Among the many questions posed by Padge Victoria Windslowe's arrest at an East Germantown "pumping party" were these two: Why would people allow an untrained medical professional to perform plastic surgery on them, and why do these cases sometimes result in death?

To be sure, Claudia Aderotimi's death after a botched buttocks-enhancement procedure at an airport hotel in Feb. 2011 and the Wednesday night arrest of Windslowe, who is suspected of, but not charged with, performing that deadly procedure, both brought shocking headlines.

They were not, however, the only times the underground world of unlicensed procedures has come to light. Similar cases have been reported in Baltimore, Detroit, Florida and Las Vegas, among other places.

The uptick in cheaper procedures luring customers to take risks in the pursuit of a well-rounded posterior prompted the American Society of Plastic Surgeons (ASPS) to launch a public safety campaign warning of the dangers of "White Coat Deception."

It was for good reason.

How does this kill?

Dr. Chris Tzarnas, chief of plastic surgery for Temple University Hospital, said silicone can travel through the bloodstream if the needle hit a vein instead of just the fatty tissue in the buttocks.

"If it's injected into a very large vein, it's going to end up in the heart and or the lung vasculature," Tzarnas said. "Then it lodges there and blocks the normal blood flow, which could be potentially catastrophic."

Tzarnas said even medical grade silicone is not approved for cosmetic injection. Surgeons use implants or the patient's own fat in butt augmentation surgeries.

Synthetic fillers that are less likely than silicone to migrate or cause inflammation are used to smooth fine lines and wrinkles in the face and hands, but in those cases surgeons use a small needle and know how to avoid veins.

Why do they do it?

Dr. Mark Solomon, an ASPS spokesman and board-certified plastic surgeon with offices in Bala Cynwyd, said buttocks elevation and shaping have become popular procedures.

He attributed this to the "notion of a full, shapely buttocks aesthetic" taking on cultural popularity. Procedures like this have long been known to the transgender community; people have left the country to have work done on hips and buttocks to look more feminine.

Solomon also noted that while people who request the procedure tend to be African-American and Latina, patients do come from all races.

The shift from legal-to-illegal procedures is due to price. It's an expensive procedure when done legally. With the web making more people aware of underground practitioners and ones in foreign countries, the lower cost can inspire dangerous choices.

"It has always been under the radar. My experience has been taking it out," Solomon said, noting that patients arrive in his office after illicit procedures go awry. "When you make that mistake, you don't know what you're getting [injected into you]. I liken it to the commoditization of plastic surgery. You can get some things done in a mall, so some people don't think of it as medical anymore. They focus on the 'plastic.' I focus on 'surgery,' because that's what it is."

"The most important message is this: If anyone is going to stick anything into your body, you should ask a few questions. It's not a matter of what it costs. It should be a matter of who you trust," said Solomon.

The criminal case against Windslowe

Lt. John Walker of the Southwest Detective Division said Philadelphia Police had not charged Windslowe with the Feb. 2011 death of the British student because officials with the FDA are still working to identify the substance that was injected into the 20-year-old last year.

"We have to understand what levels are permissible in each part of the body and then what the substance was ... and then make a determination based on that," Walker said. "If we were to go forward without this information the chances of prosecution would be very minimal."

Walker said local labs are working to identify the injecting substance in the current case, which was recovered in an unmarked water bottle from a Germantown "pumping party" Windslowe was heading to when she was arrested.

He said identifying the substance, which is assumed to be some grade of silicone, is a critical step in pressing charges in the year-old death.

Walker said police know of only eight similar deaths nationwide, and are proceeding cautiously with the case.

For Solomon, the situation is fairly simple: If Windslowe did what she's said to have done, charge her.

"If take a sharp object and stick it into another body, it's assault. It's practicing medicine without a license. Apparently, the person accused of doing this didn't think twice about doing it again" after the death, he said, noting that Dr. Conrad Murray was charged with homicide in the death of Michael Jackson. "You have no legal right to put anything into anybody."