Igho “Tiny” Ubiribo was forty-three when he died after receiving penile filler injections in Bangkok. My condolences go to his wife and family. As we discuss what happened, I want to be mindful of the pain they are going through.
His death made headlines because he was known publicly. But the questions it raises matter to anyone considering this procedure. We should be asking the same questions even if this case had never made the news.
I spent almost twenty years as an emergency room physician and have been performing cosmetic injections for eleven years. Over more than a decade, I’ve performed over one thousand penile enhancement procedures. That experience shapes how I approach this discussion. I want people to understand the procedure and its risks, while being clear about what we still don’t know about this particular case.
According to People’s reporting on the coroner’s inquest records, Ubiribo received hyaluronic acid injections on March 5 and died the next day. The reported cause of death included the injections and a pulmonary embolism. Other coverage describes material consistent with filler found in his lungs. I haven’t reviewed his medical records or the complete post-mortem report, so I can’t say exactly how this happened.
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One point worth explaining is the material itself. Hyaluronic acid, or HA, occurs naturally in the body, including in skin and cartilage. That helps explain why it’s used as a filler. But “naturally occurring” doesn’t mean an injected product is harmless wherever it ends up.
If filler enters a blood vessel, it can block circulation. Material that reaches the lungs can cause a pulmonary embolism and serious lung injury. Most people associate a pulmonary embolism with a blood clot, but filler and other materials can also cause a blockage. Fatal HA embolism has been documented at autopsy after a cosmetic injection. We can’t dismiss HA’s role simply because our bodies make it naturally.
Understanding where filler belongs is just as important. In penile shaft enhancement, the goal is to increase circumference by placing filler beneath the skin. The product is not meant to go inside the erectile chambers.
Beneath the skin is a tissue layer called dartos fascia. Deeper still is a covering called Buck’s fascia, beneath which lie the erectile structures. Important nerves and blood vessels also run through this region. Published techniques describe placing shaft filler in the loose tissue plane between dartos and Buck’s fascia. A small difference in depth can bring an instrument close to structures the clinician needs to avoid.
That’s why I’m careful with the phrase “safe zone.” There is an intended plane for treatment, but knowing where it is doesn’t guarantee that every injection stays there. Anatomy varies, and accidental injection into a blood vessel is a recognized risk wherever dermal fillers are used.
How the filler is delivered matters too. General safety guidance recommends slow injection, low pressure, and small, controlled amounts. Much of that guidance comes from facial filler practice. It supports a cautious approach, but it doesn’t establish a universally safe volume for the penis or prove that any technique eliminates the risk of death.
It’s also important to distinguish the amount delivered at one time from the total used during an appointment. A reported total volume alone doesn’t tell us how much was injected with each movement, how much pressure was used, or whether the product stayed in the intended layer.
My experience makes me take technique seriously. After an embolic event, depth, pressure, volume, and possible entry into a blood vessel all need to be investigated. But I can’t fairly say that a particular technical error caused this death based on news coverage. That conclusion requires evidence I don’t have.
Patients understandably want a number: What are the chances of something like this happening? We don’t currently have a dependable worldwide mortality rate for penile HA injections. One study followed 230 patients for six months and reported no deaths, with complications including bleeding, nodules, and infection. That is useful information, but a study that size can’t reliably measure a very uncommon fatal event. An earlier forensic report also describes a death after penile HA injections. The risk is more than theoretical, even though we can’t give patients a reliable percentage.
Before considering treatment, patients should check the clinician’s license and confirm that they are authorized to perform the procedure. They should also ask about experience with penile injections specifically. How often does the clinician perform them? What complications have they managed? Which product will they use, and who will be available if something goes wrong afterward?
Those questions are reasonable. A patient should feel comfortable asking them.
The setting matters as well. A clinic may look clean, but patients also need proper skin preparation, sterile equipment, careful product handling, and consistent infection-control practices. The team should be prepared to respond to an emergency and arrange hospital care when needed.
For patients in the United States, there is another point that needs to be explained before treatment: Penile augmentation is not an FDA-approved indication for dermal fillers. A product approved for use in the face has not, by that approval, been established as safe and effective for use in the penis.
I also believe we need to be thoughtful about who is being trained to perform these procedures. Training should require appropriate professional qualifications, supervised experience, and a working knowledge of genital anatomy. Recognizing a complication is part of the job. Completing a course alone doesn’t establish that someone is ready to treat patients independently.
Patients need clear instructions about when to seek help, too. Chest pain, shortness of breath, or collapse after an injection requires immediate emergency care. Severe or worsening genital pain, skin discoloration, fever, or rapidly increasing swelling needs urgent medical assessment. No one should put off getting help because they feel embarrassed about the procedure.
Ubiribo’s family deserves answers from a careful investigation. Those of us who perform these treatments have a responsibility to be honest with patients before they decide to proceed. That means explaining the risks, being open about what the evidence cannot yet tell us, and giving people the time and information to make their own decision.
TJ Tsay is an emergency physician.
