Like almost every woman, Fiordaliza Pichardo just wanted to look beautiful, so a few years ago, she began getting silicone injections from a woman she met through a friend in order to plump up her thighs and derriere.

She never expected to pay such a high price for her looks.

In March, a day after receiving an injection, Ms. Pichardo, 43, died of what the medical examiner later determined was a silicone embolism in her lungs.

The city’s health department fears that the illegal use of silicone as an alternative to cosmetic surgery is on the rise. The city’s poison control center has received three calls in the last 10 months from doctors who have treated patients injected with silicone; Ms. Pichardo’s case was not among them. In the previous two years, there were only two such cases.

Health department officials say there may be other cases that have gone unreported, since doctors are not legally obligated to report silicone poisoning or even death, and since silicone is hard to detect through X-rays or CT scans. The department was planning Thursday to send an advisory by e-mail and fax to thousands of doctors advising them to watch for silicone poisoning cases.

Nationally, reports of buttock enhancement using silicone and similar thick liquids have surfaced from the Northeast to Miami, and the Food and Drug Administration is also planning to issue a warning on the dangers of such practices, Siobhan DeLancey, a spokeswoman, said Thursday.

“This seems to be kind of an underground occurrence, so it’s difficult to get numbers of actual events and to know exactly what these people are being injected with,” Ms. DeLancey said. “It’s important to note that none of the products that are reportedly being used are approved for this purpose.”

Ms. DeLancey said silicone was not approved for injection into tissues at all, only for use in the eyes and in certain implants where it is contained and cannot leak into tissue. She said the F.D.A. had the ability to conduct criminal investigations, and would encourage victims to come forward “so that we can document the problem.”

Across the Internet, chat rooms, Web sites and blogs have sprung up discussing buttock injections.

The victims have become caught up in an underground beauty industry that uses injections of black-market, medical-grade silicone or industrial-grade silicone as a cheap, fast and easily accessible way to plump up breasts, buttocks, thighs and even wrinkles.

The injections are popular among Latina women and transgender women, who may be unable to afford conventional plastic surgery and who tap into it through unlicensed practitioners working through word of mouth, city officials said.

Although side effects are fairly rare, silicone can migrate through the bloodstream, creating potentially fatal clots in the lungs, as it did in Ms. Pichardo’s case, said Dr. Nathan M. Graber, director of environmental and occupational disease epidemiology for the New York City Department of Health and Mental Hygiene. It can also migrate through tissues, leading to ugly lumps and chronic pain.

The injections are administered at home, in motel rooms, in makeshift offices or at “pumping parties,” where the guests take turns injecting one another, officials said.

Young transgender women often seek out silicone injections because they are a quick way of making bodies more feminine, unlike hormone treatments, which may take years to work, said Dr. Nick Gorton, an emergency room doctor who treats transgender patients at the Lyon-Martin Health Services clinic in San Francisco.

“If you go to a pumping party, you can have it tonight,” Dr. Gorton said. “It’s a big temptation, especially among young people who, when you’re 20, you’re not thinking about your own mortality.”

People are often reluctant to report side effects, because they feel that they are turning in a member of their community, health officials said.

Industrial-grade silicone can be bought at a hardware store. But Dr. Graber said there have been reports of the use of substitutes like castor oil, mineral oil, petroleum jelly and even automobile transmission fluid.

Dr. Suhail Raoof, chief of pulmonary medicine at New York Methodist Hospital, treated a woman with silicone poisoning in 2007. She came in complaining of shortness of breath, chest pain and coughing, reminiscent of pneumonia, he said, and told doctors that she had been injected with about 500 milliliters of silicone in each buttock about half an hour earlier.

Because silicone is not visible on an X-ray or a CT scan, Dr. Raoof said, diagnosis is difficult without a biopsy. Doctors used deduction to diagnose the cause of the woman’s symptoms, and she survived, he said.

Ms. Pichardo was not so lucky.

Ms. Pichardo’s 19-year-old daughter, Marinés Rodriguez, said that her mother began getting silicone injections several years ago after a friend introduced her to a cosmetologist.

Ms. Rodriguez said the cosmetologist went to Ms. Pichardo’s home in the Bronx and to other clients in Manhattan and Miami. A cup of silicone cost $800, and the cosmetologist would inject half a cup to two cups in a single session, Ms. Rodriguez said. Her mother, she said, “didn’t really care about the price. It was more that she knew somebody who had this first.”

Ms. Pichardo came to trust the woman. “She felt that was her friend, nothing could go wrong,” Ms. Rodriguez said.

Ms. Pichardo was last injected on March 17, and died the next day. Doctors thought she had pneumonia, Ms. Rodriguez said, and the family never thought to mention the silicone injections — which were discovered during the autopsy — because they thought they were harmless.

The medical examiner has ruled her death a homicide because she was injected by an unlicensed nonmedical practitioner, said Ellen Borakove, a spokeswoman for the medical examiner. No charges have been filed. Paul J. Browne, a police spokesman, said, “We believe she has fled to the Dominican Republic and we are in discussions with the district attorney as to next steps.”

Ms. Rodriguez said the family was distraught, but found it hard to be angry. The day after her mother died, she said, the cosmetologist visited to pay her condolences. “We didn’t think she did it on purpose,” she said.

和几乎所有的女人一样，费奥达尼·皮查多只是想看上去漂亮一些，因此在几年前，她开始从一个通过朋友认识的女人那里接受硅胶注射，使大腿和臀部丰满起来。

她怎末也没有想到为了美貌她会付出巨大的代价。

三月，就在接受注射后的一天里，经法医鉴定43岁的皮查多死于硅胶肺部阻塞。

城市卫生部门担心这种代替外科整形手术的非法使用硅胶事件不停增长。城市中毒控制中心在近10个月中就接到三起接收因硅注射致病病例的医生打来的电话；而皮查多并不包括在内。在先前的两年内，类似的病例仅有两起。

卫生部门官员说也许还有其他病例并没有上报，因为医生并没有法律义务来上报硅胶中毒或者死亡事件，并且硅胶很难用X射线或CT扫描检测出来。该部门计划在星期四通过电子邮件或传真向所有的医生建议关注硅胶中毒病例。

在全国范围内，用硅胶或是类似浓稠液体来提臀的报道从东北到迈阿密都浮出水面了，发言人辛普含·德兰西周三时说，美国食品及药物管理局(F.D.A)也计划对这种危险做法发出警告。

“这看来是一个地下组织，因此很难获得案例的具体数据并弄清楚这些人到底给他们注射了什么，”德兰西小姐说。“需要注意的是，那些据说在使用的产品均没有被批准用于此用途。”

德兰西小姐说硅胶根本没有被批准注入人体组织，只是用在眼睛和某些器官移植中而并不会泄露到组织中。她说F.D.A有能力打击犯罪组织，同时也鼓励受害者能够出来合作，这样能够将问题记录下来。

互联网上，聊天室里，网站和博客上都涌现出关于臀部注射的讨论。

受害者被拉入地下美容行业，将黑市，医用或者工业硅胶注射当做一个廉价快速方便的方法去隆胸，提臀甚至祛皱。

这种注射流行于那些无法负担传统的整形外科或是相信无证医师的口耳相传的拉丁妇女和变性妇女当中，政府官员们说。

纽约市健康及心理保健部门的环境与职业流行病学主任纳丹.M.戈伯说，虽然副作用相当的罕见，但是硅胶可以通过血液转移到肺部中形成一个致命的凝块，正如皮查多的案例中出现的一样。硅胶也同样会通过组织转移引起难看的肿块和慢性疼痛。

官员说，这种注射通常实施于家里，汽车旅馆，临时办事处或者在“帮聚会”中，来宾相互给他人注射。

年轻的变性妇女通常会寻找硅胶注射因为可以快速的让身体变得女性化，不像激素疗法需要几年的时间产生作用，一位在旧金山里昂马丁公共诊所治疗变性患者的急诊医生尼克.戈登说道。

“如果你想去帮聚会，你今天晚上就可以做到。”尼克.戈登说。“这是一个巨大的诱惑，特别是在20岁的年轻人当中，你不会去想自己致命的可能性这种问题”

人们总是不情愿去报道负面消息，因为这他们觉得他们与群体成员背道而驰，卫生部官员说。

工业级硅胶在硬件商店就可以买到。但是戈登医生说有报道称会用蓖麻油，矿物油，凡士林甚至是机动车传动油来代替工业硅胶。

纽约教会医院肺内科主任苏.罗孚 2007年时治疗过一个硅胶中毒妇女。她来抱怨说呼吸急促，胸部疼痛并且咳嗽，让人想起肺炎。并告诉医生她大概半小时前给每个臀注射了500毫升的硅胶。

罗孚说，因为硅胶无法在X射线或是CT扫描中被发现，若不用活组织检查很难诊断。医生用排除法来诊断这个女人的症状而最后治愈了。

但是皮查多就没有这么幸运了。

皮查多19岁的女儿，玛丽莲.罗德琳说她的母亲几年前经朋友介绍到一个美容师那里接受硅胶注射。

罗德琳说美容师到布隆克斯区皮查多的家里来，也去曼哈顿和迈阿密的其他客户家里。一杯硅胶花费800美元，美容师每次会注射半杯到两杯。罗德琳说她母亲并不在乎钱，而是她认识其他以前做过的人。

皮查多相信了这个女人。“她觉得那是她的朋友，都不会错的”罗德琳说。

皮查多最后一次注射是在3月17日，第二天死亡。医生猜测她患有肺炎，罗德琳说，家人也从没有想到和硅胶注射有关，因为他们觉得这是无害的，直到尸检发现真相。

医学鉴定人员认定她的死亡是谋杀因为给她注射的是没有医学执照的从业医师，法医鉴定发言人Ellen Borakove说。没有指控记录在案，警察发言人保罗 J.布莱恩说，“我们相信她已经逃往多米尼加，我们在同地区律师讨论如何进行下一步行动。”

罗德琳说她的家庭不甚其扰，但是很难因此生气。在她母亲死后美容师还前来哀悼，她说，“我们不觉得她这是有目的的行为。”