How CoolSculpting's Potential Side Effects Impact the Cosmetic Procedure's Risk

People are pushing to learn more after supermodel Linda Evangelista opened up about PAH.

coolsculpting side effects
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  • Fashion and beauty icon Linda Evangelista, 56, is revealing more details about a cosmetic procedure ordeal after first turning to CoolSculpting in 2015, via a new People Magazine cover story.
  • The popular fat-freezing procedure angles to reduce fat cells by upwards of 20%, but a rare side effect known as paradoxical adipose hyperplasia (PAH) may have the opposite effect in the long run.
  • The side effect causes fat cells to enlarge and harden, and may require further sessions and/or corrective surgeries in the future.

    More people are becoming wary of fat-melting cosmetic procedures after seeing newly released photos of Linda Evangelista, a supermodel known for her work with Versace in the '90s and time spent as a Revlon brand ambassador, as she shared more details on how CoolSculpting altered her career (and life) forever.

    Evangelista, 56, first took to social media back in September 2021 to reveal that she was "brutally disfigured" after undergoing a CoolSculpting treatment in 2015. The non-invasive cosmetic procedure — which is classified by experts as crypolipoysis, and often used by celebrities at large — is intended to topically reduce body fat over a series of treatments. Fans of the bonafide fashion icon were surprised when Evangelista shared that hard fat deposits had grown on areas of her body within three months, instead of the desired slimming effect.

    The fashion icon developed what's known to experts as paradoxical adipose hyperplasia or PAH — something that doctors and care providers have always had to contend with warning patients about prior to CoolSculpting procedures. The condition (which is also colloquially referred to as the "stick of butter" effect by some) prompts fat tissue in the impacted area to grow larger and, often, harden permanently.

    "I tried to fix it myself, thinking I was doing something wrong," Evangelista told People, and explained that she wasn't fully aware of any potential side effects. "I got to where I wasn't eating at all. I thought I was losing my mind."

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    She also shared more in-depth details about the lengths she's gone to try to remove the hardened fat cells, which includes corrective liposuction, over the course of the last five years. None of the efforts have fully paid off, Evangelista told People: "It wasn't even a little bit better... the bulges are protrusions. And they're hard. If I walk without a girdle in a dress, I will have chafing to the point of almost bleeding."

    Fat-targeting procedures like CoolSculpting are normally considered an unobtrusive alternative to procedures like liposuction. But there are a few minor side effects to consider, as well as a rarer risk that Evangelista indicated had impacted her own fat cells. The supermodel also alleges that she wasn't educated about potential risks before she signed up for CoolSculpting.

    What other kinds of potential side effects do patients face prior to this procedure, and what exactly causes PAH in the first place?

    Weight loss, health and body image are complex subjects — we invite you to gain a broader perspective by reading our exploration into the hazards of diet culture.

    What Is CoolSculpting?

    To understand how an individual may end up with a hard mass of fat beneath their skin, you'll need to get familiar with the procedure first, which makes use of a long, thin CoolSculpting applicator that is positioned topically on areas of the patients' choice.

    "Fat is sucked into a suction-cup-like handpiece, and this area of fat in the handpiece is exposed to very low temperatures which, in essence, freeze the fat cells and cause them to crystalize," says Troy Pittman, M.D., a board-certified aesthetic plastic surgeon in private practice in Washington, D.C. "The frozen fat cells then die — a process called cellular apoptosis — and then the immune system clears away the cellular debris."

    This chilly approach to targeting fat deposits on the body is relatively new — CoolSculpting, in particular, was first approved by officials at the Food and Drug Administration (FDA) in 2010. But the key distinction that has people often signing up for multiple sessions of CoolSculpting over many years is the fact that it's designed to eliminate targeted areas of body fat. It is not a holistic weight loss procedure like gastric bypass, for example; CoolSculpting is intended to treat areas of fat that can't be addressed through diet, exercise or lifestyle changes, as indicated by its promotional website.

    Current recommendations indicate that CoolSculpting can be applied to areas including thighs, arms, the stomach area, the buttocks and regions of your face, particularly the chin. The procedure itself takes just a few hours at most, but patients see direct results within six months, with some research-based reports indicating that a single session can reduce up to 20% of composite fat in the implicated area. While some patients treat the same area repeatedly for better results, pricing for a single session can cost up to $4,000.

    According to Dr. Pittman, the risks that CoolSculpting patients are briefed on before their first procedure includes:

    • A feeling of pulling or tugging on the skin at the treatment site, which may include pain
    • Redness, bruising, and other skin sensitivity or swelling after the procedure, potentially up to a week afterward
    • Those who target their chins may feel sensations in their throat in the days following their procedures
    • More rarely, development of PAH within a few months after the procedure

      What is PAH and how is it developed?

      This side effect is indeed considered rare by most experts, including Dr. Pittman, and has been previously illustrated to affect less than 1% of those who turn to fat-melting cooling procedures, according to JAMA Dermatology. Plastic surgeons don't usually catch PAH until well after the procedure, as Dr. Pittman explains that growth of fat cells occurs slowly over time, and they are still unaware of what causes it in the first place.

      Nearly everyone who has experienced PAH share that the affected area may be painful or sore to touch. "This leaves patients with a treatment area that gets fatter rather than skinnier," he adds.

      It may be that PAH is more common with larger CoolSculpting applicators and older devices, but Dr. Pittman adds that the side effect is more often noted in men than in women. "It seems to appear more frequently in the lower abdomen than on other parts of the body," he says. "There's no way to predict which patients will suffer from PAH, so all patients should be warned."

      While there aren't significant long-term health risks associated with PAH, individuals will have to turn to a potentially painful surgical procedure to treat it — something that CoolSculpting patients usually wanted to avoid in the first place. Dr. Pittman says most commonly, the hardened mass of fat is removed using liposuction (which isn't guaranteed to relieve it entirely) or patients are placed into surgery to extract it outright.

      In a statement given to People in response to Evangelista's story and claims, a CoolSculpting representative said the procedure had been the subject of research published in "more than 100 scientific publications" and has been performed on more than 11 million people across the globe. Side effects like PAH "continue to be well-documented in the CoolSculpting information for patients and health care providers," they added.

      Is there an alternative to CoolSculpting?

      If hearing about Evangelista's case has you thinking about these procedures overall, many plastic surgeons may indicate that CoolSculpting isn't always the best route for topical fat reduction, despite more than eight million individuals signing up for the procedure, per the New York Times.

      "The gold standard for fat reduction is surgical liposuction," Dr. Pittman tells us. "For patients that are looking for a non-surgical treatment with minimal to no downtime, their expectations should be managed appropriately; they're not going to get a surgical result from a non-surgical treatment."

      There are also other topical alternatives to CoolSculpting specifically, including TruSculptID, which is licensed to doctors by Cutera. This treatment harnesses a "radio-based frequency energy" to target fat cells by heating them, rather than freezing them, Dr. Pittman explains, adding that the procedure maintains a similar result. Like CoolSculpting, best results may come after multiple treatments.

      Editor's Note: It's crucial that you consult your primary health care provider before seriously considering any form of plastic surgery, as your individual medical history may make certain procedures riskier for your health. This article is meant to be educational in nature and isn't a substitute for actual medical or treatment advice from a licensed professional.


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