Illegal plastic surgery made headlines again this week when Morris "Tracey Lynn" Garner was charged with depraved-heart murder in Mississippi after he injected a woman's buttocks with so much of a silicone-like substance that she later died of complications, including blood clots in her lungs.
The incident horrifies plastic surgeons, but doesn't surprise them because, they say, underground and barely legal procedures are on the rise.
"You don't even have words to speak about what a horrible thing it is when somebody who is trying to improve their appearance and self-confidence only ends up, not only potentially unhappy, but dead," said Dr. Malcolm Roth, president of the American Society of Plastic Surgeons in Arlington Heights, Ill. "We're hearing more and more about deaths when non-physicians are doing injections, and patients just aren't informed."
Roth said he has treated patients who have come to him to correct plastic surgeries gone wrong, and he has seen more and more of them over the years. Since he became president of the American Society of Plastic Surgeons a year ago, Roth said, he has talked to plastic surgeons from around the world, and they're seeing the same trend.
The number of illegal surgeries is hard to track because they aren't reported.
"It's hard to know because there's no real reporting mechanism," Roth said, adding that state laws require physicians to report patient deaths. "But if it's not a physician, who's reporting?"
Many times, the patient is looking for a bargain, especially given the economic turmoil of the past three to five years, Roth said. But often the added cost of corrective surgeries exceeds that of the underground surgery. Sometimes, the physical damage is irreversible.
For instance, most legitimate plastic surgeons don't administer liquid silicone injections at all because it's impossible to keep the material in one place, he said.
Unlike standard encased breast implants, liquid silicone injections to the breast can go so wrong that the patient will need an invasive mastectomy that goes beyond typical cancer treatment, and includes removing skin on the stomach, neck and back - even muscle tissue - to get rid of the foreign substance. They can never get it all.
Although standard encased implants can leak, they're often encapsulated in scar tissue, which contains the leak. FDA-approved silicone is also considerably safer than the silicone-like materials underground practitioners use, which has even included flat-tire glue in the past.
When autopsy doctors cut into Garner's victim's buttocks, the silicone-type material poured out in huge quantities, investigators said Monday at his preliminary hearing.
"Excessive amount of this material ran all over the floor, all over their shoes, all over the place," said Lee McDivitt, an investigator with the Mississippi attorney general's office, The Associated Press reported.
A Hinds County judge Monday ordered Garner to remain jailed without bond, according to the AP, which added that Garner has had gender-changing procedures.
His lawyer told the AP that even if the allegations are true, he doesn't believe it is depraved-heart murder, a "callous disregard for human life" that causes death.
Illegal surgeries range from such fatal silicone-like injections to relatively less risky underground procedures involving Restylane and Botox injections, which eventually go away but can still cause problems, Roth of the American Society of Plastic Surgeons said.
Dr. Nima Patel, the director of microsurgery in Maimonides Medical Center's division of plastic surgery in New York City, said a big warning sign is when a procedure is performed in a place that isn't accredited, such as a spa, a basement, a hair parlor or someone's hotel room. The surgeon should also have privileges at a local hospital in case something goes wrong.
This can be especially troubling when the patient seeks a plastic surgery procedure in another country and leaves without a follow-up, she said. A small infection on the plane ride home can turn into a raging infection that lands the patient in the emergency room.
"Recently, a tummy tuck in another country came back with a wound breakdown," Patel said. "The take-home message from all this is to know what to do if there's a problem."
Roth and Patel said they've also seen patients need corrective procedures because they originally went to doctors who hadn't had the six to eight years of plastic surgery education required for certification. A general practitioner can decide to do facelifts, buy the equipment, take a weekend class and perform them in his office, Roth said.
These are not illegal in most states if the doctor has a medical degree, but patients should be wary.
"Plastic surgery is no place for bargain shopping," Roth said. "And, unfortunately, people impulsively get something done without doing their homework."