A mother-of-three who died after a Brazilian butt lift (BBL) procedure was subjected to “clearly barbaric medical practice” to which she gave no informed consent, a coroner has concluded.

Demi Agoglia, from Salford, traveled to Turkey for the procedure in January after seeing social media ads for Istanbul-based Comfort Zone.

The 26-year-old man died in an Istanbul hospital on January 8, three days after the operation and a catalog of poor care, an inquest heard.

Bolton coroner John Pollard found that she died from micro fat embolism, which occurs when injected fat enters the bloodstream, and ruled that her death resulted from “misadventure caused by neglect”.

Her mother Christine Tiede said she told her daughter shortly before a trip to Turkey with her partner Bradley Jones on January 4 that she was a “good-looking girl” and did not need the operation.

“She was conscious of the way she looked. There was no change in her mind,” he told the hearing.

Mr Jones, a landscaper, said he also did not want Ms Agoglia to have the surgery, but he had booked the trip months in advance after “seeing some celebrity” advertising the procedure.

In the BBL procedure fat is taken from elsewhere on the body and injected into the hips and buttocks.

Mr Pollard said: “I think in this case there was no appropriate informed consent, there was no appropriate pre-operative care and advice, and there was no appropriate post-operative care.

“All this means that the overall care was well below the standard expected for this type of treatment and this lack of care significantly contributed to Demi’s death.”

The day after the surgery, Ms Agoglia told her mother: “I’ve got the buttocks I’ve always wanted”.

The next day her mother received a message from her partner: “She’s gone.”

Mr Jones told the inquest that Ms Agoglia was “shivering” and feeling “very, very cold” after the operation.

Comfort Zone staff, who later emerged were not qualified nurses, were called to the villa where Ms Agoglia was staying after she complained of chest tightness.

The inquest heard that they checked his blood pressure but did not inspect the area of ​​operation or check his heart rate and pulse.

Ms Agoglia collapsed in the villa the next day and was taken back to hospital where she died.

Her sister Chloe said in a statement read by a family friend, Ellie Foulkes, outside the court that the family was going through “the worst possible heartbreak”.

“Our Demi was a beautiful, friendly, very confident girl and did not need surgery at all.

“She came to realize that she was no good in her own right,” he said.

“Our Demi not only left behind her family, she left behind the most beautiful little boys.

“Always and forever in our hearts Demi.”

She added: “Sleep well.”

He urged people to do “more research” if they are thinking of traveling to Türkiye for surgery.

The coroner told Ms Agoglia’s family he would write to Health Secretary Wes Streeting.

“I think more needs to be done to stop this extremely barbaric medical practice being carried out at such low standards, which certainly will not be tolerated in the UK,” he said.

The BBC has contacted Comfort Zone for comment.

A Department of Health and Social Care spokesperson said: “Our thoughts are with Demi’s family and friends at this difficult time.

“It is unacceptable that people’s lives are being put at risk by inadequately trained operators in the cosmetic sector. The Government is urgently exploring options for further regulation in this sector.”

“Patients’ safety is paramount, and we would urge anyone considering cosmetic procedures to consider the potential health effects and find a reputable, insured and qualified practitioner.”

Additional reporting by the Press Association.

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