Rachel Velasco remembers walking into the emergency room at Cedars-Sinai hospital in Los Angeles last year "screaming and covered in blood" at 3 a.m. Then 23 years old, she said she was in "indescribable agony" at the site of a surgery performed on her just hours earlier.
"I've never been in so much pain, I feel like I'm dying," Velasco, an influencer, said in a video she took on her way to the hospital, which she later shared with NBC News. "All my stitches are burning. I keep passing out, like in and out of consciousness. I feel nauseous. I can barely speak. I need to get there immediately."
Velasco had been eyeing the surgery, commonly known as a Brazilian Butt Lift, or BBL, for more than a year.
BBLs, which tighten the waist and plump up the buttocks, have become increasingly appealing to influencers like Velasco, who has over 11,600 Instagram followers and an OnlyFans account. Velasco markets her sexy pictures on Instagram, in the hopes that a growing account there will result in more paying customers. She said she wanted to match the popular aesthetic of many celebrities, like the Kardashians, who have built businesses and received acclaim in part for their sumptuous curves. In 2019, the International Society of Aesthetic Plastic Surgery found that the BBL was the fastest-growing cosmetic surgery worldwide.
But Velasco's story, which she described to NBC News in detail, shows how the pressures of beauty expectations online push people to try and alter their bodies. A previous report from NBC News documented the intense pressures influencers face to get cosmetic surgery, including monetary incentives.
Velasco desperately wanted a BBL, which she thought could help her professionally and garner positive attention online. But that desperation caused her to overlook the potential risks associated with the surgery and the pain that can ensue.
Still, Velasco was lucky - dozens of BBL patients around the world have died from complications following the surgery, the American Society of Plastic Surgeons said in a 2018 press release. Velasco didn't necessarily consider her surgery botched, rather she said she was surprised at the discomfort and disappointment she experienced.
The surgery involves cutting into and taking fat from one area of the patient's body and injecting it into the buttocks. If the fat accidentally enters one of the large blood vessels found in that region, a clot can block blood flow to part of the lung, causing a lethal pulmonary embolism. BBLs have the highest mortality rate out of all cosmetic procedures, according to the Aesthetic Surgery Education and Research Foundation, a research nonprofit composed of board-certified plastic surgeons. Other patients, including some who have shared their stories with journalists, say they developed life-long heart issues or were left with bumpy, misshapen behinds.
That danger has been heightened in recent years by a confluence of factors, including social media-fueled demand and ineffective regulation, as reported by Bloomberg in July.
That regulatory framework has left some patients in the dark about what to expect from their procedures and doctors.
In Velasco's case, she had no idea that the license of her surgeon, Dr. Anna Gevorgyan, had been placed on probation by the California Medical Board in late 2020. According to records reviewed by NBC News, the board said that "she committed repeated negligent acts in her care and treatment of one or more patients" - none involved BBLs - but it allowed her to continue performing surgery on patients. Gevorgyan is not required to disclose her probationary status to patients, and Velasco didn't allege negligence against her, but said she wished she knew that she was on probation earlier.
Velasco said Gevorgyan did explain to her some aspects of her surgery, but Velasco said she didn't expect the severity of the side effects she would later experience.
Another woman who received a liposuction treatment from Gevorgyan in 2020 told NBC News that she also wished she had known about Gevorgyan's probation prior to her procedure.
The surgeon is still allowed to practice legally today. The state's probation system lets some doctors who have faced allegations of medical negligence continue to see new patients as long as they meet certain requirements - in Gevorgyan's case that included an education course, a medical record-keeping course, a professionalism program, a monitor who delivers quarterly reports to the medical board and quarterly declarations to the board, according to the agreement between Gevorgyan and the medical board. Gevorgyan didn't respond to multiple requests for comment.
The pressure to look 'perfect'
In April 2021, Velasco wanted to make a change, and quickly. Her backside was flat, she said. She cropped all of her Instagram photos above the waist.
Those posts would receive a variety of comments, many of them abusive. One said she looked "botched." Another person called her a catfish, someone who deceives others with fake or altered photos online. Velasco said the comments brought out her insecurities.
"I was just so thirsty to get a BBL," Velasco said. "I knew there was nothing I could change about these comments, but I knew I could change my body."
There was just one problem. All of the plastic surgeons Velasco was interested in were booked out for a year or more.
As an alternative, Velasco turned to a well-known medical spa in Los Angeles called 7Q Spa that serves some of the city's biggest social media stars.
A med spa is a medical facility designed with the ease of a day spa in mind. They typically offer minimally invasive or noninvasive procedures - facials, microneedling, fillers, Botox and laser hair removal - which can be performed by a physician's assistant or nurse under the supervision of a doctor.
Velasco really wanted to go to a surgeon known for operating on A-list celebrities, but 7Q Spa had an impressive clientele, too. Tana Mongeau, who has more than 5 million YouTube subscribers, has received procedures from 7Q Spa and advertised them on social media, including through a partnered giveaway for free lip filler. Mongeau did not respond to a request for comment.
Velasco said she found out that 7Q Spa was advertising BBLs on its Instagram account, which has more than 80,000 followers. 7Q Spa also has positive reviews on Yelp and Google, where it averages a 4.5 star rating. Velasco said she had no idea 7Q Spa offered surgical procedures before seeing the posts, since she had only seen the influencers - like Mongeau - advertise injectables. Velasco said she was impressed by the before and after photos on the spa's Instagram.
"They do a lot of people's work there, and it looked pretty solid, so I trusted them," Velasco said.
Velasco said she went to the med spa for a consultation, and she was told that she could get a BBL procedure almost immediately.
"I was like, 'Great, a week and a half, I will see you there,'" she said.
When Velasco first consulted with 7Q Spa, she said that workers told her the procedure would take place in a "sister studio" next door. Since NBC News reached out to 7Q Spa for comment, different representatives for 7Q Spa have indicated that Gevorgyan actually works in that sister studio. An NBC News visit to 7Q Spa found that the med spa and the sister studio, Vitality Medical Center, occupy adjoining units in a strip mall. The front door of 7Q Spa is side-by-side with Vitality Medical Center, which, according to California business registration documents, has the same CEO as 7Q Spa. Gevorgyan's services are advertised through 7Q Spa's social media accounts. Velasco said her appointments were made with 7Q Spa and that the two units are connected on the inside, allowing her to walk through 7Q Spa to the medical center where her surgery took place.
A lawyer representing 7Q Spa declined to comment for NBC News' story, but said in an email that 7Q Spa maintains that "they have honored all policies, procedures and obligations to each and every one of their customers and patrons."
Dr. Steven Williams, a board-certified plastic surgeon practicing in the Bay Area who performs BBLs and owns a San Francisco Bay Area med spa, said that the potentially "dangerous" procedure should be performed in a surgery clinic.
7Q Spa and Vitality Medical Center were not listed in a database of California's accredited outpatient surgery centers, according to a search conducted by NBC News.
According to the California Medical Board, if a surgical procedure uses anesthesia "in doses that have the probability of placing a patient at risk for loss of the patient's life-preserving protective reflexes," it must take place in an accredited, licensed or certified surgery center. If a procedure uses local anesthesia, it does not have to take place in an accredited setting.
'The worst pain of my entire life'
Velasco said her consultation was with Gevorgyan, who she said goes by "Dr. G."
Gevorgyan isn't a board-certified plastic surgeon. According to her National Provider Identifier, a unique identification number for American health care providers, she is licensed in California with a specialty as an OB-GYN, someone who specializes in obstetrics and gynecology. According to a brochure Vitality Medical Center posted on Instagram, Gevorgyan says she has specialized in reconstructive and cosmetic surgery since 2009 and received additional training in cosmetic surgery.
Velasco said that she was told Gevorgyan was an OB-GYN in advance of her surgery, and that 7Q Spa staff assured her that Gevorgyan was qualified to perform the BBL procedure.
Williams, who is President-Elect of the American Society of Plastic Surgeons, said that injectable treatments should be performed by a plastic surgeon or a dermatologist. "That's not always the situation, because other practitioners have realized there is money to be made," he said.
Velasco said Gevorgyan described the BBL as a surgery performed while she was awake, with local anesthesia - meaning she wouldn't be unconscious during the procedure. Gevorgyan, Velasco said, told her that she would talk to her throughout the procedure so Velasco could communicate if something was wrong.
Williams said that for a full fat grafting BBL procedure, in which liposuction is performed on one area of the body before a fat transplant, local anesthesia could actually make the surgery more difficult.
"We're trying to move around relatively large volumes of fat and that can be very, very challenging under local anesthesia," Williams said. "The wider the area you're treating, the more local anesthesia you have, and there can be complications. Post-operative pain can be more difficult because you've done this under local anesthetic."
Williams has not seen Velasco or specifically reviewed her case. A December 2018 article in the Journal of the American Society of Plastic Surgeons said that in a study of 32 patients who received BBLs with local anesthetic, no deaths or complications occurred.
On April 23, 2021, a Friday, Velasco's younger brother drove her to Gevorgyan's office. She said that Gevorgyan administered laughing gas to her through a tube, in addition to local anesthetic near the surgical site. Velasco shared videos she recorded with NBC News that show her awake and continuing to hold the tube and breathe in the gas during her procedure. Laughing gas, or nitrous oxide, is a sedative that is commonly used to calm patients during medical and dental procedures. Unlike other forms of anesthesia, it is not meant to be used alone to put patients fully to sleep.
"I was fully awake during the BBL, which is kind of crazy," Velasco said. "Like, if I go through my camera roll I was high off laughing gas, Snapchatting my friends. In the background, you hear my butt with fat getting injected into it."
Velasco paid $9,100 in cash for the surgery. She provided NBC News with a picture of her receipt.
After the surgery, Velasco said she felt great and, at first, she couldn't feel her stitches at all. She said she was put into a medical garment resembling a leotard and given Tylenol with codeine. Velasco said Gevorgyan told her she would see her at their appointment the next morning and gave Velasco her personal cellphone number in case of complications.
Velasco said she remembered being told, "Here's some Tylenol, we'll see you tomorrow."
"I got home, I fell asleep for about three hours," she said. "Around 9 or 10 o'clock that night, I started to feel the worst pain of my entire life."
'A lot can go wrong'
While in pain, Velasco said she started reading about the experiences of other BBL patients and felt worried about the level of pain she was in.
"I started to get super paranoid, my anxiety started getting to me, I was like, 'I'm literally dying, this is not normal, I'm in so much pain,'" Velasco said. "I was in my apartment all alone, I wasn't on IVs or anything."
Velasco said she begged her brother to drive her to the emergency room, where Velasco said doctors calmed her down. Her hospital records show Cedars-Sinai administered a urine test and blood test. Velasco said the doctors also gave her painkillers. At 7:30 a.m., Cedars-Sinai released her because doctors said it would be in Velasco's best interest to consult with her surgeon, Velasco said.
"She was literally so pissed that I went to the hospital," Velasco said about Gevorgyan. "She was like, 'Why did you go there? I told you to call me,' because I had her personal cell number."
Velasco said she felt bad when Gevorgyan rebuked her for going to the hospital, and then she inhaled more laughing gas so that the doctor could change her bandages and give her a lymphatic massage to reduce swelling around the incisions. The sedative left her feeling optimistic and loopy, Velasco said, so she exited Gevorgyan's office without asking further questions.
Four days later, Velasco said she stopped feeling pain from the surgery, but the consequences of the BBL weren't over. Velasco said the procedure has left a 4-inch puckered scar on her stomach, which she says hasn't gone away. When she told Gevorgyan about her concerns, Velasco said that the doctor recommended new services - more lymphatic massages from Gevorgyan. Those didn't reduce scarring either, Velasco said.
Alex, a former 7Q Spa customer who left a negative review online, said she didn't know the status of Gevorgyan's license when the doctor performed surgery on her and would not have proceeded with the surgery had she known.
"I was like, 'Can you show me your accreditations?' She was very shady about it, like, 'How dare you question me?'" Alex, whose last name NBC News agreed to withhold for her privacy, said.
"She was so mean to me," Alex said.
On Oct. 29, 2020, Alex arrived at Gevorgyan's office for her liposuction appointment. She wanted to remove fat from her inner thighs and under her arms as a pick-me-up during quarantine.
Alex, now 36, said she is unhappy with the results of her surgery, which she said made the back of her legs look misshapen. She said that the armpit liposuction did "nothing." Alex said that when she went back to Gevorgyan with her complaints, the doctor advised Alex to purchase lymphatic massages from her to reduce swelling from the procedure.
Alex said she eventually consulted with another surgeon about the areas of her body which had been operated on by Gevorgyan.
"The scars are still awful from it," she said. "He had to do my thighs again, but he won't touch parts of me, because of the scar tissue."
A murky system
The California Medical Board is tasked with overseeing medical professionals and medical facilities in the state. The board alleged in a March 18, 2020 complaint that Gevorgyan had failed "to provide an appropriate physical examination and written clearance" for an elective cosmetic surgery procedure, "employed, directly or indirectly, aided, or abetted one or more unlicensed persons to engage in the practice of medicine," and "engaged in conduct which breaches the rules or ethical code of the medical profession." Gevorgyan accepted a settlement with the board on Oct. 2, 2020 - less than a month before Alex's surgery.
By accepting the terms of her probation, which will last until the anticipated end date in September 2023, Gevorgyan did not admit wrongdoing but gave up her right to contest the allegations brought against her.
In the same complaint that led to the 2020 settlement, the board also called into question Gevorgyan's conduct during a liposuction treatment at a clinic she used to own. Specifically, the complaint alleged that Gevorgyan pre-medicated a patient with Xanax, Tylenol and a combination of nitrous oxide and oxygen administered during the procedure.
The California Medical Board revoked her license as part of the settlement, but stayed the revocation and granted her a 35-month probation. In a statement to NBC News, the board said that the state code requires it to pursue rehabilitation efforts "wherever possible" when taking action against a physician's license.
"The Board considers the facts and circumstances of each case to determine whether revocation is necessary to protect the public, or whether the public can be protected with appropriate terms and conditions in place in order to rehabilitate the licensee," the board said.
Probation limits the way Gevorgyan can oversee the practice of medicine, including her ability to supervise medical assistants and own businesses offering elective cosmetic surgeries, and the level of supervision she can expect from the California Medical Board.
But state records indicate that Gevorgyan co-managed the business next door to 7Q Spa in January 2021, which was registered at the time with the California Secretary of State as Glenoaks Surgical Center. It has since been renamed Vitality Medical Center.
Alex provided NBC News with an invoice for her procedure that was printed on 7Q Spa letterhead with Gevorgyan listed as her surgeon.
The experiences of Velasco and Alex underscore how consumers looking for surgical procedures at med spas can often have trouble knowing exactly what they are signing up for. Velasco and Alex said they understood there was a medical center connected to 7Q Spa, but they didn't realize it was a separate company.
Gevorgyan doesn't appear on 7Q Spa's website as a provider, but a representative who answered the spa's phone in January identified her to NBC News as the surgeon who performs BBLs advertised by 7Q. The procedure was described on the med spa's website as "7Q Spa & Laser Aesthetic's minimally invasive Brazilian Butt Lift procedure," but the procedure's description was removed from the website shortly after NBC News first reached out to 7Q Spa for comment in February. 7Q Spa also took the word "BBL" out of their Instagram bio after being contacted by NBC News, but has advertised the procedure in posts as recently as November.
One 7Q Spa Instagram post from November is captioned "Petite BBL" and "Liposuction of the midsection with fat transfer by Dr. Gevorgyan!"
Since NBC News reached out for comment, an Instagram account identified as Vitality Medical Center, the surgical office located next to 7Q, has begun advertising BBLs. The account links to 7Q Spa's account in its description and includes Gevorgyan's name, identified as the surgeon, in captions advertising the procedure. 7Q Spa also added a line to its Instagram bio that says "Surgeries performed by Dr. Gevorgyan."
Since her surgery, Velasco said she's resumed using the popular photo-editing app Facetune to blur her scar.
"I would have not done this if I would have known that I would have a scar and it would be this big hooplah," Velasco said. But worst of all, when Velasco requested her before and after photos from 7Q Spa, she said that the BBL had barely changed the appearance of her body.
"You cut my body open for what?" Velasco asked.
In December 2020, after Gevorgyan's license was placed on probation in California, her former state of practice took permanent action against her. The Illinois Department of Financial and Professional Regulation placed Gevorgyan, who used to practice in Evanston, in the "refuse to renew category" for a medical license based on the CMB's findings.
Not including her hospital bill, Velasco said she has paid more than $13,000 for her BBL procedure, her medical garment and her lymphatic massages.
Despite Velasco's experiences, she said in October that she's still interested in pursuing the BBL treatment somewhere else.
Velasco didn't immediately think to share her story because she hoped Gevorgyan would give her the results she was looking for. When she was asked to get more lymphatic massages or pay another $6,000 for a procedure to remove the scar, Velasco decided she wanted to prevent others from going through the same thing by speaking out.
Her little brother had already made a TikTok about Velasco's experience without naming the clinic or Gevorgyan. It has more than 1.1 million views.
This article was originally published on NBCNews.com