Source: CNN Brasil

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