Dr. J Timothy Katzen, a plastic surgeon in Beverly Hills accustomed to skin tightening surgeries and butt lifts, began encountering a disturbing new trend: patients presenting with severe complications from illicit silicone injections in the buttocks. These non-FDA approved procedures, which legitimate plastic surgeons are warned to avoid due to risks of lifelong pain, disfiguring injuries, and even death, started appearing in a 'tidal wave' at Dr. Katzen's clinic. Many patients admitted to receiving these discount shots from traveling injectors in their homes or local salons, rather than from licensed medical professionals.

According to multiple patients, the primary perpetrator of these injections was Libby Adame, 55, also known as the 'butt lady,' who operated with her daughter, Alicia Galaz, 26. Adame, who holds no medical degree, was recently found guilty by a jury of second-degree murder and practicing medicine without a license. This conviction stemmed from the death of Hollywood actress Cindyana Santangelo in March, following silicone injections into her buttocks. Adame was sentenced to 15 years to life in prison, with a minimum of 15 years before parole eligibility.

Dr. Katzen has treated an estimated 30 to 100 patients who claim to have been injected by Adame and Galaz, describing horrific complications. Some patients experienced silicone leaking so profusely from their buttocks that it adhered to the operating table. In other cases, patients were left with palm-sized areas of dead skin, resulting in gaping wounds and permanent scars.

Patients often opt for silicone injections due to their significantly lower cost compared to standard procedures like a Brazilian Butt Lift (BBL), which typically costs around $8,000 and requires surgery and weeks of recovery. Illicit silicone injections, costing only a few hundred dollars, can be performed quickly in non-clinical settings. However, the risks are dire; silicone can enter the bloodstream, travel to the heart or lungs, and cause fatal blockages such as heart failure.

This is not Adame's first conviction related to patient deaths from silicone injections. In a separate case last year, she was convicted of involuntary manslaughter for the 2019 death of 26-year-old Karissa Rajpaul, who also died after receiving buttocks injections. Her daughter, Galaz, was similarly convicted of involuntary manslaughter in Rajpaul's case. Adame received a sentence of four years and four months, while Galaz received three years and eight months; both were released after the trial, having already served their sentences since their 2021 arrests.

Prosecutors in the 2024 trial for Rajpaul's death also presented security camera footage of Adame fleeing a salon in South Gate, California, in 2018, as paramedics arrived to treat another woman who later died from similar injections. No charges were filed in that particular 2018 death. Dr. Katzen notes that charges for disfigurement or injuries from these injections are rarely filed, suggesting that the reported cases represent only a fraction of those harmed.

Dr. Katzen estimates he has consulted with at least 3,000 individuals who received silicone injections from various injectors. He is aware of numerous other operators across the US and globally, with patients receiving not only silicone but also aquarium sealant and even cement into areas like the buttocks, breasts, chest, biceps, and penis, all in pursuit of a more voluminous appearance.

A major concern is the lack of regulation surrounding silicone use. The FDA advised plastic surgeons to stop injecting silicone into patients in 1992 due to safety concerns. While silicone is used in breast implants, it is contained within an implant shell and not injected directly. The FDA states people should not inject a 'large volume' of silicone for body contouring, but the ambiguity of 'large volume' creates a loophole for illicit injectors. Industrial silicone, often used for home repairs like sealing windows and fixing leaks, is readily available in hardware stores.

For Adame's patients, Dr. Katzen observed botched injections leading to leaking silicone and infections causing skin to turn black. Other patients sought silicone removal due to pain, often from scar tissue buildup, and symptoms like joint pain, skin bumps, and hardening. These complications, typically appearing within five years, are often linked to an immune response causing inflammation. Surgical removal of as much silicone as possible is the primary treatment option. Despite the dangers, these unregulated injections persist on the black market.

Libby Adame has denied guilt in Santangelo's death, claiming she only provided a 'consultation' and another person performed the injections, though no evidence supports this. Her lawyers have stated their intention to appeal her conviction.