When 19-year-old Ecuadorian model Catherine Cando won the Reina de Durán (“Queen of Durán”) pageant in October, she also won a new car, a smart tablet and a free cosmetic surgery procedure.

But the surgery, a liposuction procedure, was ultimately the prize that took Cando’s life.

According to a January 13 Vice article, Cando died on the operating table, but differing explanations for how she died muddle the picture. Staff at the cosmetic surgery clinic say she died of a heart attack, while telling the clinic’s lawyer it was actually a brain edema, or a swelling of the brain. Her death certificate lists her cause of death as hypovolemic shock, which occurs when the body loses a significant amount of blood.

Perhaps the most tragic thing about Cando’s fatal liposuction was the fact that she didn’t seem to want or need it, Vice reports. Just days after winning the Reina de Durán pageant, she told a reporter she didn’t plan on using her free procedure, saying there was nothing she needed to change. She only agreed to get liposuction after intense pressure from the surgeon.

Cosmetic surgery is huge in South American countries; Brazil and Colombia are two of the world’s leading nations in the field. It’s normal for South American beauty pageant winners to be awarded with a free procedure.

Statistics show that the most popular cosmetic procedures for women are currently facelifts and rhinoplasties, with about 37 procedures per surgeon each year for each. There are about 36 ablative skin resurfacing procedures per surgeon per year, and blepharoplasty — eyelid surgery — is next in line with 34 procedures per surgeon.

But with such high demand came the emergence of cosmetic surgeons offering lower-quality work for lower prices. Stories similar to Cando’s abound. A few years ago, Brazilian model Pamela Nascimento’s liposuction turned fatal after she had a liver hemorrhage. It’s believed her surgeon punctured her liver during the procedure.

According to the New York Post, Cando’s family has filed a complaint against her surgeon, who has since been arrested for alleged negligence. The investigation into her death is ongoing.