Gluteal Augmentation with Castor Oil Associated with Severe Hemolysis, Multi-Organ Failure, and Death

Cosmetic procedures such as hip and buttock augmentation are increasingly popular, yet the field remains unregulated with unlicensed practitioners performing procedures and unapproved materials being used. A 26-year-old woman received injections of castor oil for buttock and hip augmentation, resulting in multi-organ failure and death. Castor oil contains ricinine, a small-molecule biomarker readily detected in urine that indicates exposure to castor oil. This report describes castor oil toxicity and exemplifies the need for education regarding non-FDA-approved injectables.