Reversing cosmetic procedures is gaining momentum — and it's not always possible

Following the wave of facial fillers and other body modifications, there has been a growing demand to reverse cosmetic procedures once considered synonymous with beauty. Driven by celebrities and influencers, the movement suggests a shift in standards and the way the body is perceived.

In Brazil, data from the International Society for Aesthetic Plastic Surgery reinforces this trend: breast implant removals more than doubled between 2019 and 2023, jumping from 19,355 procedures to 41,314 in four years. The return to naturalness also appears in facial interventions. According to the British Association of Aesthetic Plastic Surgeons, there was a 27% drop in demand for facial fillers in 2023 compared to the previous year in the United Kingdom. In the United States, the American Academy of Facial Plastic Surgery reported a 14% reduction in filler applications in 2022 compared to 2021. The American Society for Aesthetic Plastic Surgery reported a 57% increase in demand for filler removals between 2020 and 2021.

Although there is no official data on cosmetic procedure reversals in Brazil, experts report a significant increase in demand for this type of intervention. According to dermatologist Daniel Coimbra, coordinator of the Cosmiatry Department of the Brazilian Society of Dermatology (SBD), the increase is particularly concentrated in cases of improperly applied fillers—a common occurrence in the wave of procedures that promise "facial harmonization." "Often, they are performed without technical criteria, with low-quality products, or by unqualified professionals, which poses risks to patients' health and self-esteem," summarizes Coimbra.

According to the SBD dermatologist, the most frequently reversed procedures involve hyaluronic acid fillers, especially when applied excessively, in inappropriate anatomical areas, or with the promise of transforming facial features. Fillers in the lips, under-eye circles, and jaw are among those that most motivate the search for hyaluronidase, an enzyme used to dissolve hyaluronic acid.

One of the main reasons for procedure reversals is the feeling that facial harmonization paradoxically ends up making the face less natural. According to plastic surgeon Murillo Fraga of Einstein Hospital Israelita, the main group seeking this type of correction is between 40 and 55 years old. "Performing non-surgical procedures in series ends up making the face more artificial. These patients no longer see themselves," says Fraga.

Complications and adverse reactions

Health problems are also among the reasons people seek reversal. The Einstein plastic surgeon notes that the most common procedures in his practice involve hyaluronic acid fillers applied to the eyelids, lips, and jaw. "Despite being absorbable, hyaluronic acid can attract water and cause chronic edema," he warns.

But there are more complex cases, especially when permanent materials that don't respond to enzymes like hyaluronidase were used. Examples include substances like polymethyl methacrylate (PMMA) and silicone. "These cases are difficult because these products penetrate the tissues and cannot be completely removed," says Murillo Fraga. In addition to fillers, the growing use of biostimulants has led to complications such as nodules—a reaction of the body to the substance that sometimes requires surgical intervention.

Breast implants can also cause adverse effects and lead to implant removal. One factor is adjuvant-induced autoimmune syndrome (ASIA), known as "silicone disease," associated with symptoms such as muscle pain, chronic fatigue, anxiety, and systemic inflammation. Other known complications include capsular contracture and implant rupture.

Persistent dissatisfaction

Psychological and identity factors may also underlie the decision to reverse cosmetic procedures—especially when the new appearance no longer matches the person's self-image. "In cases where the individual simply regrets the procedure, I believe they may simply not have recognized the post-intervention change and wish to return to their former self," analyzes clinical psychologist Rogéria Taragano, coordinator of Outpatient Anorexia Nervosa Care at the psychology department of the Institute of Psychiatry at the University of São Paulo's Hospital das Clínicas (IPq-HCFMUSP).

However, the phenomenon can be more complex when it involves persistent dissatisfaction, which may indicate the presence of underlying psychological disorders. The main one is body dysmorphic disorder (BDD), a psychological condition in which the patient experiences a negative evaluation of their image (facial, body, or both, or even just specific body parts), with intense psychological distress and emotional responses that can include shame, aversion, hatred, anxiety, and even disgust toward the body. "Such feelings can even lead to self-harm and suicidal thoughts," notes Taragano.

Quantitative data corroborate the significant prevalence of BDD in aesthetic clinic settings. A meta-analysis published in the Brazilian Journal of Plastic Surgery revealed that approximately 12.5% of patients applying for or undergoing aesthetic procedures were diagnosed with the disorder, a percentage much higher than the estimated 2% in the general population.

Another relevant factor is the impact of social media and filters on platforms like Instagram and TikTok on people's body perception, especially younger and more psychologically vulnerable people. "The negative effect [ of filters ] has been quite significant, as we've observed in our clinical work," says Rogéria Taragano. "These individuals tend to compare their real image with those manipulated on social media, sometimes modified through artificial intelligence. As a result, they experience high levels of body dissatisfaction, perfectionism, low self-esteem, social isolation, anxiety, and symptoms of depression."

Not everything can be reversed

The growing search for cosmetic procedure reversals poses technical and ethical challenges for healthcare professionals. For the SBD dermatologist, one of the main difficulties lies in the lack of knowledge about the previously applied product, the quantity used, and the depth of application. "Often, the patient doesn't know which substance was used, whether it is absorbable or permanent, or in which areas it was injected. Furthermore, a poorly executed application can compromise the anatomical planes of the face, causing fibrosis and asymmetries that are difficult to correct," says Daniel Coimbra.

In many cases, complete reversal is not possible, especially when it involves biopolymers or materials not approved by the Brazilian Health Regulatory Agency (ANVISA). "Even when the product used was hyaluronic acid, reversal may require many sessions of hyaluronidase and may not completely reverse the condition, as excessive application can lead to changes in the injected tissues ," warns the dermatologist.

Proper patient guidance is another challenge. For Murillo Fraga, this role should fall to the physician, who must act ethically and transparently when recommending the most appropriate procedures for each age group. "It also involves telling the truth: after a certain change, you can't continue insisting on non-surgical procedures," says the Einstein surgeon. "This is the fundamental point: when there's a loss of anatomical positioning of structures, there's no technology capable of returning the anatomy to its correct location."

This care becomes even more important given the regulations governing who is authorized to perform these interventions. In Brazil, different professional categories—such as dentists, biomedical scientists, pharmacists, and physiotherapists—are authorized to perform minimally invasive procedures, such as the application of hyaluronic acid and botulinum toxin, through specific certifications from their professional boards. This diversity expands access but hinders uniform oversight of the quality and safety of applications.

"The doctor's ethical responsibility is to refuse unnecessary interventions and identify possible signs of self-image disorders, such as body dysmorphia," argues the SBD specialist. "A medical consultation should be more than just technical: it's a time for listening, guidance, and the joint development of realistic goals. A good professional doesn't do what the patient 'asks'; they propose what the patient truly needs."

Source: Einstein Agency

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