By Meredith Cohn, The Baltimore Sun
7:54 PM EST, November 22, 2011
Some women who want rounder, fuller buttocks are turning to a dangerous cosmetic procedure: illegal injections of silicone offered by people who lack medical training and may buy their supplies in home improvement stores.
The trend — which has already sent one exotic dancer from Baltimore's Block to the hospital with silicone in her lungs — has alarmed public health officials and plastic surgeons, who say the injections can maim or kill recipients. The U.S. Food and Drug Administration and other agencies have been investigating the incident in Baltimore and others across the country.
A woman was arrested in Miami recently after allegedly injecting tire repair adhesives in a similar procedure. Earlier this year, a British woman died after an improper procedure in a Philadelphia hotel room, and a New York City woman was arrested on charges that she performed illegal breast and buttocks-enhancement procedures in her home, according to news reports.
"Who would imagine someone would let someone else inject them with something from Home Depot? It's insane," said Dr. Michele Shermak, a Lutherville plastic surgeon and spokeswoman for the American Society of Plastic Surgeons, which has launched a campaign to educate the public on the perils on plastic surgery performed by the untrained.
"It's horrible on so many levels," she said. "You're going to have a toxic reaction."
An FDA affidavit contained in court records identified the woman who injected the Baltimore dancer as Kimberly D. Smedley, 45, of Atlanta. She was arrested in Washington last month with three 18-gauge medical needles among her personal belongings. The case remains sealed, and the specific charges are unknown.
Doctors including Shermak say they've been hearing more about illegal silicone buttock injections lately, but the rubber-like synthetic compound has had a long history of trouble-making in the body.
The FDA says the medical-grade liquid version is only approved for treatment of detached retinas. But doctors say over the decades it's been used by doctors and nondoctors for everything from breast augmentation in transgender people and muscle atrophy in HIV patients to fuller lips.
Plastic surgeons say there is enough evidence now that injectable silicone is dangerous and is not used in procedures today. Encased silicone used as buttock and breast implants is still considered safe.
Doctors found that the injectable kind causes an inflammatory reaction in the tissue where it's injected. That can mean redness and pain, and possibly a chronic wound and infection. It can also spread through blood vessels to other organs. Non-medical grade silicone injected in a non-sterile environment can cause more havoc, including infections.
The risk may seem worth it to some women — legitimate buttock lifts are among the fastest-growing cosmetic procedures in the United States. Procedures were up 143 percent in 2010 from 2000, according to the plastic surgery society. Still, there are only about 3,300 procedures a year, compared with close to 300,000 breast augmentations and more than 250,000 nose jobs.
The cost is around $4,400 for a buttock lift and $4,500 for the less frequently performed silicone implant.
According to an FDA affidavit, the exotic dancer from Baltimore may not have gotten much of a deal. She paid $1,000 for each of four sets of injections after meeting Smedley in the club where she worked.
Smedley, who is not a licensed doctor or nurse, was arrested Oct. 11 in a Marriott hotel in Washington after getting off a flight from Atlanta. The dancer, who is not named in court documents, had told authorities that Smedley was injecting silicone into other dancers in a downtown Baltimore hotel.
Two days after her last injection in March, the dancer went to Johns Hopkins Hospital complaining of shortness of breath and was treated for pneumonia. A day and half later, according to court records, the woman felt worse and went to Good Samaritan Hospital, where she remained for 10 days.
There, she was given blood thinners to alleviate clots. A CT scan showed silicone in her lungs — where it remains.
The FDA agents said in court records that the silicone came from a large, unlabeled jug and may been purchased at a home improvement store where it is sold as caulk and other adhesives.
Brian Schleter, a spokesman for the Baltimore City Health Department said officials are attempting to warn other exotic dancers who work in the adult entertainment district known as The Block.
"Many dancers receive needle exchange and reproductive health services through our Needle Exchange Program on Thursday nights on the Block," he said. "We will be educating these clients on the health risks of these procedures."
Doctors say treating those with silicone is difficult. The only way to get rid of it is to cut out the tissue and surrounding tissue that has been impacted, according to Dr. Patrick J. Byrne, director of the Hopkins Division of Facial Plastic and Reconstructive Surgery, who was not personally involved in the dancer's treatment.
He said that's what he had to do for a patient who came to him this week. She had silicone injected into her lips about 15 years ago, and it had become bumpy between her nose and lips.
Byrne said such injections have always been an "off label" use by FDA standards but were not infrequent 20 to 30 years ago. Doctors are allowed to use drugs approved for one use for something else, but Byrne said it's not common to go that far afield from the approved uses. He knows of no plastic surgeon who would now inject silicone for a cosmetic procedure of any kind.
"To go from a retina to a lip is a leap," he said. "This is why it's important to only have procedures done by board-certified plastic surgeons."
Dr. Larry Lickstein, a plastic surgeon at the Cosmetic Surgery Center of Maryland, said silicone injected in women would have to be removed, a procedure that could leave women looking for fuller backsides with less tissue than when they started. The result could also appear deformed.
He said the procedure recommended now by plastic surgeons to augment a buttock is grafting fat from another place on the body.
Fat can now be harvested from the abdomen, for example, without harming the cells. It can then be purified to remove blood, broken cells and anesthesia and gently distributed within the buttock tissue so that it can form new blood supplies and live permanently, he said.
"You want to limit the inflammatory response," Lickstein said. "There can be significant and severe consequences of cutting corners."
Sun reporter Justin Fenton contributed to this article.
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