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A 48-year-old New York woman traveled to Philadelphia to undergo an illegal butt implant surgery and died. Now her case has been ruled a homicide by the city’s Medical Examiner, officials said Tuesday, the New York Daily News reports.

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Although silicone butt injections are banned in the U.S., its use is at high demand in the underground market to increase the size of lips, breasts and butts primarily. Leslie Ayala came to Philly to get the procedure done but went into cardiac arrest while recovering at a friend’s home on June 17, officials said.

Ayala was taken to Jacobi Medical Center, where she later died. While arrests have yet to be made, her death has been ruled a homicide.

The US Food and Drug Administration is reportedly so concerned about illegal silicone injections that it launched a nationwide campaign designed to warn women using the hashtag: #CheckBeforeYouInject.

The FDA web site states:

Injectable dermal fillers are medical devices regulated by the U.S. Food and Drug Administration. Although the FDA has approved certain injectable dermal fillers for use in the face (for example, to enhance lips and cheeks) and hands, no injectable filler is FDA-approved for large-scale body contouring or body enhancement.

That means you should never get an injectable filler as a breast filler, “butt filler,” or filler for spaces between your muscles. And you should never get any type of injectable filler for large-scale body contouring or enhancement. These kinds of uses can lead to serious injury, permanent scarring or disfigurement, and even death.

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Earlier this year, singer K. Michelle fulfilled a promise to her fans to remove her butt implants.

“For me, I’ve always been open. I’ve always been curvy, but it was never enough,” Michelle shared while appearing on the talk show, The Real. “I thought, ‘I’m having trouble with men right now and maybe if I had a big ol’ huge butt, then I’d get bigger love.’ So that’s what I did. I did butt, I did hips.”

The 33-year-old singer said her implants were affecting her health:”It’s to the point where the aching and the pain that made me get checked for lupus, now it’s due to my legs. My butt is so big that my legs are not holding it.”

BET reported that K. Michelle struggled to find a reputable doctor to remove the implants was not easily done. “People don’t talk about it. I’ve gone to doctors who don’t want to touch it. I’ve found one doctor who is going to do it for me. But imagine if you don’t have the money to get it out?”