Libby Adame, a Riverside County woman long accused of performing illegal cosmetic procedures, was sentenced Wednesday to 15 years to life in state prison after a Los Angeles jury convicted her of second-degree murder in the death of actress Cindyana Santangelo.
Adame, 55, was also found guilty of practicing medicine without a certification for the March 24, 2025, injection that caused a fatal embolism. The procedure took place inside Santangelo’s Malibu home, prosecutors said, using silicone that was neither medically approved nor legally administered.
She already had a 2024 conviction for involuntary manslaughter after another client died.
Newsweek contacted attorneys for Adame for comment via email outside of normal office hours on Thursday.
Why It Matters
Adame’s sentencing is more than the conclusion of one homicide case—it underscores a wider public-health crisis in the unregulated world of cosmetic enhancement.
The conviction marks a rare moment of criminal accountability for a practice that continues to thrive in social-media-driven beauty culture despite repeated federal warnings.
Health officials say underground silicone injections, often administered in homes or hotel rooms by unlicensed providers, have caused scores of injuries and deaths nationwide.
The case of Santangelo, a working actress and recovery advocate, has become a cautionary example of how demand for low-cost body-contouring procedures collides with a system that too often fails to protect consumers.
What To Know
Prosecutors Cite Prior Warnings
Deputy District Attorney Lee Cernok told jurors that Adame had been explicitly warned a year earlier that another client’s death could bring a murder charge.
During her 2024 sentencing for the unrelated killing of 26-year-old Karissa Rajpaul, Cernok said, a judge cautioned Adame that repeating such work would expose her to homicide liability if a patient died.
In her closing argument, Cernok reminded jurors that during Adame’s first trial in April 2024, Los Angeles County Superior Court Judge George G. Lomeli had explicitly warned the defendant she was “on notice of the dangers that could result” from her illegal cosmetic procedures following her conviction for involuntary manslaughter in the death of Rajpaul.
Lomeli cautioned that if another client died, Adame could face a murder charge.
“Did she know better?” Cernok asked the jury. “The answer is a resounding yes.”
Despite that warning, Adame continued offering injections promoted under the nickname “the Butt Lady.”
Prosecutors said Cindyana Santangelo died after being rushed from her Malibu home to a hospital in Ventura County, where doctors determined that a silicone injection had caused a fatal embolism.
Cernok told jurors Adame was aware of the health dangers long before Santangelo’s death, and there was “no reasonable doubt in this case.”
Defense Denies Direct Involvement
The defense, led by attorney J. Michael Flanagan, countered that Adame “did not do it,” arguing there were “no injections this time by her.”
Flanagan acknowledged that Adame had previously performed a similar procedure on Rajpaul in 2019 that ended in her death but said his client—known as “the Butt Lady” or “La Tia”—was only acting as a consultant for doctors licensed in Mexico and not performing injections herself.
Flanagan told the jury that Adame was still on probation at the time of Santangelo’s death and knew she could not legally do “butt work” in California.
He contended that Adame arrived at Santangelo’s home too late to have carried out the procedure and that investigators focused prematurely on her as the only suspect.
According to his argument, Adame noticed that Santangelo already had bandages on her buttocks during their meeting in the home’s “beauty room,” suggesting another individual had performed the injections earlier.
Taking the stand in her own defense, Adame denied giving Santangelo any injections that day.
When asked by her attorney if she knew who did, she replied, “No.” She testified that she had completed “thousands” of similar procedures and could tell the puncture marks on Santangelo’s body were “too high,” saying she had not administered the injections.
Adame said Santangelo appeared short of breath from the time she arrived and that the late actress’ husband asked her to leave after calling 911.
Husband’s Testimony and Evidence
Frank Santangelo, the victim’s husband, told jurors that his wife had only wanted a minor “butt enhancement” to smooth hormone-related lumps, not to enlarge her body.
He described her later gasping for air, “squirming on the massage table,” and bleeding from both injection sites.
He said Adame promised to fetch something from her car to help, then left and never returned.
After her death, he recovered messages and photos on his wife’s iCloud showing Adame’s tattoos, which he provided to authorities as evidence.
Security footage from 2018, cited at trial, showed Adame fleeing a South Gate salon as paramedics arrived to treat a woman who later died after receiving a similar injection. No charges were filed in the 2018 death.
Cindyana Santangelo, 58, appeared on television show such as ER, CSI: Miami and Married … With Children and featured in music videos, including Young MC’s 1989 hit Bust a Move.
She also ran Mermaids Cove Malibu, a sober-living facility for women.
Her husband, Frank Santangelo, testified that Adame fled their home as his wife began convulsing following the procedure.
“She was killed in the prime of her life in her own home after being unlawfully injected with unsafe and unapproved substances,” the family’s subsequent civil complaint alleges (Frank Santangelo et al. v. Libby Adame).
Defense attorney J. Michael Flanagan argued that Adame had only been acting as a consultant for doctors licensed to work in Mexico and denied that she personally administered the injections that killed Santangelo.
“She did not do it,” he told jurors.
Adame herself testified that she merely arrived after the procedure had been completed.
The jury rejected that account.
In addition to murder and unauthorized practice, jurors found true a special allegation that Adame caused great bodily harm, adding several years to the base sentence.
Adame’s earlier conviction stemmed from the 2019 death of Rajpaul, who lost consciousness during a similar unlicensed procedure in Sherman Oaks.
Adame was sentenced in April 2024 to four years and four months, while her daughter and assistant Alicia Galaz received three years and eight months.
Both received credit for time served and electronic monitoring, enabling Adame to return to the community within a year.
Broader Health And Legal Context
The Food and Drug Administration has repeatedly warned that injectable silicone is not approved for cosmetic use.
In a 2017 safety communication, the FDA stated: “Injectable silicone can migrate within the body and cause serious side effects, including embolism, stroke, and death.”
The agency has urged consumers to seek licensed medical providers and avoid so-called “pumping parties” in homes or hotel rooms.
Public-health officials say black-market body-contouring procedures continue to proliferate despite such warnings.
According to public-health data, unlicensed silicone injections have been linked to numerous deaths across the United States since 2002, with authorities nationwide having examined more than a dozen such fatalities involving untrained practitioners using industrial-grade silicone.
Documented cases include the deaths of Claudia Aderotimi in Philadelphia in 2011, Karima Gordon in Mississippi in 2012, Shatarka Nuby in Florida in 2012, and Daysha Phillips in Missouri in 2015—each resulting in criminal prosecutions of the individuals who performed the procedures.
In 2021, Newsweek reported on the case of Rachelle Demosthenes, a 32-year-old mother from New Jersey, who died after undergoing cosmetic surgery in Miami and being sent to a Florida recovery home where she was supposed to receive post-operative care after her “Brazilian butt-lift.”
Santangelo’s family said they hope Adame’s punishment deters others from similar practices.
Cindyana Santangelo’s “death not only could have, but should have been prevented,” the civil complaint reads.
Adame’s attorney said she intends to appeal the conviction.
What People Are Saying
J. Michael Flanagan defense attorney for Libby Adame, told the judge: “This was not an investigation. This was a rush to judgment.”
Cindyana Santangelo’s husband, Frank, cited the “damage done by this woman” referring to Adame and said family members have had their lives “turned upside down.”
What Happens Next
Adame is expected to appeal her second-degree murder conviction in the death of Cindyana Santangelo, while the victim’s family pursues a separate wrongful-death lawsuit in Los Angeles County Superior Court.
The appeal will focus on whether the trial was properly conducted, a process that could take years.
The civil case, filed by Santangelo’s husband and sons, seeks damages for negligence and fraud.
Meanwhile, state regulators and the FDA are likely to use the case to renew warnings about illegal cosmetic injections and push for stricter enforcement against unlicensed practitioners. This could make Adame’s conviction a potential turning point in how authorities and consumers address the dangers of underground cosmetic procedures.