The Temptation of Propofol Abuse: The Cost of Life Hidden Behind Cosmetic Procedures

Hello,

This is Dr. J from Cheongdam SNU Plastic Surgery Clinic.

‘Comfortable sleep anesthesia’ is advertised by cosmetic clinics,
inside which your brain and organs may be slowly dying.

Recently, among patients undergoing cosmetic procedures in Korea,

propofol sedation therapy, known as ‘sleep anesthesia’,

is spreading like a trend.

Amidst the alluring expressions of marketing,

patients mistake this for

‘comfortable and harmless sleep’;

however, the reality is a dangerous medical procedure

that can threaten life.

Today, we will uncover the truth of why propofol abuse

is ‘Russian roulette for beauty’.

# Korea’s Ministry of Food and Drug Safety Warning: Risks Indicated by Legal Regulations

The Ministry of Food and Drug Safety

published propofol safety use standards in September 2020,

stating that ‘the frequency of administration for simple procedures/diagnoses

should not exceed once a month’.

This is a regulatory measure that acknowledges propofol’s addictiveness

and risk of misuse and abuse.

Furthermore, medical institutions are advised to consider using alternative drugs

such as midazolam if a patient frequently visits the same institution

or strongly requests propofol anesthesia.

The marketing term ‘sleep anesthesia’ causes serious misunderstanding.

This expression, commonly used in commercial cosmetic clinics,

leads patients to expect the same safety as normal sleep.

However, according to research by Professor Avery Tung of the University of Chicago Medical School,

a propofol-induced state is a dangerous medical condition

completely different from physiological sleep.

📍 Brainwave patterns:

Natural sleep has REM/non-REM cycles, but

under propofol, only unique brainwave patterns appear.

📍 Responsiveness:

Natural sleep can be awakened by stimulation, but

in a propofol state, there is no response to external stimuli.

📍 Physiological functions:

During sleep, respiration and blood pressure are maintained, but

propofol causes respiratory depression and

blood pressure reduction.

# Propofol’s Triple Burden on the Body: The Tragedy of the Brain, Heart, and Organs

1) Silent death of brain cells:

Permanent loss of cognitive function

In animal experiments, neonatal mice aged 7 days were administered

medium/high doses of propofol (100-150mg/kg) for 5 days,

resulting in a significant increase in hippocampal neuron death.

This occurred due to the overexpression of apoptotic factors (Bax, caspase-3)

in the CA3 region of the hippocampus, a key area for memory formation.

Such damage to the developing brain

led to impaired spatial learning ability and

memory in adulthood.

Repeated administration of medium/high doses of propofol overexpresses inflammatory cytokines (IL-1β, IL-6, TNF-α), causing brain inflammation and impairing cognitive function.

2) Propofol Infusion Syndrome (PRIS):

The shadow of sudden cardiac arrest

This is a fatal syndrome whose likelihood rapidly increases

in patients receiving continuous high-dose propofol for more than 48 hours.

It occurs when propofol paralyzes mitochondrial function.

📍 Energy metabolism collapse:

Decreased fatty acid oxidation → reduced energy production

📍 Metabolic acidosis:

Lactate accumulation → blood acidification

📍 Heart muscle destruction:

Rhabdomyolysis → acute kidney failure

📌 Fatal signs of Propofol Infusion Syndrome (PRIS)

The mortality rate of PRIS is 18-32%,

which is a risk level comparable to that of COVID-19 critical patients.

Especially if a patient discharged after a cosmetic procedure

shows PRIS symptoms at home,

timely treatment is difficult, maximizing the risk of death.

3) Liver and Kidneys:

The forgotten victims

Propofol metabolites are processed in the liver

and excreted through the kidneys.

In animal experiments, long-term exposure to high-dose propofol

caused the following organ damage:

📍 Liver damage:

Focal hepatocellular necrosis,

fatty degeneration (fat accumulation within hepatocytes)

📍 Kidney damage:

Acute tubular necrosis,

myoglobinuria (when accompanied by rhabdomyolysis)

📍 Lung damage:

Interstitial pneumonia, pulmonary edema

2023 Meta-analysis

(252 studies, 30,757 subjects) results:

Propofol group

mortality rate 5.2% vs control group 4.3%

Propofol increases the risk of death by 10% compared to other anesthetics.

# After 50, a warning bell for propofol

The tragedy of patients with impaired liver function

In patients with cirrhosis, the half-life of propofol

is extended to more than twice that of normal individuals.

This is because propofol remains in the body for a long time

due to reduced liver metabolic capacity.

When propofol is used in patients with cirrhosis,

the risk of delayed consciousness recovery and

respiratory depression significantly increases,

and it can worsen hepatic encephalopathy.

The suffering of patients with kidney disease

In patients with chronic kidney disease stages 4-5

(glomerular filtration rate <30mL/min),

propofol metabolites accumulate due to reduced kidney excretion.

This leads to a prolonged sedative state

and a risk of cognitive function decline.

Notably, there are reports of a 2.1-fold increase in stroke incidence

in patients who used propofol after kidney transplant surgery.

Vulnerability of the elderly

When using propofol in patients over 55 years old,

thorough dose adjustment is necessary.

Due to age-related decrease in liver and kidney function,

and increased vulnerability of the blood-brain barrier,

severe respiratory depression can occur even with small amounts.

In fact, over 70% of propofol-related deaths

occur in elderly patients over 60 years old.

📌 Age-specific propofol safe dosage and risk factors

# A life-saving choice in a hospital, not a beauty salon

Propofol should

‘only be used under the supervision of a specialist’.

Professor Avery Tung of the University of Chicago Medical Center

emphasizes the following:

‘Propofol gives the illusion of safety because recovery feels fast.

However, blood pressure and respiration can drop sharply,

and the level of consciousness can instantly shift from sedation to anesthesia.’

Guidelines for sedative endoscopy also

state that ‘when administering propofol, equipment and personnel

must be fully prepared for emergencies’.

Many cosmetic clinics often lack such infrastructure.

The price of beauty should not be life.

Propofol abuse can lead to

‘a single procedure resulting in permanent loss’.

A 2023 meta-analysis of over 30,000 data points

warns that propofol carries a 10% higher risk of death than other anesthetics.

Repeated use of propofol for cosmetic purposes

causes a triple burden of brain cell death, exposure to cardiac arrest risk,

and organ damage.

Before being lured by marketing like

‘comfortable sleep anesthesia’,

one must confront the cost of life hidden behind it.

So that your beauty is not built upon the sacrifice of your liver and kidneys,

and so that a single ‘comfortable sleep’ does not turn into eternal sleep.

True beauty blossoms from a healthy body and a clear mind.

Propofol abuse is the most dangerous temptation that destroys that foundation.

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