💉 Beauty black market

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Hello! Welcome to another edition of the Brazil Society newsletter! This week, we’re talking about the underground market for beauty procedures in Brazil. If you have any questions about this newsletter, or topics you’d like to see covered in future issues, you can reach me at [email protected] 

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The rise of clandestine beauty procedures in Brazil

It has become a familiar headline in Brazil: A patient dies during an illicit cosmetic procedure. A practitioner faces charges after a botched treatment. Regulators crack down on hormone therapies marketed on social media as “the beauty chip.”

These extreme cases expose a thriving underground market for cosmetic interventions, leaving medical associations and regulators scrambling to respond. Oversight loopholes have made it easy to find ads and social media posts promoting low-cost procedures that promise physical transformations — though often at the hands of unqualified practitioners.

These unlicensed providers lure patients with enticingly low prices, slickly curated social media ads and the promise of immediate availability — no weeks-long waiting lists for appointments or exhausting rounds of tests.

“They are turning the human body into an object of financial speculation,” said Volney Pitombo, president of the Brazilian Society of Plastic Surgery. “Someone with a large following can claim to be a doctor or specialist, and patients often have no idea how much risk they are taking.”

Pitombo told The Brazilian Report that his organization has seen a sharp rise in cases of patients seeking qualified doctors to fix complications from unlicensed cosmetic procedures. “Accidents happen,” he said. “But only a trained professional can correct a procedure when something goes wrong.”

While evolving (and often unrealistic) beauty standards, shaped in part by social media, are not unique to Brazil, the country’s long-standing obsession with aesthetics has fueled a surge in alternative beauty treatments.

Brazil performs more plastic surgeries than any other country in the world and ranks second only to the United States in non-surgical cosmetic procedures, according to 2023 data from the International Society of Aesthetic Plastic Surgery.

Brazilian plastic surgery has earned global renown, thanks in part to the legacy of pioneering surgeon Ivo Pitanguy, whose techniques shaped modern cosmetic surgery. The country is also closely associated with specific procedures, most notably the world-famous “Brazilian butt lift.”

But as demand for aesthetic procedures rises, so do the risks — and the consequences for an industry operating in the shadows.

Regulatory gray areas

A recent controversy has put a spotlight on polymethylmethacrylate (PMMA), a gel-like substance commonly used in cosmetic fillers. The Federal Board of Medicine (CFM) has urged Anvisa, Brazil’s health regulatory agency, to ban its use in aesthetic procedures.

While Anvisa has authorized PMMA only for medical treatments addressing deformities caused by disease, the substance is widely used for purely cosmetic enhancements — often by non-medical professionals. Though recommended solely for treating shallow wrinkles and folds, PMMA has become a popular alternative for buttock augmentation, despite the risks of the substance migrating into the bloodstream, which can lead to severe complications.

Brazilian law states that any invasive procedure must be performed by a licensed physician, but there is a legal gray area over what qualifies as invasive. As a result, different professional boards independently define which procedures their members can perform.

Dental surgeons, for example, have become major providers of Botox injections after the Federal Board of Dentistry ruled that their training equips them with sufficient knowledge of craniofacial anatomy to administer the procedure.

Botox — the brand name for botulinum toxin — has become a booming market in Brazil, accounting for nearly half of all non-surgical cosmetic procedures performed by doctors, per industry data.

A thriving underground market

The lack of clear legislation on non-invasive procedures has led to a poorly regulated market. While Anvisa oversees the approval of substances used in treatments, a clandestine industry supplies non-medical practitioners with unauthorized materials.

Seizures of illegal Botox have surged since 2018, according to Federal Police data obtained by the news website Uol. Medical associations are calling for stricter regulations, demanding that procedures such as Botox injections, hyaluronic acid fillers and chemical peels be performed only by licensed doctors.

Yet on social media, not only are these treatments widely advertised, but training courses — often illegal themselves — are also marketed to non-medical professionals.

A CFM investigation recently uncovered over 3,500 online courses teaching cosmetic procedures such as PMMA fillers. Alarmingly, only 2% required students to be physicians. Over 80% of the courses were entirely online.

In June, the risks of this unregulated market became tragically clear. A 27-year-old man died during a phenol peel, a harsh chemical procedure used to treat wrinkles and acne scars. The treatment was administered at a beauty clinic run by a social media influencer who had taken an online course to learn the technique.

The practitioner had no medical background and was not even registered as a beautician. She has been charged with murder and is awaiting trial. The case prompted Anvisa to ban the use of phenol for cosmetic peeling procedures.

A fight for oversight

With gaps in regulation, medical boards have stepped up their monitoring efforts and public awareness campaigns.

According to the CFM, Brazil recorded approximately 10,000 police cases and lawsuits related to illegal medical practice between 2012 and 2023 — a figure that includes both cosmetic and non-cosmetic procedures.

Pitombo, of the Brazilian Society of Plastic Surgery, said the organization has a legal team dedicated to handling patient complaints related to unqualified procedures.

“Brazilian plastic surgeons are among the most highly trained in the world,” he said. “Patients must research qualifications and verify credentials before undergoing any procedure.”

Other stories we’re following

⛪ The ceiling of Salvador’s landmark Church of São Francisco collapsed, killing one tourist and injuring five others. The tragedy has raised concerns over the role of Brazil’s National Historical and Artistic Heritage Institute (IPHAN) in maintaining heritage sites managed by religious orders, renewing scrutiny over the preservation of the country’s colonial landmarks.

🦟 Brazil’s Health Ministry has issued a warning over a surge in yellow fever cases, particularly in the states of São Paulo, Minas Gerais, Roraima and Tocantins, urging those who are not yet immunized to get vaccinated before Carnival in early March, when millions of Brazilians and tourists will travel across the country.

🙏 More than one-eighth of Brazilians are “religious nationalists,” according to a Pew Research Center survey that examined the role of religion in public life across 36 countries. This cohort believes Christianity should shape national identity and lawmaking.