Dr. Mendieta is one of America’s top plastic surgeons, a sculptor of buttocks on par with Michelangelo whose book on butts, The Art of Gluteal Sculpting, was published in 2011.

“The buttock today is what breasts were in the 60s,” Dr. Mendieta told me inside his office. Dr. Mendieta is absolutely correct about the growth in popularity of butt augmentation among Americans. The number of legal butt procedures in the US increased by 176 percent between 2000 and 2012, exploding into a $26 million industry. Dr. Mendieta has been happily riding the crest of this ass wave. Ten years ago, 20 percent of his practice was the buttocks. Today, it’s 90 percent. And while Dr. Mendieta would prefer to focus on molding new posteriors, more and more he’s been finding himself reconstructing the buttocks of women who’ve received black-market injections.

“There’s no question that I’ve been performing these reconstructive procedures at an increasing rate,” he said. He explained that he’s fixed about 30 illegally injected asses in his career, and five in 2013 alone. “People are coming to me from all over the world, mainly the United States. It’s endemic in South America, Miami, and New York, and some in LA. But Miami is a bigger hub for this stuff. My feeling is that I will see even a higher number in the future, because it can take five to ten years for the injections to react.”

Which leaves Dr. Mendieta squarely on the front lines in the battle over illegal butt tampering—a battle that keeps getting worse. Of all the victims of illegal butt injections he’s operated on, he said that Silicone Patient #1’s was one of the most severe cases he’d ever seen.

“I had to cut a great deal of flesh out with the silicone,” he said, “because it had impregnated her tissue. We pulled out a pound and a half of pure, rock-hard substance from each cheek.”

The task of removing the damaged tissue and reconstructing Silicone Patient #1’s ass was such an undertaking that it had to be broken up into two operations. The $6,000 she spent on her butt injections no longer seems like a bargain; she estimates that it has cost her nearly $70,000 and counting to get her butt back into shape, and Silicone Patient #1 still hasn’t undergone the second procedure in which the remaining impregnated tissue will be removed and her cheeks will be further fine-tuned. The truly sad thing is that she’s one of the lucky ones. There’s only one Dr. Constantino Mendieta, but who knows how many Silicone Patient #1s are out there suffering?

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There’s only one Dr. Constantino Mendieta, but who knows how many silicone patient’s are out there suffering”