We all do strange things in the name of beauty, but there are lines that shouldn’t be crossed. The latest tragedy came last week, when 34-year-old Kelly Mayhew died after getting injections to enlarge her butt in a New York City basement.  

Butt augmentation is one of the fastest-growing aesthetic procedures, increasing 86 percent from 2013 to 2014, according to the American Society for Aesthetic Plastic Surgery. The trend overlaps with the rising popularity of ample-bootied stars like Kim Kardashian and Nicki Minaj, driving many young women, mostly in their 20s, to seek out some enhancements of their own.

What went wrong in Mayhew’s case was the use of free-floating silicone, according to Manhattan-based plastic surgeon Dr. Tracy Pfeifer. “We never inject silicone, ever,” she says. “[Mayhew] had nonmedical-grade silicone [used in her procedure]. It’s obviously not something that should be injected.”

The practice of injecting free silicone to enhance a body part has been around since the 1940s and ’50s, according to Pfeifer. However, “it is not anything doctors would do” and can lead to deformity and worse. “Even with medical-grade silicone, the problem is it’s permanent — if something goes wrong, it’s very difficult to get silicone out,” she explains. “Sometimes, it is used on something like an acne scar, but it’s only a small drop.”

When done correctly, butt enhancement “is a straightforward procedure,” says Pfeifer. The two most common methods are fat redistribution, in which fat is taken from elsewhere in the body (usually the waist and thighs) and added to enhance the size and shape of the butt, or implants, as done in breast enhancements, inserted through a small incision.

How to know your doctor is legit

Even in the proper setting and in the right hands, the procedure is not without risks. “People should understand that even as a plastic surgeon injecting fat into the buttocks, we have to be very careful,” Pfeifer says. “Nothing is foolproof.”

Controlling for risk factors is about more than having careful knowledge of anatomy, a sterile operating room and experience with the tools and materials used in the procedure. If something goes wrong, such as a blood clot, “it’s immediate, and you have to know how to save that person’s life.”

Each state has an online database of licensed plastic and cosmetic surgeons; specifically, seek out a doctor certified by the American Board of Plastic Surgery. “Also, look to see what professional societies the doctor belongs to,” Pfeifer advises. “If a doctor is certified with American Society for Aesthetic Plastic Surgery, the doctor is board-certified.”

For recovery time, whichever method you choose, you’re looking at a lot of soreness and up to two weeks of no downtime: “You can sleep on your side, and you’re not going to sit on your bottom for a week or two,” Pfeifer says. 

Expect to pay between $4,000 and $8,000 for a professional butt enhancement. Financing is available — aesthetic surgeons use a service called CareCredit to arrange financing for patients. “If the price is too good to be true, it’s too good to be true,” Pfeifer cautions. “What is your life worth?”