The sentencing of Libby Adame, widely known by the moniker “The Butt Lady,” has drawn renewed attention to the dangers of underground cosmetic procedures and the tragic consequences that can result when medical treatments are performed outside regulated environments. The 55-year-old Californian woman was convicted of second-degree murder for administering a fatal silicone buttock injection to actress Cindyana Santangelo, 58, leading to her death in March 2025.
The case has highlighted a pattern of unlawful cosmetic practices linked to Adame over several years, including a previous fatal incident for which she had already faced prison time. Cindyana Santangelo, remembered for her work in television and film, lost her life after seeking a cheaper, unlicensed alternative to professional buttock augmentation. Her death and the subsequent trial sparked intense emotional testimony, legal debate, and public conversation about body image pressures, medical regulation, and accountability.
The sentencing was delivered in a Los Angeles courtroom by Judge Sam Ohta, who expressed the grave nature of Adame’s actions. Adame was ordered to serve 15 years to life in prison, reflecting both the severity of Cindyana Santangelo’s death and Adame’s history of involvement in similar illicit procedures.
Despite the defense arguing that Adame played only a peripheral role, the jury found overwhelming evidence indicating that she had personally administered the injection that caused a fatal embolism. Santangelo’s family delivered emotional statements during the sentencing hearing, describing the devastating impact of her loss. The case has since become a symbol of the lethal risks associated with unregulated cosmetic enhancement services, which continue to thrive despite repeated medical warnings.
Cindyana Santangelo’s Career and Final Procedure
Cindyana Santangelo had previously enjoyed a varied entertainment career, appearing in well-known television series including CSI Miami, ER, and Married…with Children. She was referred to by some in the industry as the “Latin Marilyn Monroe,” a nickname acknowledging her charisma, glamour, and public presence. Over the course of her acting journey, she also appeared in films, including the 2003 feature Hollywood Homicide, where she acted alongside Harrison Ford. Santangelo was admired for her lively on-screen presence and had remained a public figure throughout her life.
In the months leading up to her death, Cindyana Santangelo sought to enhance her appearance through a cosmetic buttock augmentation. Professional procedures of this nature typically involve either surgical implants or injections of medical-grade substances administered by licensed specialists in certified facilities.
However, due to the high cost and the increasing popularity of informal cosmetic enhancements promoted online, some individuals pursue cheaper, underground alternatives. These operations are dangerous, particularly when they involve silicone oil, a substance not approved for injection into soft tissue. When silicone oil enters the bloodstream or migration occurs, it can lead to catastrophic medical complications, including pulmonary embolism, organ failure, and death.
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Cindyana Santangelo reportedly arranged for the cosmetic procedure through informal networks and trusted Adame based on her reputation in certain circles. Adame was known in Southern California communities as “La Tia,” meaning “The Aunt,” a nickname suggesting familiarity and approachability.
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However, behind this perception was a history of unlicensed medical work conducted outside safe clinical environments. The injection given to Santangelo resulted in silicone material entering her bloodstream, ultimately causing a fatal embolism. Emergency services were unable to reverse the effects, and Santangelo’s passing led to a criminal investigation that revealed not only the circumstances of her death, but also Adame’s previous involvement in similar cases.
Legal Proceedings and Prior Convictions
The legal case that unfolded brought several troubling details to light, particularly concerning The Butt Lady’s history with illegal cosmetic injections. Prosecutors had already tried Adame once before, in connection with the 2019 death of 26-year-old Karissa Rajpaul in Sherman Oaks. Rajpaul had received buttock injections from Adame and her daughter, Alicia Galaz, leading to fatal complications. In that earlier case, Adame was convicted of involuntary manslaughter and sentenced to four years and four months in prison.
However, due to credit for time served and electronic monitoring tied to her 2021 arrest, she was released within approximately one year. Court records from the Rajpaul case further indicated that Adame had been present during another fatal cosmetic injection incident in 2018 in South Gate. Video footage reportedly showed her leaving the scene moments before paramedics arrived. While no charges were filed in connection with that occurrence, the footage became a point of evidence illustrating a broader pattern of behavior.
During the recent trial for Santangelo’s death, defense attorney J. Michael Flanagan asserted that Adame was not the person who administered the fatal dosage of silicone. He argued that, at most, Adame acted in a consultative capacity, suggesting that another individual must have injected the material. The jury rejected this argument. Testimony and evidence indicated that Adame was directly responsible for the injection that led to Santangelo’s death.
The courtroom saw emotional statements from Santangelo’s family members. Her husband, Frank Santangelo, expressed the profound loss felt by himself and their sons. He lamented that his children would face significant life events without their mother and emphasized the irreplaceable role she played in their family. Her son, Dante Santangelo, shared that he had been overseas at the time of the incident and never imagined such a crisis could occur. Their statements illustrated the lingering emotional toll the case will continue to have on those closest to the actress.
Broader Implications and Public Safety Concerns
The repeated incidents involving Adame have sparked wider discussions about the prevalence of underground cosmetic procedures. Despite the medical community’s warnings, the market for informal or illegally performed body contouring has continued to grow in response to social media influence, cultural beauty standards, and the high cost of authorized cosmetic surgery.
These procedures are often advertised discreetly and arranged through private messaging, social networks, and referral chains. The individuals performing them typically lack medical training, sterile facilities, or knowledge of safety protocols. Silicone injections, in particular, are especially dangerous. Unlike approved medical fillers, liquid silicone oil has no safe pathway for absorption in the body.
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Once introduced into tissue, it can travel throughout the body, enter major blood vessels, and block blood flow. Even when complications do not occur immediately, recipients can experience chronic pain, deformities, infections, and long-term health effects that require reconstructive surgery to address. Regulatory agencies, including the U.S. Food and Drug Administration (FDA), have repeatedly issued warnings against the injection of industrial-grade silicone.
The case has also emphasized the challenges law enforcement faces in stopping unlicensed cosmetic services. Underground practices tend to shift locations frequently and operate through word-of-mouth networks. Victims often hesitate to come forward due to embarrassment, fear, or not realizing that what they received was illegal. Legal consequences for practitioners can also be limited without clear evidence connecting them directly to harm.
However, the growing number of fatal incidents has drawn increased attention from prosecutors, leading to more aggressive efforts to prosecute such cases when fatalities occur. Santangelo’s death underscores the ongoing risks of unregulated cosmetic interventions and the importance of medical oversight.
Her legacy in the entertainment world, combined with the preventable nature of her passing, has drawn widespread public reflection on the cost of seeking aesthetic enhancement outside of legitimate medical practice. The sentencing of Adame represents a legal acknowledgment of the gravity of the harm caused, though the emotional and personal impact remains profound for those who knew and admired Santangelo.
The case continues to serve as a cautionary example of the danger posed by unlicensed cosmetic procedures, particularly the use of injectable silicone substances, and reflects growing legal accountability for those who administer them without medical authorization.