CoolSculpting Left One Supermodel Disfigured — Here’s Exactly What Happened, According To Doctors

Linda Evangelista coolsculpting pah
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Celebrities and cosmetic procedures go hand in hand. From Botox and fillers to rhinoplasty and liposuction, the pressure to look good is paramount for people in the entertainment industry, even more so for women. Usually, these procedures go over quite well with impressive results that are unrecognizable, but every now and then, there’s a cosmetic disaster — and supermodel Linda Evangelista, who is famous for her work with brands like Versace in the 90s, is publicly sharing her story with CoolSculpting.

From August 2015 to February 2016, the model underwent seven sessions of CoolSculpting, an in-office cosmetic procedure that selectively targets and freezes away fat cells. “The fat freezing in CoolSculpting is called cryolipolysis — ‘cryo’ means icy cold and ‘lipolysis’ means the breaking down of fat,” explains Tahl Humes, MD, medical director and founder of VITAHL Medical Aesthetics. “CoolSculpting uses cold to freeze fat causing apoptosis or programmed cell death.”

It’s FDA-cleared for several areas of the body and has been widely performed in doctors’ offices around the world for the last decade or so. And while the usual outcome for CoolSculpting patients is a smoother figure and an overall reduction of body fat, Evangelista was left with anything but. In fact, according to her Instagram post in September 2021, the noninvasive procedure left her “permanently deformed” and “brutally disfigured.”

In a recent interview with People, she recalled trying to fix it herself through diet and exercise but with no success. “I got to where I wasn’t eating at all. I thought I was losing my mind,” she said, adding that she finally went to her doctor to assess the situation. “I was bawling, and I said, ‘I haven’t eaten, I’m starving. What am I doing wrong?'”

Turns out, Evaneglista experienced a rare, yet traumatic, side effect of the procedure known as paradoxical adipose hyperplasia (PAH), which causes fat cells to multiply instead of shrink in response to the procedure. “Specifically, patients experience the development of firm, fatty growths where the CoolSculpting applicators were placed, typically six months or so out from the procedure,” explains Darren Smith, MD, NYC-based plastic surgeon. People who have experienced PAH say that the affected area is also painful or sore.

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Why does PAH happen after CoolSculpting?

While doctors aren’t quite sure why this happens, Dr. Smith points out that one theory links the development of PAH to the use of suction (negative pressure) during the CoolSculpting process. “We know that negative pressure helps with wound healing by causing an up-regulation of blood vessel production, cell growth, and other processes that help wounds close,” he says. “It is possible that a similar process is occurring in PAH, resulting in the production of increased fatty tissue.”

It’s important to note that this side affect is rare: More than eight million CoolSculpting treatments had been administered in the U.S. as of 2019, per the company’s website, and according to JAMA Dermatology, PAH affects less than 1 percent of patients. Still, it has cropped up in many doctor’s offices; in fact, out of the four doctors we reached out to for this story, three have treated at least one patient who has experienced PAH. It’s the reason Dr. Smith no longer offers CoolSculpting in his office: “Since Ms. Evangelista’s disclosure, awareness of PAH has burgeoned, and we are seeing more and more of these cases,” he says.

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It’s also important to remember, however, that any cosmetic procedure has its risks, and CoolSculpting is no different. For this reason, it is vital that practitioners communicate those risks to their patients so that they can make an informed decision before undergoing treatment. “An informed consent conversation should always include discussion of risks, benefits, and alternatives — and all questions and concerns should be addressed prior to the procedure,” says Hadley King, MD, dermatologist in NYC specializing in medical and cosmetic dermatology.

What can you do to minimize the risks of PAH?

Unfortunately, there’s no way to determine which patients are at higher risk for experiencing PAH or any other CoolSculpting complications. “The best way to minimize the risk of these procedures is to go to a board-certified plastic surgeon [or dermatologist] that specializes in body contouring and has multiple methods of body contouring available in his or her practice,” says Dr. Smith. “Moreover, these are physicians that are in the best position to fix CoolSculpting problems if they do occur.” For example, PAH can be treated with advanced liposuction techniques, including ultrasound-assisted liposuction and radiofrequency skin tightening, he says.

Though, in some serious cases, areas affected by PAH are harder to treat. Evangelista told People that after five years of corrective liposuction, she has seen little improvement: “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.” However, Dr. Humes also emphasizes that in most cases, there are ways to treat PAH so that those affected do not have to live with it.

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Patients who have a personal history of cryoglobulinemia, cold agglutinin disease or paroxysmal cold hemoglobinuria should avoid CoolSculpting altogether, and would likely be advised to do so by the right practitioner, adds Boston-based plastic surgeon, Samuel Lin, MD. Bottom line: What happened to Linda Evangelista is awful, and while PAH is a rare, it’s an important reminder that all cosmetics procedures come with risks. Doing your homework and consulting with board-certified doctors will put you in the best position for good results.

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