A woman has denied causing the death of a man by giving him a fatal dose of silicone during a penis enlargement procedure.
Kasia Rivera, 35, pleaded not guilty to reckless manslaughter following the death of 22-year-old Justin Street.
Prosecutors say the father of two had gone to Rivera on May 5 seeking a penile enhancement procedure.
They claim she administered a silicone shot to Street's penis without a medical licence or any proper training, triggering his death the following day.
His death was ruled a homicide following an investigation, and a pathologist concluded that he died of a silicone embolism.
Investigators believe Rivera may have conducted several unauthorised procedures from her flat, but prosecutors said a search for witnesses, and a public plea for people to step forward, had not found any other clients so far.
Rivera, who remains free on $75,000 bail, declined to comment through her court-appointed lawyer on Tuesday.
She was charged last month and could face up to 10 years in prison if convicted.
Dr Daniel Elliott, an associate professor of urology at the Mayo Clinic in Minnesota, said it was the first case he had heard of involving a silicone injection to the penis.
"If there were a legitimate method for penile lengthening, Johnson & Johnson or Pfizer would have bought it up and made billions and billions of dollars worldwide," Dr Elliott said. "The fact that they don't means it does not exist."
Enhancement procedures performed by unlicensed practitioners or people with no medical training are more commonly seen among women, he said.
Besides liquid silicone, injections of substances including paraffin, petroleum jelly and hydrogel have been illegally used to enlarge women's breasts, hips and buttocks.
In February 2011, a woman from London died after receiving cosmetic injections to enlarge her buttocks at a hotel near Philadelphia International Airport.
Police said 20-year-old Claudia Aderotimi died after she and a friend arranged online to receive injections. Ms Aderotimi died after complaining of chest pain and difficulty breathing following the procedure.
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