"I wanted the round butt. The whole J-Lo look," Ouk said, explaining her insecurities about her body and her desire to transform it.
According to a 2014 report
, 11,505 buttock augmentation procedures using fat grafting -- where fat is transferred from the abdomen or thighs to the buttocks region -- were performed last year. That's an increase of 15% from 2013. Buttock implants, another augmentation procedure, increased 98%, from 942 procedures in 2013 to 1,863 in 2014.
Fat grafting procedures have since become the go-to procedure, according to Dr. Scot B. Glasberg, president of the ASPS. Perfecting the techniques for a fat transfer procedure, commonly called the "Brazilian butt lift," has been one of the instigators for increased demand.
The second factor? Pop culture
. "Whether it's Kim Kardashian (or) Jennifer Lopez," there's been significant exposure of the buttocks in the entertainment world, according to Glasberg, who is also affiliated with Lenox Hill Hospital in New York City. But butt augmentation procedures are costly, averaging approximately $4,500
, not including anesthesia, operating room facilities and other related expenses.
"I wasn't ready to dish out $10,000 or $20,000 for a Brazilian butt lift," Ouk explained. Then she heard about a less expensive alternative. A friend had achieved amazing results from butt injections for only $2,500 from a "Dr. David." Ouk made an appointment.
"Everything seemed so legit," she recalled. Dr. David, the injector, showed credentials, saying he practiced as a doctor in both the Dominican Republic and Florida. And even though the procedure was done in a three-story house, the space was set up just like a clinic, says Ouk. There were even other girls waiting for similar procedures.
Ouk was told the butt injections were safe, and indeed, the results were instant. Unfortunately, other symptoms were instant, too.
'You can't fix death'
"That whole night was just a nightmare," Ouk remembered. "I was just so shaky. I couldn't breathe." Dr. David told her to drink lots of water and discouraged her from going to the hospital, but Ouk went the next day -- the first of more than 25 trips she says she made over the next year and a half.
Meanwhile, Dr. David had vanished. The three-story house was empty when Ouk returned a week later.
Ouk's now-complicated medical history includes bouts of pneumonia, coughing up blood, leg swelling and numbing in her toes, according to her doctor, which are effects of the silicone permeating her lungs. Although her experience may seem like the worst-case scenario, she actually considers herself fortunate.
Kelly Mayhew of Maryland recently died
after losing consciousness in a New York basement, following what is believed to be an illegal butt injection procedure.
Mayhew's case serves as another grim reminder of the red flags patients ignore to save money. Receiving unlicensed procedures, in unsterile conditions, with unknown fillers can produce huge health consequences.
"We see horrible infections, horrible scarring and frankly, horrible results from an aesthetic standpoint," says Glasberg. While infections can be treated, other results, such as hardening scar tissue and chronic pain, can't be reversed. And "you can't fix death," Glasberg added.
"Why did that happen to (Mayhew)?" asked Ouk. "I did the same thing she did. I regret not paying the $20,000 ... to do it right," she said. Ouk is now having surgery to remove silicone. "I've seen other cases where the girl would lose her limbs," she added.
Behind the black market
While patients think they're escaping the fee of a certified surgeon in the short term, illegal injectors are reeling in big money -- but it's risky. Kimberly Smedley of Atlanta served jail time for administering illegal silicone injections for more than a decade; her case offers an insider look into the lucrative dealings of the underground market. As part of an FDA criminal investigation
, the government says Smedley charged between $500 and $1,600 a session and ultimately received more than $200,000 in cash.
Smedley injected customers with silicone intended to be used for metal or plastic lubrication -- and not in the sterile environment of a clinic, but in hotel rooms along the East Coast, in Baltimore, Washington, Detroit, New York and Philadelphia, according to the U.S. Department of Justice. Like many practitioners on the underground market, Smedley used super glue with cotton balls to cover the injection site and keep silicone from leaking out.
"Of course money was one of the reasons I did it," Smedley said, but added she thought she was also helping people improve their self-esteem, "as twisted as it sounds." Her word-of-mouth network consisted of strippers, professional women and celebrities. Many were from the transgender community. She chronicled the experience in her 2014 book, "The Backside of the Story
"When I went to prison, I had a lot of time to look back and reflect," says Smedley, though she admits if she hadn't been caught, she'd likely still be doing the injections. "But sometimes you don't look at negative actions until you have to deal with the consequences."
Even now, she gets solicited for her former services, though Smedley says she declines. "You just always pray that the person has a great outcome," she added -- and she advised both injectors and patients to avoid the black market route.
'Ticking time bomb'
There's still cause for worry, said Dr. Tansar Mir, plastic and reconstructive surgeon at Lenox Hill Hospital in New York, even if illegal injection patients have escaped bad effects thus far.
"It's a ticking time bomb," said Mir. "All of them are going to have problems one day." He added that complications can pop up 20 years down the road. For that reason, Ouk is scheduled to have a procedure to remove the silicone that was injected and allow her immune system to heal.
But not everyone is a candidate for such procedures. Proactive education for the public is vital. The ASPS recommends patients ensure their doctor has gone through the rigors of board certification and is operating in an accredited facility by checking www.plasticsurgery.org
Plus, patients should listen to their intuition. "If a patient walks into a garage or hotel, which doesn't feel right," said Glasberg of ASPS, "it probably isn't right, and they should run the other way."
While any major surgery carries risk, no matter how well trained the personnel or how advanced the equipment, cutting corners can make it so much worse.
Ouk, too, cautions those interested in butt injections -- or plastic surgery in general -- to pay the extra money to get it done the right way. Or be prepared for costly results. "If you're going to pay $2,500 for a plastic surgery procedure," she added, "you're going to get what you pay for."