Plastic surgery, especially aesthetic procedures, has grown rapidly in recent years—with increased demand and innovation. However, with this growth comes significant risks. One name that has surfaced often in discussions of complications and fatalities in buttock-augmentation surgery is Dr. Constantino Mendieta. In this blog post, I explore the background of Dr. Mendieta, outline the deaths and controversies linked to his work, examine the broader context of risk in buttock-augmentation surgery (notably the so-called “Brazilian butt lift” or BBL), and draw lessons for patients considering these procedures.
Who is Dr. Constantino Mendieta?
Dr. Constantino Mendieta is an American plastic surgeon, often cited as a pioneer in gluteal (buttock) augmentation, especially fat-transfer techniques. Wikipedia+2OUP Academic+2
Here are a few key points about him:
- Born December 6, 1963, in Los Angeles, California. Wikipedia
- He has been associated with gluteal sculpting, fat-grafting, and has published on these topics. Wikipedia+1
- He has been involved in high-profile procedures and also has faced lawsuits and scrutiny in connection with complications. Wikipedia+1
Because he specializes in an area of higher risk (buttock fat-grafting), his practice and outcomes are of significant interest when discussing safety in aesthetic surgery.
The Deaths & Controversies Associated With Dr. Mendieta
It’s important to clarify upfront: while Dr. Mendieta is linked to controversies involving patient deaths and complications, this does not necessarily mean every adverse outcome was solely his fault or that he was convicted of wrongdoing in every case. What follows is a summary of publicly documented issues.
1. The case of DJ Betty Pino
One of the most cited incidents is that of Betty Pino, a popular Miami radio DJ, who died after undergoing surgery to remove previously injected silicone in her buttocks.
- According to an autopsy, her death was caused by complications from the silicone-removal procedure, including infection leading to sepsis. malpracticeteam.com+1
- Dr. Mendieta reportedly performed the reconstructive/removal procedure, though he disputed some details of the autopsy report—claiming he did not perform a purely cosmetic removal of liquid silicone, but rather reconstructive work. malpracticeteam.com+1
- Pino’s family reportedly considered legal action against Mendieta for alleged breach of care. malpracticeteam.com
This case serves as a well-documented example of complications in gluteal augmentation/removal, and the role a surgeon may play in dealing with previously injected materials (like liquid silicone) that are not standard or safe.
2. Lawsuits & malpractice claims
Dr. Mendieta has also been named in other legal actions related to cosmetic surgery complications:
- A suit filed by fitness influencer Jenelle Butler alleged that after a surgery to remove injected silicone (arranged via the TV show The Doctors) with Mendieta, she suffered excessive bleeding, dead tissue, scarring, and required multiple reconstructive surgeries. Podhurst Orseck, P.A.
- The procedure was free, but complications were severe and the case raised issues of surgeon selection, informed consent, and the riskiness of removal of non-standard materials. Podhurst Orseck, P.A.
3. Association with BBL mortality data
Although Dr. Mendieta is not specifically named in every death, he appears in studies and literature concerning buttock fat-grafting mortality risks.
- A 2017 paper from the Aesthetic Surgery Education and Research Foundation (ASERF) task force listed Dr. Mendieta as a consultant and noted his practice in Miami. PMC
- Various articles note that the majority of deaths from “Brazilian butt lifts” (BBLs) occurred in high-volume, budget clinics—including in Miami where Dr. Mendieta practices—and that gluteal fat-transfer mortality is significantly elevated. OUP Academic+2OUP Academic+2
While these data do not implicate Mendieta as responsible for each death, they place him in the context of a high-risk surgical domain.
Why Are BBLs & Gluteal Fat-Grafting So Risky?
To understand the controversies, we need to understand the technical risks of these procedures.
Anatomy & procedure risk
- The so-called Brazilian butt lift typically involves harvesting fat (via liposuction) from one area of the body and injecting it into the buttocks to achieve greater volume and contour.
- In many of the deaths studied, the fat was injected into or below the gluteal muscle (intramuscular or submuscular) rather than strictly superficial (subcutaneous). This poses risk because of nearby large blood vessels and the potential for fat to enter the venous system, travel to the lungs, and cause a pulmonary fat embolism (PFE). OUP Academic+2OUP Academic+2
- According to the ASERF “Report on Mortality from Gluteal Fat Grafting,” fat injected deep (into muscle) was associated with a 6× higher risk of non-fatal pulmonary fat embolism. PMC
Mortality rates
- Estimates vary. One source quotes a mortality rate for BBLs (when performed by board-certified plastic surgeons) around 1 in 2,351 to 1 in 6,214. RealSelf.com+1
- Another article focusing on South Florida found 25 BBL-related fat-embolism deaths between 2010-2022, with 92% of those occurring in high-volume budget clinics. OUP Academic+1
- These numbers show that although the absolute risk may look small, for elective aesthetic surgery in otherwise healthy patients, it’s relatively high compared to many other procedures.
Contributing factors to risk
From the literature and investigations, several key risk-factors emerge:
- High-volume, low-cost clinics: Many deaths occurred in clinics that perform numerous BBLs quickly and at lower cost. OUP Academic+1
- Short surgical times: Reports of 90-minute operations for multiple BBLs in a day raise concerns about speed vs safety. OUP Academic
- Intramuscular injection of fat: As highlighted, injecting fat into the muscle or beneath is riskier. PMC+1
- Lack of oversight / accreditation: Some clinics may not be fully accredited ambulatory surgical facilities (ASCs) or may employ non-plastic surgeon providers. Transparency and reporting may also be weaker. OUP Academic
What Has Been Done to Improve Safety?
Given the alarming number of deaths, regulators, professional societies, and surgeons have responded with new recommendations and rules.
- The Florida Board of Medicine issued a “subcutaneous-only injection” rule for BBLs in 2019, limiting fat injection to the subcutaneous space (not muscle) in the state. RealSelf.com+1
- Ultrasound guidance during injection (to ensure cannula is in correct plane) has been recommended. OUP Academic
- Professional societies (e.g., ASAPS) increased CME, guidelines, and warnings about BBLs and fat embolism risk. PMC+1
- Surgeons like Dr. Mendieta himself have publicly commented that the “learning curve” for BBL is still significant, and that once new techniques mature, safety improves. RealSelf.com
It is clear that the environment of BBL surgery is evolving, but risks remain sizeable.
Assessing Dr. Mendieta’s Role & Reputation
Given his prominence in this field, how should we view Dr. Mendieta’s role in the context of deaths and controversies?
Positive aspects
- Dr. Mendieta has been a recognized figure in gluteal sculpting, and his publications and clinical work have influenced the field. Wikipedia+1
- He has publicly acknowledged the high risk of fat-grafting in the buttocks and supported efforts to make it safer, stating that BBLs were going through a “learning curve.” RealSelf.com
Critical / controversial aspects
- He (and his clinic) have been named in lawsuits related to complications (for example the Butler case). Podhurst Orseck, P.A.
- Some of the most concerning data about BBL mortality are geographically centered in his region of practice (Miami / South Florida) and in high-volume clinics where his name has been associated. While correlation is not causation, the association prompts scrutiny. OUP Academic+1
- Patients and critics argue that in the field of high-risk aesthetic surgery, prominence does not fully insulate a surgeon from adverse outcomes or from being tied to systemic problems (e.g., clinic business model, volume, cost pressures).
Balanced view
It is reasonable to conclude that Dr. Mendieta is a major figure in a high-risk niche of plastic surgery. While he may not be singularly responsible for all adverse outcomes, his practice is part of the landscape where many of the highest-risk cases occur. For anyone considering a procedure in this domain, the prominence of his name underscores the importance of due diligence, surgeon selection, clinic environment, and informed consent.
Lessons for Patients / What to Ask Before Undergoing a Gluteal Augmentation
Given the above, here are questions and considerations for anyone thinking of a BBL or similar gluteal procedure.
Key questions to ask your surgeon / clinic
- What is your board-certification and experience specifically in gluteal fat grafting? Ensure the surgeon is certified by a reputable plastic surgery board.
- What is the technique you’ll use for fat injection (subcutaneous only vs intramuscular)? Safer recent guidelines favour subcutaneous only.
- Can you provide mortality / complication statistics for your clinic / practice, especially for this exact procedure? Transparency matters.
- Where will the surgery take place (hospital, accredited surgical facility, outpatient clinic)? Is the facility accredited? Accredited facilities tend to have better safety measures.
- How many of this exact procedure are done in your clinic per day / week? High-volume “chop-shop” scenarios have been implicated in increased mortality.
- What is the aftercare plan? If complications arise, how are you equipped to respond (e.g., emergency care, ICU access)? Because some complications like fat embolism require rapid intensive intervention.
- What materials are being used (fat transfer vs implants vs previously injected silicone)? If you have prior injected silicone or foreign body, you’ll need a specialized removal plan.
- What are the full risks spelled out, and do you have clear informed consent for all known risks including death? A well-informed patient is less vulnerable.
What red flags to watch out for
- Very low quoted price compared to average — might indicate high-volume discount clinic.
- Surgeon or clinic unwilling to provide complication / mortality statistics or references.
- Clinic performing many of these procedures in a short timeframe (e.g., multiple BBLs per day).
- Apparent emphasis on social media marketing rather than patient safety and long-term results.
- Previous injections of liquid silicone or non-standard foreign materials in the buttocks (these complicate surgery).
- Unclear after-care plan or no clear arrangement for emergencies.
Conclusion
The case of Dr. Constantino Mendieta—and more broadly the deaths and complications associated with gluteal fat-grafting (BBLs)—highlights a sobering reality: cosmetic surgery, especially at the cutting edge of body-contouring, is not risk-free. The presence of well-known surgeons like Mendieta does not eliminate risk; in fact, their involvement underscores how even top practitioners operate in a domain with significant hazard.
For anyone considering such a procedure:
- Take your time: Don’t rush into a decision because of marketing or low cost.
- Do your homework: Verify credentials, techniques, clinic environment, complication history.
- Ask hard questions: Understand exactly what plane the fat will be injected into, what the facility’s safety protocols are, and how emergencies are handled.
- Be realistic: Understand risks—even with all care, adverse outcomes (including death) have occurred in this field.
- Prioritize safety over price or speed: When it comes to elective aesthetic surgery in high-risk areas, cheaper/faster often means more dangerous.
