Five medical doctors gave evidence last week in the trial of beautician Zunilda Anaya Baldovino, who is accused of injecting two clients with a noxious substance at a beauty salon in October and November 2016.

The court heard from one victim/complainant last week, referred to by the Cayman Compass as E to protect her privacy. E said her face became red, hot and swollen, with lumps in different spots, after the defendant injected her with what E thought was vitamins.

The second complainant was to have given evidence on Friday, but she was off island. She was rescheduled for Friday, Sept. 28, when the trial resumes.

The first doctor to give evidence was dermatologist Rebeca de Miguel, who saw E in 2016. She ordered a biopsy – an examination of tissue from E’s face. She said the lab doing the examination agreed that the tissue contained a substance that was compatible with a silicone product. Dr. de Miguel said silicone is not absorbed by the body and is almost impossible to remove.

Dr. Carlos Sedano, a plastic and reconstructive surgeon, saw E a week after she experienced her symptoms. He saw lumps in the corners of her upper and lower lips. He did not know what had been injected, so he prescribed medication for the inflammatory reaction.

Asked about silicone, he agreed that it is a non-absorbable filler. He noted that injection of silicone was not approved by the U.S. Federal Drug Administration. Dr. Sedano said silicone was very difficult to remove if injected and could cause deformity and other problems.

He said if a person had a reaction to absorbable filler, it would normally clear up in days or weeks, but sometimes up to six months or a year, depending on the individual. The inflammation he saw in E could have happened with an absorbable filler, he pointed out, because reactions depend on the individual. But this kind of treatment was a medical, not a cosmetic procedure, and should only be done by a plastic surgeon or dermatologist, he emphasized.

Dr. Ciro Adamo’s evidence concerned the complainant who has not yet given evidence. He also explained that medical grade silicone was available to medical practitioners and was only used for retinal detachments. The problem with ordinary silicone oil of a non-medical grade was that it could be mixed with other substances. A small amount of silicone could cause inflammation and concentrate tissue locally, he said. He added that it could migrate and be difficult to remove.

Crown counsel Darlene Oko asked if it would be dangerous for someone not medically trained to inject an individual with non-medical grade silicone. Dr. Adamo said doctors and nurses could inject approved substances. Injection of a filler by an untrained practitioner or someone self-injecting was an issue all over the world and there was continuing debate about the products. With approved fillers, the main dangers were over-injection or injection at the wrong site. Non-approved material was in “a completely different ballpark” because there was no control and what was injected was not known.

The next witness was Dr. Pascual Abenoza, a board-certified dermatopathologist with Dermpath Diagnotics in Miami, who examined E’s tissue, sent to him by Dr. de Miguel. He said he was 70 to 80 percent sure that the tests he conducted suggested the substance was silicone.

Defense attorney Jonathon Hughes asked if it were possible to estimate when a foreign material was introduced into tissue. Dr. Abenoza said it would take six to 12 months to cause this degree of scarring and fibrosis [hardening of tissue].

Dr. Eduardo Barroso, a plastic and reconstructive surgeon who practices in Florida and Cayman, who also treated E, said he found multiple granulomas, which he described as reactions to an irritant. He also found deformity around her mouth, hardness of tissue, redness and inflammation.

Dr. Barroso said E was distressed, coming to realize she had a problem that was permanent with few options.

He said her condition was consistent with injection with a foreign body, most likely silicone. Any approved product would have disappeared over time, he pointed out. Her condition could have come from improper sterilization of whatever was used to do the injection and/or the silicone itself being contaminated.

There is no cure for silicone granulomas, he said, and it is difficult to remove them without causing deformity. He said he told E that the only option would be to remove the ones bothering her the most.

Ms. Oko asked his opinion about a non-medically trained or licensed individual giving an injection into another person’s face. Dr. Barroso said it would be unethical, unprofessional and, as far as he was concerned, criminal. With no training, there was no ability to deal with complications, he pointed out. “You wouldn’t do it to a dog – why would you do it to a human being?” he asked.

When Mr. Hughes suggested that E could have been injected with a product that was not silicone, Dr. Barroso said he had never seen any other product cause the type of granuloma E had. “What she had on her face was a typical silicone reaction,” he stated.

The final medical witness was Lyria Josephs, a nurse and former deputy director and registrar for Cayman’s Health Services Commission.

Ms. Josephs said Zunilda Baldovino was never licensed to practice as a healthcare provider. She said cosmetologists and beauty therapists were not included in the list of “Professions allied with Medicine” under the Health Practice Law. Cosmetologists and beauty therapists are not regulated under the Health Practice Law, she said.

Asked if Ms. Baldovino was legally entitled to administer anything by injection, Ms. Josephs replied, “Apparently not.”

Ms. Baldovino has pleaded not guilty to two charges of doing a reckless and negligent act – supplying or administering “medicine or poison or dangerous matter” in a manner so rash or negligent as to endanger human life or safety.

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