The $60k Viral Chemical Peel From Hell

Dr. Chang (00:04):
You are listening to Secret Services, where we discuss the procedures nobody admits to, but everyone's curious about. I'm your host, Dr. Christopher Chang. Welcome back to another episode of the Secret Services podcast. I'm Dr. Chang.

Jackie (00:19):
And I'm Jackie.

Dr. Chang (00:21):
All right, Jackie. Good to see you one more time. So tell us what we're going to talk about today.

Jackie (00:26):
All right. So there's a moment that happens in a treatment room that nobody films. The moment of a chemical lands on the skin, it turns frosty white and the person holding the brush has to decide whether what they're seeing is the result they were going for or the beginning of a problem. We're going to talk about what the moment looks like when it goes right, what it looks like when it goes wrong and why no downtime might be the most expensive two words in cosmetic medicine. Stay with us. All right. So a patient books appeal and tells you they have a wedding next weekend. What conversation are you having with the patient?

Dr. Chang (01:02):
Whenever I have a patient that is coming for a big event coming up, I always caution them that we have to be conservative because especially if it's a wedding, like you're in the wedding or something like that, there's just too much at stake to risk an unpredictable outcome. So whether that's an injection, Botox, filler, surgery, of course, anything, you have to recognize that you cannot rush the healing process. It's just going to take however long it takes. So that always makes me nervous and always try to tell patients, okay, certain type of facial might be good. Exfoliating may be good. Dermaplanning might be good, but things that get a little bit more risky, especially things you've never tried before, be careful. Be careful. People who say there's no downtime, even if you've never tried it before, you have to be careful. Don't try anything totally new.

Jackie (01:55):
And I think it's a big education point for patients. Be honest about what's going on in your life, what's coming up. I feel like oftentimes something might take a little longer to heal and then after the fact they're like, "Well, I have my daughter's wedding next week." And it's like, "You should have told us." So it's definitely one thing to think about if you're getting anything done, tell your provider what you have going in your life, what your goals are, what this is for, so they can steer you in the right direction.

Dr. Chang (02:28):
Right, exactly. We don't want you to feel self-conscious about whatever you've had done and that distracts from your important event or the things you want to enjoy, essentially. But getting back to it, a chemical peel is typically a skin treatment that's done. As an outpatient, you come to the office, you get your skin cleaned and then we apply a solution to the skin and there's a chemical reaction that essentially causes a little change to the skin and you get some sort of a shedding of the outer layer of the skin and new firmer, tighter baby skin underneath comes in. Have you ever had a chemical peel?

Jackie (03:10):
I actually haven't.

Dr. Chang (03:11):
Oh, really?

Jackie (03:12):
Yeah.

Dr. Chang (03:12):
Okay. So chemical peels are pretty popular though.

Jackie (03:15):
I know. I'm trying to think. There's not a reason why I haven't. I just don't know why I haven't.

Dr. Chang (03:21):
Yeah. So there's a couple different types of peels that you can do in terms of the depth. So if you think of your skin, the top layer of skin being the epidermis, surface level peels are very gentle. And so you can use those. Those are like salicylic acid. Have you heard of that, like salicylic acid peels?

Jackie (03:39):
Yep.

Dr. Chang (03:40):
So pretty safe. They can offer that over the counter for you at home. It's probably a low concentration and so that's just going to affect the top layer of the skin. Other like light glycolic acid or diluted glycolic acid peels might be considered superficial. So the reason why that's safe is because it doesn't penetrate that deep and won't cause scarring because it won't go deeper into the dermal level. A medium level peel would be something like a TCA peel or a higher glycolic acid peel and that would go further into the dermis and at least with TCA, you get that frosting and penetration. And again, by how long it sits on the skin would affect the result, the concentration of it would affect the result and how long it takes you to apply the neutralizing agent so that it doesn't have continued absorption and effect. The deepest peel goes all the way down the deep level of the dermis and that would be something like what's called a phenol peel or croton oil peel.

Jackie (04:38):
I see those on TikTok.

Dr. Chang (04:40):
And those are the ones-

Jackie (04:41):
The phenol peels.

Dr. Chang (04:41):
Yeah, you'll see for some reason, I guess they're big in Brazil or you'll see these people who have these crusty, like crazy thick peel.

Jackie (04:48):
It literally looks like they are taking a Halloween mask off. They completely burned their whole skin and they're just like pulling the crust off.

Dr. Chang (04:58):
But they did. It's a chemical burn. The results will be impressive, but it is a chemical burn.

Jackie (05:06):
The first time I saw that I was like, I thought something went wrong when I saw the video and then the person kept talking and they're like, "No, this is what was supposed to happen."

Dr. Chang (05:16):
Well, they're not new. I mean, those have been around for decades and it's funny how the trends in plastic surgery change. People just were very much into them in I think the '90s and then they fell very much out of favor as people just would not tolerate so much downtime. It was just too much downtime and now that people are kind of seeing them, they had a moment on social media a little while ago that was repopularizing them, but it's real difficult because you can get some scarring and things like that if it's too deep.

Jackie (05:49):
Yeah. Well, I also was thinking, because the videos that I've seen at least, the people were at home in their bathroom peeling it off and in my head I was like, should you go back to where you got it done and have them help you peel it off so you're not just ripping everything out?

Dr. Chang (06:05):
That seems like it could be quite painful.

Jackie (06:07):
Yeah, I would think so.

Dr. Chang (06:09):
So it is a chemical burn though. I mean, that's how it works. It causes some injury, peels off the skin. The new skin that's raw underneath there has to heal. So like any burn, you'll have smooth skin, but if it's too severe of a burn, you get contracture or distortion of the skin and smoothing of the skin that's too smooth. Or you could also get pigment problems. You could have hypopigmentation or ... So if you are anybody, even if you're fair skinned and white, you can still have splotchiness where you lose pigment and the melanocytes have not picked back up.

Jackie (06:43):
So are many people in the US doing those?

Dr. Chang (06:47):
I wouldn't say many people. So that actually brings up a good point. If you're going to anesthetician or depending on the state, only certain level peels should be done. You really have to go to a surgeon or a medical doctor to get a more invasive, severe peel in some states.

Jackie (07:08):
Well, I don't know if you've seen on TikTok, but this girl has been coming up on my TikTok a lot. Her name's Victoria Nelson. She once called this celebrity esthetician Sonia Dakar Decker. I might be saying it wrong. She was calling her her LA mom and she recounted how her routine facial in Beverly Hills ended with an unscheduled chemical peel that immediately turned her skin frosty white, which she mentioned the white, but then it left lasting marks and has led to more than $60,000 in corrective procedures over the last two years. Per California licensing rules, aestheticians can perform superficial peels, but cannot perform medium death peels. So they're alleging that she was kind of like blurring the lines of what she was allowed to do, but I don't know if you saw her face, but a little shocking.

Dr. Chang (07:59):
So first of all, we don't live in LA. I think the DC market's a little bit different, but this whole concept of celebrity aestheticians is just a strange thing to me because you trust them just because they have celebrity clients, I guess. I think that's what that means. But the second part of this is she had a peel that turned white, it didn't go well, but she spent $60,000 in corrective procedures. It seems like a lot of money to be doing all these extra things and I wonder what she had done.

Jackie (08:31):
I know one of the things she had done was microneedling afterwards and I think more like lasering to try to correct this.

Dr. Chang (08:41):
Yeah. And you take a look at her face where she has this scarring and frosting, it's sort of strange that why does she have this big weird uneven thing, like a big P on the side of her cheek.

Jackie (08:52):
Yeah. It looks like a P.

Dr. Chang (08:53):
It doesn't make sense why it would be given in that pattern.

Jackie (08:57):
Right. I was like, it says an unscheduled chemical peel. So I wonder, I'm like, was there a certain area maybe the esthetician was trying to treat?

Dr. Chang (09:06):
Yeah, from reading the story-

Jackie (09:07):
A spot treatment.

Dr. Chang (09:09):
From reading the story, they had a relationship and had had many acne treatments and facials and things like that that they had done together. And I guess at the end of the last session she said, "Oh, well, let me do a litle chemical peel for you. " But it's unclear to me whether that was supposed to be spot treatment. But anyway, I think that a peel can be dangerous just like you would think of a laser that could be dangerous. The idea is to perform calculated injury and your body does the healing so that what is left behind from the healing is smoother, tighter and more even in skin tone. So it's a calculated injury people. It's very, very important that you recognize that. Now it can be a much more gentle calculated injury or it could be more severe and it's unclear whether the concentration of that was too high or left on too long or whatever solution they used was too harsh or whatever happened, but it doesn't look good.

Jackie (10:06):
And I also think it says also microneedling, which is kind of funny because then the treatment plan after she did this to her face was to then follow up and do microneedling and other lasers. So then was she just doing more and more work to her face that she wasn't supposed to be doing?

Dr. Chang (10:22):
Well, I don't know if she ... I know she got a second opinion. I can't remember whether she got some of that follow-up care and subsequent treatments from-

Jackie (10:31):
I think she did initially, yeah.

Dr. Chang (10:32):
This original Sonya Deckar aesthetician because if she claimed responsibility and owned up to having that, she shouldn't charge her $60,000 to fix her own mistake.

Jackie (10:42):
Right. Yeah, that's a good point.

Dr. Chang (10:45):
But it's interesting, the licensing agency is not the board of health or the board of medicine in California, it's the board of barbering and cosmetology

Jackie (10:58):
The same as like a hairstylist.

Dr. Chang (11:00):
Like beauty school dropout, it's a totally different standard I think probably primarily focused on hygiene I would assume then safety or medical medical stuff because it's just different. It's a different discipline, I think.

Jackie (11:21):
Right. So if you saw something like this developing right afterwards, what would your advice had been for Victoria?

Dr. Chang (11:29):
If you see an outcome that you are not expecting, I think it's important that you try to seek some help, a second opinion, get a referral to somebody who has more experience than other doctor, bounce some ideas off. Ultimately you want the patient to have a great result or resolve any problem that comes up. You have to check your ego and your pride of not ... She probably doesn't want to tell anybody because I'm this famous celebrity aesthetician. So I don't want other people seeing my complication. You got to put that aside and say, "Well, we got to get the best care for that person to make sure the outcome is as optimized as possible." And I think that's why it's good to be a good citizen in your community to have friends who you can lean on to say, "Hey, something didn't go right. What can I do to get this patient better? How can I refer this patient over so you can give me help with a second opinion?" You have to be good standing in your community. And if you're a lone wolf, although you can be great financially, great by reputation, you won't have that support network probably of your community. So it's really important, I think.

Jackie (12:35):
Yeah. So phone a friend in this situation. Use your resources.

Dr. Chang (12:40):
Everybody who has any experiences had a bump in the road, a complication, an unintended outcome that they wish had been better. Everybody.

Jackie (12:49):
Especially the irony in LA, there should be so many people that you could reach out to to be like, "Hey, I had this happen. What can we do right now to fix this?"

Dr. Chang (12:59):
Yeah. I think I saw something about this similar thing about Texas or one of the southern states maybe there was a med spa that was in a lawsuit or something and the supervising medical director was like 50 or 100 miles away I mean really, really far away and so they're not really involved with what's happening in the practice of the patients. They probably sign off on the notes once every two, three months when they kind of swing by to pick up the charts. But the whole point of having a medical director is to keep things safe with the standard of care high. So that's the purpose for those regulations.

Jackie (13:40):
So that could be something important for patients if you're going to see an esthetician ask who's the medical director? You could look them up, see what their credentials are. They may not even be like in plastic surgery or something like that or dermatology. They just have a medical record.

Dr. Chang (13:58):
There are so many medical directors of these med spas that are essentially just using it to make an extra buck to have their name and license essentially just sold out to the people running the medical spa. So there is a lot of sort of pimping out their license essentially so that people can order under their name, but they really claim zero responsibility expertise or even interest in what's going on. They just kind of see it as a, "Okay, send me a check once a month to use my name and my license so you can order your Botox and stuff." But she looks like she's recovering well, this lady and I think that she's gone viral because she's an influencer, she's young, she's pretty, and she went to a very supposedly reputable person. So I think hopefully it will end well. She looks like she's recovering, although scarring, especially on the face is very traumatic, but I think she'll be okay and she still looks very beautiful on her social media page and TikTok.

Jackie (14:58):
And I think she does wrap it all up with she just kind of wanted to put her story out there, not even to like railroad Sonya, but to just put her story out there and make people aware. Hopefully she's helping other people be educated.

Dr. Chang (15:15):
Which is what we're doing. We're amplifying the story too. I think that it's good to educate patients too about what to work with.

Jackie (15:21):
And just be careful.

Dr. Chang (15:22):
Expect.

Jackie (15:23):
Yeah, definitely.

Dr. Chang (15:25):
For sure. So are you going to get a chemical peel now?

Jackie (15:28):
I still think I would.

Dr. Chang (15:30):
Yeah.

Jackie (15:30):
Yeah.

Dr. Chang (15:31):
So chemical peels are great. I think that before we had lasers in the office, I did chemical peels a lot and my favorite was a TCA peel because sometimes even when you do a facelift or something like that, when you tighten the skin, you can reposition the volume and tighten the skin. But that superficial layer where you have a little bit of wrinkling, a little bit of sun damage really does well when you kind of ... Imagine you're sanding a piece of wood. You just smooth it out a little bit and that is a really good way to really put the finishing touches on like a facelift or something like that.

(16:04):
So it's more affordable than lasering, but lasering, I can fine tune everything. I can use all the different parameters on the computer essentially to like give the lips a different setting versus the eyelids versus the cheeks and all this sort of stuff. Whereas as we were discussing before, there is a little variability on those TCA peels and things you spread it on. Did it frost up and turn white? Did it sit white long enough? Did I neutralize it at the right time? And so there is a little bit more finesse and less forgiveness I think with a chemical peel because you are-

Jackie (16:36):
You got to be a chemist.

Dr. Chang (16:37):
Yeah, exactly. Right. It's like being a baker. You're kind of like, okay, does that recipe seem like good and is it going to be even and smooth on both sides and that kind of stuff?

Jackie (16:45):
Yeah. I think I'll give it a try.

Dr. Chang (16:48):
But oh yeah, there you go. I couldn't discourage you. You're in. We'll get you one.

Jackie (16:52):
I trust my doctor.

Dr. Chang (16:53):
Yeah, there you go.

Jackie (16:54):
But we'd love to hear what you guys think. Check out Victoria Nelson's TikTok and then leave us a comment.

Dr. Chang (17:00):
Yeah. All the links will be in the show notes. So check it out, give us a call and leave us a comment. But we'll see you guys next time.

Jackie (17:08):
Thanks guys.

Dr. Chang (17:10):
Thanks for listening to Secret Services, the podcast where we see everything and say nothing except right here. I'm Dr. Christopher Chang, double board certified plastic surgeon located in Tysons, Virginia. Follow us on TikTok @CongressionalPsurgery or on Instagram @congressionalplasticsurgery. To send us a classified message or to hear more episodes, go to secretservicespodcast.com. Links to everything we talked about on today's show are available in the show notes. Oops, patient's here. We got to go.