Dr. Constantino Mendieta, a Miami plastic surgeon, can tell you when and where the problem was born: At the 2000 Grammys when Jennifer Lopez wore a green Versace dress that accentuated her curvaceous derriere, prompting legions of women to search for ways to replicate the look.
Nose jobs, breast implants and liposuction were well-established procedures by that point, but there hadn't been significant demand for buttocks enhancement. When women asked how to emulate the look they saw on TV, they were offered two options: a $10,000 buttocks augmentation procedure performed by a plastic surgeon or $200 shots of silicone and other chemicals administered by unlicensed individuals in motel rooms, basements and garages. For those who have chosen the latter, doctors have seen everything from kitchen oil to cement to crazy glue being used. The injections have always been illegal. The results were quick and dramatic, which attracted even more customers, but after about 10 years the synthetic substances tend to migrate to other regions in the body and can cause irreparable damage, even death. Some women are living with lifelong deformities. Others are going to jail.
Since the procedures are illegal, statistics on the number of women receiving the injections and the injuries they cause are not readily available. But doctors say they are still seeing women -- more of them, in fact -- requesting the look. In the United States, nearly 12,000 buttocks augmentation procedures were performed last year, the International Society of Aesthetic Plastic Surgeons reports. The FBI said the number of cases where individuals pose as fake doctors to perform the illegal injections is on the rise especially in Florida, New York, California and Texas.
“Initially it looks fantastic. It looks and feels amazing. The problem is in 10 years. That’s when the body starts to reject it,” said Mendieta, who specializes in butt augmentation surgery. While not all bodies reject the synthetic materials, he said, those that do can be disfigured for life or face dangerous illness.
“I think we’re going to see an epidemic of these reactions in the next few years,” Mendieta said. “I think we’re heading for a big problem.”
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Dr. Christopher Khorsandi, a plastic surgeon in Las Vegas, agrees. He told IBTimes he estimates thousands of illegal silicone injection procedures are performed each year in the United States.
The problem may be even more widespread in Latin America. In South America, silicone injections have been used for decades. Dr. Lina Triana, a plastic surgeon in Cali, Colombia, about 300 miles west of Bogota, is treating an increasing number of patients suffering side effects.
“I see a lot of women who were injected up to 10 years ago who are now having reactions,” Triana said. She has seen patients who were injected with everything from industrial grade silicon to kitchen oil -- materials the body can’t absorb and which cannot be completely removed. “It’s an epidemic in Colombia,” Triana said.
Recently, popular culture has become even more focused on women's backsides: Twerking and “belfies” -- butt selfies -- have led more women to feel they need to change their shape. High heels, thigh shapers, thongs, butt padding and skinny jeans can give the illusion of fuller curves, but they are temporary and not necessarily as dramatic as what plastic surgery can do.
“In the old days, it was more about being as skinny and a little square,” Mendieta said. “Jennifer Lopez single-handedly turned that around and said, ‘Hey, it’s about curves.'”
Unlike silicone injections, which are not approved by the U.S. Food and Drug Administration, plastic surgeons have safe and legal methods to give women bigger bottoms. Doctors can harvest an individual’s own fat cells taken from other parts of their bodies -- known as fat grafting -- or place a silicone implants into the patient’s butt cheeks.
Cosmetic surgeons have witnessed a 58 percent increase in the number of buttocks augmentations performed last year in the U.S., the American Society for Aesthetic Plastic Surgery said. Outside U.S., large buttocks have been popular far longer, particularly in South American countries such as Brazil. There were more than 63,000 butt augmentation procedures performed in 2013 in Brazil -- nearly five times the number performed in the United States that year, the latest statistics from the International Society of Aesthetic Plastic Surgeons indicate.
Mendieta and Khorsandi have felt this high demand firsthand. Ten years ago, 20 percent of Mendieta’s practice focused on buttocks procedures. Today, it’s 90 percent. When Khorsandi started his practice six years ago, he would see one patient per quarter. Now he sees one to two patients a week.
Augmentation surgeries have long recovery periods. There's significant pain and swelling, and patients can’t sit down for weeks. In the United States, the average cost for butt lifts and butt augmentations are around $4,000, the ASAPS said, but the procedures can triple in price depending on the city and surgeon. For instance, Mendieta charges anywhere from $10,000 to $14,000 for fat grafting procedures.
The alternative may seem more appealing to some. Illegal injections are quick, non-surgical and cheaper, costing as little as $100 to $200 a shot, Dr. Chukwuemeka Onyewu, a plastic surgeon in Silver Spring, Maryland, who has treated patients suffering from problems related to illegal buttock injections, told IBTimes.
Within a month of receiving the injections, the patient's posterier will begin to show changes. Many women receive repeated injections, anywhere from 10 to 20 injections per side, per session, depending on how much volume is placed in each needle.
“While it’s not clear if this is to create even more volume, I would suspect that some are returning to try to cover up contour irregularities and camouflage problems with more silicone, doubling down on a bad decision,” Khorsandi said.
In the United States, the ease of administering the injections has led to “pumping parties” -- gatherings that are the underground version of Botox parties. Instead of taking place in Orange County mansions with injections administered by doctors, "pumping parties" take place in hotel rooms, garages, basements and back rooms with unlicensed practitioners as hosts. Some beauty spas offer the shots on a secret menu. A quick search on Alibaba, the Chinese online commerce company, shows hundreds of listings for injections for sale with points of origin ranging from Thailand to Qatar.
“The reports sound like they are something out of Tarantino movie -- secretive meeting spots, unsavory individuals, questionable products being injected, and unsanitary conditions,” Khorsandi said. Six years ago, he started to see patients who had received the injections in clinics in South America and Mexico, but that has changed. “Due to the growing demand for a shapelier bottom, the injectors are showing up on our shores -- caulking guns in hand.”
He described how a patient came to his office recently with a bad reaction from silicone injections she received in Tijuana, Mexico, 20 years ago.
“Her shape is good but the silicone is hard as a rock. She says that she knows of two Mexican women who travel from city to city [in America] and do it in people's houses,” Khorsandi said.
Participants fall victim to what he called “white coat deception,” Mendieta said. They are fooled by someone claiming to have medical training when in fact the person has none. While some have been arrested for practicing medicine without a license, and in other cases, murder, many continue to fly under the radar, injecting women all across the country. To date, deaths have been reported in Mississippi, Alabama, Georgia, Florida, Pennsylvania, Nevada and New York.
In mid-July a New York City woman was sentenced to two to three years in prison after she was found administering illegal butt injections and closing up wounds with Krazy Glue. Another famous incident took place in Miami. Ron Oneal Morris, who was born a man but identifies as a woman, was sentenced to 336 days in prison after she was found injecting super glue and Fix-A-Flat into women’s buttocks during a four-year period.
In Mississippi, a woman died days after being injected with a “silicone like substance” in her buttocks that spilled "all over the place" during her autopsy, an investigator testified in September, the Associated Press reported. Her alleged injector, Morris Garner, 53, who goes by the name Tracey Lynn Garner, is currently awaiting trial. If convicted of two murder charges, she could serve a life sentence.
Hip-hop performer "Black Madam,” formerly known as Padge Victoria Windslowe is awaiting trial in Philadelphia for the death of a woman she allegedly injected with silicone. The woman, 20-year-old Claudia Aderotimi, flew from London to Philadelphia to receive the injections at an airport hotel in 2011. She died soon after. In 2012, Windslowe was arrested after another woman complained of being hosptalized twice following injections Windslowe gave her at “pumping parties” in the East Germantown neighborhood in Philadelphia.
Most of the time 10 to 20 shots are done per session. There's no regulation -- or consistency -- about what is in the syringe. When the injections were first performed in the 1980s (mostly to smooth out facial pitting), medical grade silicone was brought in from Mexico to do so. While that kind of silicone is not necessarily safe, the risk of contamination was low compared with today’s cocktails because it was injected in small amounts. The risk of silicone spreading to other parts of the body was relatively small, unlike injections in larger regions such as the breasts and the butt.
Also unlike silicone implants, where the synthetic material is encased in a prosthesis, injecting free silicone oil into the body gives it ample opportunity to migrate. When the body recognizes the foreign substance, it tries to expel it in one of two ways: breaking it up or moving it to other organs for secretion. But silicone is a synthetic polymer, which means the body can’t absorb it.
“Raw silicone is vastly different than the silicone inside an FDA-approved breast implant,” Khorsandi said. “Raw silicone can cause inflammatory reaction when injected directly into the soft tissues. It can embolize, it can become infected and it can kill you.”
Ever since the silicone injections became popular for the breasts and the butt, the use of medical grade silicone from Mexico -- which is expensive -- was discontinued because prices were too high. Recently, pumping party hosts have been known to use cheaper alternatives such as mineral oil to achieve the same look.
Liquid silicone injected into the body has been a known hazard since the 1940s. Back then, doctors in Japan and Las Vegas injected non-medical grade silicone for breast enlargement surgeries. The substance eventually spread and caused serious medical problems, and in some cases required mastectomies to correct the surgeons’ poor judgment. Some cases were fatal. By the 1960s, silicone injections for cosmetic purposes had been banned by the U.S. Food and Drug Administration. But that didn’t stop it from being used. Liberace received numerous injections into his cheekbones. Elaine Young, a Hollywood real estate agent for the stars, followed Liberace’s model and received injections in the 1970s; the silicone eventually spread from her cheeks, resulting in vision problems and disfiguring lumps. She underwent 46 corrective surgeries and died in 2006 of cancer that originated in her face. Today, the only FDA-approved silicone injection is used in a procedure to repair retinal detachment.
Whether it’s pure silicone or a concoction of cement, glue and tire sealant, bad reactions may not happen right away. Once injected, the substances can take years to migrate to other parts of the body and cause blood clots, septic infections and sometimes death. On the skin's surface, patients may see polyps, boils, skin discoloration and necrosis.
“The skin turns jet black. It’s firm, like a hard leather handbag,” Onyewu said. An individual’s hips and butt will feel like “big golf balls” are underneath it, he said.
Once a patient seeks out help from a plastic surgeon, their options are limited.
Onyewu has treated patients who received the illegal shots for about five years and has seen more patients with deformed butts enter his office in recent years. That could be due to the high demand for bigger behinds, but he speculates it could also be the result of plastic surgeons shying away from treating butts loaded with junk.
“I think a lot of doctors are reluctant to treat these kind of patients because they’re not sure what they’re dealing with,” Onyewu said. “There’s no precedent -- this is so new. A lot of people won’t even touch them. When they find somebody who has experience, who has done this before with some success, then they all come out of the woodwork.”
For the past six years, Khorsandi has treated numerous patients who have received the shots both overseas and in the U.S. He's sympathetic to their discomfort, but warns them that corrective action presents hazards of its own.
“I often refuse to remove silicone that is injected into patients who are simply unhappy with the cosmetic outcome. There has to be a good reason to go in and try to take it out, because the injections can be anywhere in the buttocks -- in the fat, in the muscle, and around nerves and vascular structures,” Khorsandi said. He described how a colleague tried to help a patient with complications from silicone injections by removing the substance. That patient went on to have further complications and died under the surgeon’s care, Khorsandi said. “The risk is there even in skilled hands,” Khorsandi said.
In the beginning Onyewu said he tried to suction out as much of the substance as he could. Over time, his process has evolved to treating some of the affected area with steroids to tone down the inflammation. “Now I’m comfortable with the path of physiology that’s going on and I tailor the treatment according to that,” he said.
Onyewu described a 36-year-old patient he has treated for the past several years who received illegal silicone injections at a pumping party in Baltimore. “Both buttock cheeks have big craters and eroded skin,” he said. He estimates he has performed six to eight operations since she sought his care. “She has a big open wound on one of her buttock cheeks and the other is severely scarred,” he said. Her dressings have to be changed twice a day, by herself. There is also a machine that she carries around with her designed to help close the wound.
Almost as disturbing is the lack of remorse some patients express about their choices, Onyewu said.
“There’s a couple people who said they would do it again. They would just pick a different person, somebody who has a better track record,” Onyewu said. “They don’t really seem to get that they nearly lost their lives with that stuff.”