CULIACÁN, Mexico — When Paulina Ramírez García was rolled in to surgery for a “mini” liposuction procedure in the city of Culiacán, she knew exactly the look she was going for. She thought that sucking some fat out of her tummy and using it to accentuate her hips and buttocks would help her achieve the “buchona” look, coveted by women in her state of Sinaloa and exemplified by famous role models such as Emma Coronel, the wife of legendary narco kingpin Joaquín “El Chapo” Guzmán.
“Buchona” is a local word that has for decades been used to describe the women romantically involved with narcos. But the term has come to signify the body so many women here aspire to for the status and association that it implies: Big busts and butts, combined with a tiny waist, that are achievable only via surgery.
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The point isn’t to be a narco or a buchona but to look like one. “For many Sinaloan women, their life’s focus is to marry a narco because of what it implies—the lifestyle, clothes, house, cars,” said Isaac Tomas Guevara Martinez, a social psychologist who studies violence in the state of Sinaloa. “Emma Coronel is the prototype of the ideal body type for many women.”
But Ramírez García’s procedure didn’t turn out the way she’d planned. Soon after her $2,000 surgery in March, Ramírez García, who was 26, went into septic shock. During the lipo, the doctor perforated her internal organs six times, including her lungs and intestines, according to the Sinaloan authorities and her family members.
Turns out that the doctor who performed the procedure—Dr. Amayrani Adilene Rodríguez Pérez—was not a qualified plastic surgeon but rather a general practitioner, according to the state prosecutor. She was operating in one of dozens of clandestine, unlicensed “clinics” scattered around Sinaloa.
Ramírez García spent three weeks in hospital, mostly intubated, her family said. During that time, the skin on her abdomen rotted away completely, photos seen by VICE World News showed. She died on March 9, 2022, some 22 days after her surgery.
Rodríguez Pérez, her “plastic surgeon,” who was later arrested on homicide charges, didn’t visit her once during her time in hospital, her family said. Rodríguez Perez’s lawyers did not return calls and messages for comment on her case or her practice, and after the charges were downgraded to manslaughter, she was released on bail to await a hearing, scheduled for November, where she will enter a plea of guilty or not guilty.
The buchona culture has exploded on platforms such as Instagram and TikTok, which are both awash with women showing off their expensive curves, and giving pre- and post-surgery advice. Ramírez García loved social media and celebrity culture, her uncle José Angel Angulo, said, and like other women in the state, she was obsessed with looking like the bodies she saw on Instagram and Facebook. “Girls used to want a quinceañera for their 15th birthday. Now they ask for lipo,” said Angulo.
Dozens of clandestine plastic surgery clinics have popped up “exponentially” over the last two years across Sinaloa, according to Randy Ross, a commissioner from the local public health risk-prevention agency, Comisión Estatal para la Protección contra Riesgos Sanitarios, known by its Spanish acronym Coepris. There are 233 clinics currently registered with the agency across the state (it only started registering such clinics last year), and in early September—six months after Ramírez García’s death—government inspectors closed 24 for failing to meet the basic requirements. But you cannot regulate what you cannot find, and the vast majority of the clinics like the one that allegedly killed Ramírez García don’t even register with the authorities and operate completely under the radar.
VICE World News visited the “clinic” where Ramírez García got her “mini” lipo: a plain, white building on the side of a road on the outskirts of Culiacán, utterly inconspicuous. The mirror-glass windows and doors were covered by black iron bars. There were no visual signs of what went on behind those doors, a common characteristic of these sorts of clandestine clinics, said Ross.
“The clinics are hard to detect because they look like normal houses, so you have to have people report them,” Ross said.
But reports remain scant, and the government doesn’t keep a tally of deaths caused by complications linked to this kind of surgery, according to Dr. Rafaela Martinez Terrazas, a certified plastic surgeon who’s been working out of Culiacán for nearly two decades. She described Ramírez García’s death as “the tip of the iceberg” and said she frequently has to clean up messes such as infected wounds and other complications left by clinics like the one that Ramírez used or similar.
“There’s no way of knowing how many women die like this,” said Martinez Terrazas.
Both respected doctors like Martinez Terrazas and charlatans who operate in the shadows are catering to the massive market for plastic surgery in a state famous for the beauty of its women as well as its drug-trafficking history and culture. The demand for the “buchona” body is very high, despite the risks.
The buchona look is something of a badge of honor, synonymous with the generalized narco style and fashion in a state where drug-trafficking culture has become normalized. For the recent Independence Day celebrations, the Sinaloan government paid a musician for his famous narco-corridos (drug-trafficking ballads) to play in the official celebrations in Culiacan’s zocalo.
The look itself is cartoonish and exaggerated; the point is not to achieve a “natural” look or to conceal that they’ve had surgery. Rather, the fact that you’ve had the surgery means you can afford it, so part of the physical ideal is also a display of the women’s, or their men’s, wealth.
“Sinaloa has such a defined style thanks to that [narco] culture. These women look like dolls. They have waists like Barbie. They have firm breasts that are almost impossible to achieve naturally,” said Belem Angulo, a 26-year-old local woman who also had cosmetic surgery.
Another woman called Janet Martinez Quintero, 38, described El Chapo’s wife Emma Coronel as “an artist.” Martinez Quintero runs a business that helps women from other countries to travel to Sinaloa for plastic surgery in Culiacan, and said that she had had more than two dozen surgeries herself. “The best plastic surgeons in the world are here,” she said.
Social media has supercharged and amplified the “buchona” subculture, making content of the body beautiful available to women of all backgrounds and social classes. It is no longer just the reserve of the state’s narco-royalty. Type Emma Coronel, or the word “buchona,” into the Instagram search box and dozens of accounts appear showing women with impossible bodies.
To pay for the procedures, a type of pyramid scheme known locally as “cundinas” has proliferated, to help lower-income women get access to treatments at these shadow clinics. Members in a group pay a set amount of money each month, and each participant eventually gets surgery as funds accumulate. Such groups usually appeal to younger women, said Angulo. “They saw a business opportunity there.”
Women pay an amount every two weeks and depending on when they joined the scheme, eventually their opportunity for surgery will come around. Sometimes the operations on offer are cheaper than they might be with other high-end doctors, but often women are drawn to the schemes to manage their modest incomes. “It’s a way of saving,” said Angulo.
VICE World News made contact with a couple of “cundina” providers via Facebook, but the women running them went quiet after a few days, and didn’t follow up on meetings to discuss them and the surgery they offer. The schemes are not official, or regulated by any authority. Nor do they struggle to generate demand.
“Lipo is a risky surgery and that should be carefully considered and you need to investigate [doctors] before going for surgery there. But beauty surgery has become so normalized here that that side of things is being forgotten,” said Angulo.
A 29-year-old woman who grew up in Sinaloa, and asked to be called Kendra, said that she had her first lipo three years ago, also in an unregulated clinic. She also got her nose done and her lips botoxed. She knew the clinic was unregulated but took the risk anyway. She didn’t have any post-op complications.
“When I was younger, I never identified with the desire for a tiny waist, a big butt…that’s not how I grew up,” she said. “But when I was older I saw how my friends started going to those doctors. And the ones who had the tiniest waists looked the best. The same with the women with the biggest breasts. And I started saying to myself then ‘when I’m big, I want big boobs, I want a big butt’…it was like a dream of mine.”
Telenovelas about narcos from Colombia and Mexico, such as Munecas de la Mafia (Mafia Dolls) and Narcos Mexico, she said, were a huge influence, as was the narcocorrido genre of ballads that glorify drug traffickers.
So strong is the aspirational culture around the look that women like Ramírez Garcia are willing to take the risk of getting surgery on the cheap. Her aunt, Arely Ramírez Garcia, said people warned her niece not to get the surgery, but that she went for it anyway. What Ramírez Garcia didn’t know was that her “surgeon” was not a plastic surgeon, and the clinic was unregulated. VICE World News learned of two other women in addition to Ramírez García who suffered complications following lipo treatments from Rodríguez Pérez.
What further consequences Rodríguez Pérez will face for allegedly running her clandestine clinic remains to be seen, and will be decided by Sinaloa’s questionable justice system. State Attorney General Sara Bruna Quiñónez Estrada said that she and her prosecutors were disappointed when the homicide charges against her were downgraded to manslaughter by a judge. “We appealed,” said Quiñónez Estrada.
“To begin with, the doctor wasn’t certified, she didn’t have a [plastic surgery] specialization. The conditions in which she was working didn’t abide by what the health law dictates for this kind of surgery. The establishment didn’t have the necessary health measures. It was improvised. There were lots of reasons,” she explained.
So Rodríguez Pérez gets to stay home until a decision is made on her case in the coming months, an unacceptable fact for Ramírez Garcia’s family. In the humble, one-story home where she was brought up in the small city of Eldorado, about an hour’s drive from the capital of Culiacan, her grandmother Dolores Garcia, aged 72, keeps photos of her granddaughter burning around a candle in an improvised shrine.
“She wasn’t a plastic surgeon – she was a pirate doctor!” said Garcia, who believes Rodríguez Pérez belongs in prison. “So that other innocent girls don’t fall prey to this.”
America Armenta contributed reporting.
