Clara Tolentino was terrified when her 43-year-old sister died last year after getting liquid silicone injections to add a bit more shape to her buttocks.
The 35-year-old Tolentino had good reason to be. In 2006, she paid $2,000 to get liquid silicone injections, too.
"I didn't do it as many times as my sister ... But I was afraid," said the Dominican woman who lives in the Bronx. "I was afraid that something was going to happen to me."
Her sister, Fiordaliza Pichardo, died in March. According to an autopsy, about 1,400 milligrams of silicone were in her lungs. Fresh injection sites dotted her thighs and buttocks. The New York City medical examiner's office said the cause of death was silicone pulmonary embolism.
In the United States, liquid silicone is not approved for cosmetic injections. It can kill, disfigure and cause long-term health problems. Still, it is avidly sought on the black market by untrained providers for those women who desire rounder breasts, buttocks and more shapely thighs.
Especially notorious are "pump-up parties," where people, often members of the male-to-female transgender community, gather for liquid silicone injections in hopes of feminizing their appearance.
According to a study reported at the 2006 meeting of the Radiological Society of North America, 11 women or transsexuals suffered silicone pulmonary embolism and died after getting liquid silicone injections. The study included 44 people over a 15-year period.
"Every single complication we found was associated with this illegal type of use," said the study's lead author, Dr. C. Santiago Restrepo, a professor of radiology at the University of Texas Health Science Center at San Antonio "Unfortunately, since this is an illegal practice, it's very difficult to know how widespread or what the numbers are."
Both the U.S. Centers for Disease Control and Prevention and the U.S. Food and Drug Administration do not keep data on injuries or deaths caused by illicit cosmetic injections.
"There are regulatory gaps and issues that we need to start working on from a public health perspective," said the CDC's Dr. Priti Patel. She was among investigators sent to North Carolina in 2007 after three women suffered kidney failure following cosmetic injections of possible liquid silicone.
The U.S. Food and Drug Administration has not approved silicone injections since 1992. Only one liquid silicone product is currently FDA-approved, for treating a retinal disorder usually associated with AIDS.
Still there are people who overlook the warnings. Aided by the Internet or word-of-mouth, they seek out providers masquerading as professionals. They obtain silicone not intended for medical use, in large volumes at low prices, authorities say.
"It's like going to Home Depot, buying some industrial silicone, putting it in a syringe and injecting it," said Dr. Renato Saltz, president of the American Society for Aesthetic Plastic Surgery, which has been working to warn people about the dangers of getting cosmetic injections from unlicensed providers.
Cost is often the main draw to the black market. For instance, a treatment to augment the buttocks at a legal clinic might cost on average from $5,000 to $7,000, Saltz said. Unlicensed providers charge thousands less.
The woman who Tolentino said injected her and her sister did not respond to messages left with relatives at her house in Yonkers. She has not been charged in Pichardo's death.
Besides liquid silicone, other substances are used by untrained providers to modify the body, including paraffin, petroleum jelly and hydrogel.
Almost a year ago, Zakiya Teagle, 33, of Tampa, Fla., wanted to augment her buttocks and she and a friend paid $250 each for 20 injections of what was supposed to be hydrogel and saline, according to the Hillsborough County Sheriff's Office.
Both women began to feel back and leg pain shortly afterward and were hospitalized with organ failure for nearly a month.
Teagle said she continues to have physical problems.
"We still have lumps and bumps where injections took place," she said recently. "They do move around. They get sore and it feels like someone's pinching or poking you with a knife, just jabbing you."
Teagle said she can't sit for long stretches of time, and takes a battery of medications to ward off complications from the toxins still in her body.
Sharhonda L. Lindsay, of Tampa, Fla., the woman who injected Teagle and her friend, has been sentenced to 48 months' probation for practicing medicine without a license. She could not immediately be reached by phone for comment.
Speaking in her native language, Tolentino tries to explain why she and her sister decided to turn to an unlicensed provider to augment their bodies.
"The desire to look better can take you to extremes," she said in Spanish. "My sister wanted to look better and better. But it was overtaking her."
Tolentino said that many Dominican women want to have "un poquito" — a little bit — more shape to their buttocks. Whatever plumpness she had from the injections is gone now, she said.
A month after her sister's death, city health officials warned of a spate of illicit cosmetic injections that led to hospitalizations involving Hispanic women and members of the male-to-female transgender community.
Margarita Pichardo, the mother of Fiordaliza, said she didn't understand why her daughter would go to such extremes to get the body she wanted.
"My daughter was beautiful," she said. "She looked very good."