Taliyah Cassadine recalls the lowest point in her life: She was rolling around on the floor of a cheap motel, trying to reshape the silicone in her hips. Cassadine, a 36-year-old trans woman living in Atlanta, had gone to a “pumper”—a black market plastic surgeon who injects illegal liquid silicone to reshape patients’ bodies. Her pump doctor was going to give her bigger, more voluptuous hips; Cassadine was competing in a beauty pageant and wanted to fill out her gowns.
Instead, she says, the injection made her look like she had a shoebox on her backside. This is actually quite common, Cassadine tells me. Pump doctors will even use rolling pins on smaller areas, like the breasts, to even out a silicone injection. The hips are often so big that patients have to roll around on the floor to smooth things out. The moment Cassadine had to do that was a wake-up call.
Illegal silicone injection is a growing black market industry, and one that regularly disfigures and sometimes kills its clients. Liquid silicone is illegal for medical use in the United States, but is prevalent in South America for body contouring, and sometimes “medical grade” liquid silicone is smuggled in from places like Colombia. Legal dermal fillers in the US are made up of collagens, fat (sometimes the patient's own fat), and hyaluronic acid—all substances the body can recognize and safely absorb. The silicone is used in conventional breast implants is a cohesive, pillow-like object that doesn’t ordinarily move or rupture. This creates the misconception of liquid silicone as being safe for bodily injection. It's not. And pump doctors, of course, aren't required to use medical grade products. Their silicone sometimes comes from the hardware store.
Pumping is especially common among trans women, many of whom end up with lifelong health problems as a result. In 2017, Deanna Roberts was convicted for killing Atlanta-based trans woman and performer Lateasha Shuntel, who died within 36 hours of receiving a silicone injection. Roberts accidentally hit one of Shuntel's arteries, which caused the silicone to travel to her lungs, liver, kidney, heart, brain, and spleen. Shuntel died from a “silicone polymer embolization." Even though trans women know the consequences of silicone injection, many still pursue it.
“The first person who injected silicone in me went to prison soon after for killing someone,” Cassadine tells me. “[But] pumping can be extremely important. It can make or break you. I competed in pageants and was told I wasn't giving enough ‘female illusion.’ Five years of first runner up.” The “illusion” she refers to implies that she didn’t look enough like a biological woman to the judges.
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Cassadine did finally win first place after extensive pumping. It's also broken her—she has had severe pain and infections from the silicone, and at one point was about to have her leg amputated. Cassadine says that the “make you or break you” appeal of silicone goes far beyond winning pageants in the trans community. For many people, liquid silicone is the only way they can afford to achieve the "feminine" look they want. Going to a licensed plastic surgeon is far too expensive. Cassadine also says many trans women rely on liquid silicone to increase their value as sex workers. Johns are more willing to pay top dollar for a trans woman with curves in all the right places.
One of the reasons Cassadine was drawn to liquid silicone injection is because it is quick and cheap. Even when she has had health insurance, it never covered cosmetic procedures. For a trans woman to receive breast implants from a licensed plastic surgeon is an expensive, drawn-out ordeal. The process to stretch out the breast skin so an implant will even fit can take many months. On top of that, implants are expensive—between $5,000 and $10,000.
Pumping, on the other hand, can be done for a couple hundred dollars in one day, and Cassadine says pump doctors are well known and readily available in the trans community. The irony is that, by now, Cassadine has spent thousands more dollars removing silicone from her body than she would have had she gotten implants from a licensed doctor in the first place.
Of course, having the money to pay for surgery is only one obstacle. As late as the year 2000, there were only a handful of places in the nation where transgender women could get gender-affirming surgery, says Jess Ting, a specialist in transgender surgery at Mount Sinai Hospital in New York City. Legitimate hospitals and academic medical centers wouldn't allow it, he adds, because it was viewed as unnecessary surgery. One of the few places transgender women could seek surgery was a small hospital in Trinidad, Colorado (about 200 miles south of Denver) that treated thousands of patients. But, of course, that was for the privileged few who could afford to travel to such a remote place for medical care. Hence the need for a black market.
Ting compares liquid silicone to cancer. The worry is that the silicone will spread. Some of the worst cases are where it spreads via the lymph nodes, where the silicone can wreak havoc on the immune system. Even if the silicone stays in one place, it can cause terrible infections. “Say you survive the injection and look great for years. Eventually your white blood cells attack it and form multinucleated, giant cells,” he tells me. Essentially—the silicone turns into a tumor. “We treat liquid silicone in the breasts like we do breast cancer. We do a total mastectomy, but leave the skin and nipple for immediate breast reconstruction,” Ting says.
Unfortunately, there’s no way to remove all the silicone in a patient's body. Ting says he can remove most of it from specific sites, but with silicone's propensity to travel, he can never be sure that it isn't hiding somewhere else in the body. He hopes to perform fewer and fewer silicone removal surgeries as more trans women have access to quality cosmetic surgery.
“I would like to see transgender people have the option for legitimate surgery so they don't have to go to the black market. If they had coverage, the black market and its ugly side effects wouldn't be a problem,” Ting says.
Cassadine now has her own grassroots approach for stopping liquid silicone injection in the trans community. She educates trans women in the pageant community about the dangers of liquid silicone by sharing her story about her search for beauty, and the terrible health problems she's experienced. One of Cassadine's biggest points is that for trans women to obtain the body of their dreams, they need patience. She says that mainstream medical care, even if it takes months or years, is the only way to go for body contouring.
Today, Cassadine administers The Divine Cassadine Transition Scholarship, which helps pay for trans women in the pageant circuit to receive cosmetic surgery the safe way. She helps these women afford deposits for plastic surgery, silicone removal, and other medical necessities in order to keep them from turning to pump doctors. In 2017, Divine Tanisha Cassadine, Taliyah's “gay mama” (a sort of trans mother who takes young trans women under her wing) died from complications due to liquid silicone. This is her way of paying homage to the woman who taught her how to be a woman.
“My mother was injected on a Saturday. That Monday she went to the hospital, Tuesday she went into a coma, and by Wednesday she had died. The doctor put ‘natural causes’ on the death certificate,” Cassadine alleges. “That's a pump doctor's dream because they can't get prosecuted. That pumper who killed my mama is still working.”
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