Why It's Not Okay to Inject Bathroom Caulk Into One's Breasts and Buttocks

It doesn't sound safe. But how did it end in manslaughter?

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Flickr/permanentlyscatterbrained

Oneal Ron Morris, the 31-year-old transgender pseudo-cosmetician known as "The Dutchess," is back in the news today. We previously knew Morris as the scrub-and-stethoscope-wearing entrepreneur accused of injecting people with concoctions of silicone-based Home Depot merchandise. Bathroom caulk, Fix-A-Flat, and cement were among the substances she allegedly used as cosmetic filler, to round out people's cheeks, butts, breasts, hips, and other places of interest. 

People willingly paid her to come to their homes and do so -- presumably not knowing the contents of the injections -- in the interest of meeting unrealistic expectations of beauty propagated by society. Society could not be reached for comment.

"It's just allegations, like, I'm innocent or whatever," said the unmoved Dutchess last year.

No comment yet today, however, after being charged with manslaughter in the death of Shatarka Nuby. Nuby's death was allegedly the direct result of unsavory cosmetic injections performed by Morris.

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Oneal Ron Morris, "The Dutchess" [via The Smoking Gun]

How the allegations play out will now be a matter for Florida's Broward County courts.

As bad as it sounds, though, how does injecting synthetic goo into someone's butt actually kill them?

The theory behind injectable silicone fillers is an interesting and potentially promising one. Let's say for example that -- for whatever reason beyond our scope of passing judgment -- a woman would like slightly more effervescent or full-bodied breasts. But she doesn't want to pay for or endure the risks of breast implant surgery. Why don't we just inject a little silicone instead, basically like we do with collagen injections in people's lips? There would be no need for general anesthesia, no cutting, and it would only take a few minutes.

While it's something that is done -- more so in Europe than the United States -- safely, sterilely, by doctors, the results often aren't that great. One common problem is that the body's immune system reacts to the silicone like it's an infection, walling it off and forming dense scar tissue around it. Hard lumps form under the skin, and people say their breasts look and feel like bags of marbles.

We see that demonstrated here in the face of one of The Dutchess's patients.

dutchesspatient.pngRajindra Narinesingh, a patient of The Dutchess [YouTube]

Ideally, liquid injectable silicone acts both as a direct volume filler and a stimulant for new collagen formation by the body. Only pure, medical-grade silicone should be used, though. It's best done by a sterile technique called microdroplet serial puncture. It's recommended to be given in very small (0.5 to 1.0 mL) treatments, not less than one month apart. These measures can decrease this bumpy outcome, among other complications.

We don't have randomized studies to validate the safety of injectable silicone; however, when performed by experts using pure silicone in small quantities at appropriate intervals, retrospective studies have shown that the risk of serious complications is low. 

When improper formulations or techniques are used, though, silicone can induce severe adverse effects. Bathroom caulk is notably not a pure or sterile form of injectable silicone.

According to an assistant medical examiner in Tallahassee, Shatarka Nuby's cause of death was "massive systemic silicone migration."

If that's the case, it means that the silicone-ish products under her skin migrated throughout her system in massive quantities to the arteries in her lungs, where it clogged them or caused them to burst. She eventually started having trouble breathing, and before long died of respiratory failure. That could also be called a silicone embolism, and it's not an uncommon complication of these back-alley silicone injections.

Theories to explain the respiratory failure after a silicone embolism have focused both on the obstruction of the lung capillaries and on biochemical changes leading to lung toxicity. The patients' blood also sometimes starts to clot irregularly, presumably as a reaction to the silicone therein, which can also cause strokes or more pulmonary emboli. At the same time, most patients do hemorrhage into their lungs.

These studies that report the physiologic mechanisms of silicone embolism don't even factor in the additional toxic chemicals that may have been present in the substances allegedly injected by The Dutchess. We don't have long-term prospective data on the effects of Fix-A-Flat in one's lungs, but it's safe to assume it didn't help.


Presented by

James Hamblin, MD, is a senior editor at The Atlantic. He writes the health column for the monthly magazine and hosts the video series If Our Bodies Could Talk.

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