Karima Gordon was blessed with an exotic beauty that made her a natural model. But at 37, with her days as a teen beauty queen quickly disappearing in her rear view mirror, Gordon found herself looking in the same direction to revive her career. What she needed, she decided, was a bigger behind.

Butt enhancement surgery—more accurately, "gluteal augmentation"—can be expensive, however. Procedures can start at around $5,000. So instead of going under the knife, Gordon traveled from her home in Atlanta to Jackson, Mississippi. There, she received silicone injections for just $1,500 from Tracey Lynn Garner, who claimed to be a registered nurse. Karima Gordon died just days after the procedure, the silicone having traveled through her bloodstream to her lungs. Garner, who was not a nurse, is now serving life in prison for Gordon's murder.

Thousands of people every year seek to improve on nature, the vast majority seeking qualified professionals instead of quacks like Tracey Garner. Most manage to do so without complications. But the Internet is littered with stories and pictures of plastic surgery nightmares. There's even an entire reality series devoted to the topic—Botched, on CNBC sister network E!.

But this is serious business according to plastic surgeon David H. Song, M.D., of the University of Chicago, an internationally recognized expert who is president of the American Society of Plastic Surgeons.

"This is real surgery with real complications," Yet, he says, "Some patients spend more time researching a car" than they do researching their plastic surgeon.

Indeed, the majority of the procedures Song performs are what he calls "revisionary"—fixing prior surgeries gone bad.

Song, who specializes in breast surgery, has seen it all—from botched implant surgeries that become infected, to implants that are improperly positioned, leading to a condition called synmastia, best described by its nickname.

"It's commonly called the uni-boob," Song says.

Many of the revisions Song performs are the result not of botched procedures, but of medical complications like radiation treatment for breast cancer that can compromise a reconstruction. On the morning we spoke with him, he was getting ready to operate on a mastectomy patient, removing her implants and performing a procedure known as a DIEP Flap, in which tissue from the abdomen is used to reconstruct the breasts.

Regardless of the reason, Song says, revisionary surgeries can often be more difficult than the initial surgery.

"You don't necessarily have the complete roadmap" when performing a revision, he says, either because the initial surgeon is long gone, or because of problems like scarring. For the patient, they will be undergoing another surgery, which even under the best conditions is inherently risky. Song says that is why it is so important to do your homework in the first place when considering plastic surgery.

"Ideally, you want to do it right, and you want to do it once," he says.

The first step is to make certain your surgeon is board certified. But in the world of cosmetic surgery even that can be complicated, because there are so many organizations out there that claim to certify plastic surgeons.

Song says to only consider surgeons certified by the American Board of Plastic Surgery. It is the only board recognized by the American Board of Medical Specialties—the umbrella organization for all medical boards.

To become a board certified plastic surgeon, Song says, doctors must undergo at least 6 years of surgical training—"and most do a couple years more than that"—followed by oral and written exams. You can check your surgeon's status on the organization's web site.

Song says it is also important to have realistic expectations going into a procedure.

"Aesthetic surgery is and can be an inexact science," he says.

A good surgeon will walk you through the potential variables and complications, and won't be afraid to try and talk a patient out of a procedure if necessary.

Breast surgery—whether cosmetic or reconstructive—is by far the most common procedure according to the American Society of Plastic Surgeons. But butt enhancement is growing fast, according to statistics the organization released in February.

Last year, more than 22,000 people underwent some form of butt enhancement including lifts and implants. That's a 30 percent increase from 2014, and more than a 1,500 percent increase from 2000. And that doesn't include the so-called "lower body lift," which targets the abdomen, waist and thighs in addition to the buttocks. That procedure has grown nearly 4,000 percent since 2000.

Silicone injections, like the ones Karima Gordon underwent, are not included in those figures. They are not medically recognized procedures and are considered inherently unsafe, with some fly-by-night operators injecting patients with liquid cement and even tire sealant.

Yet thousands of women every year, inspired by high-profile derrieres like those of Kim Kardashian and Jennifer Lopez, seek to improve their own assets on the cheap, only to pay with their health or even their life.

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