A Riverside woman already convicted in a prior buttocks injection death is now on trial for murder in a second case, with prosecutors alleging she injected silicone into a Malibu woman who later died.
Libby Adame, 55, faces charges of murder and practicing medicine without certification in connection with the March 24 death of Cindyana Santangelo. Prosecutors say Adame ignored prior warnings after being convicted in 2024 of involuntary manslaughter in the 2019 death of Karissa Rajpaul during a similar procedure.
Deputy District Attorney Lee Cernok told jurors that a judge had previously warned Adame she could face murder charges if another death occurred. “That’s why we’re here,” Cernok said. She argued Adame fled Santangelo’s home as the victim’s husband waited for paramedics, leaving her to die hours later at a Thousand Oaks hospital.
Defense attorney J. Michael Flanagan countered that Adame never performed the procedure, claiming she acted only as a consultant. He said text messages between Adame and Santangelo show no specific discussion of injections. Flanagan told jurors his client intends to testify in her own defense.
The prosecution’s first witness, Ventura County Assistant Chief Medical Examiner Dr. Othon Mena, testified that Santangelo’s autopsy revealed puncture marks and silicone consistent with buttocks injections. He ruled the cause of death a pulmonary embolism from silicone injection, classifying it as a homicide caused by an unlicensed medical procedure. Under cross-examination, he acknowledged Santangelo’s preexisting health issues, including prior breast implant surgery.
Adame, arrested in May, has remained in custody since. Testimony in the trial will continue Thursday.
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