What to Know About the Linda Evangelista Case If You’re Considering CoolSculpting

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Sharing with followers that she’s coming out of a very difficult period in her life, supermodel Linda Evangelista recently posted online that she has been suffering from a side effect after undergoing a CoolSculpting fat reduction treatment. Instead of eliminating the fat in the treatment area, she says something called Pardoxial Apidose Hyperplasia (PAH) caused the fat to increase, leaving her “unrecognizable.”

In an Instagram post, Evangelista shared that the reason we don’t see her alongside her peers whose modeling careers are thriving, is because of a complication with the fat-reduction treatment. “I was brutally disfigured by Zeltiq’s CoolSculpting procedure which did the opposite of what it promised. It increased, not decreased, my fat cells and left me permanently deformed even after undergoing two painful, unsuccessful corrective surgeries. I have been left, as the media has described, ‘Unrecognizable.’”


PAH causes fat cells in the treated area to enlarge rather than killing them off, which is what is supposed to happen during cryolypolisis. The freezing activates a reactionary process in the fatty tissue that thickens and expands rather than breaking down and allowing the body to process and remove them. Many people refer to this side effect as the “stick of butter” because the tissue takes the shape of the CoolSculpting applicator when it hardens. According to the 2014 study published in JAMA Dermatology, PAH has an incidence of 0.0051 percent or about 1 in 20,000 treated patients. 

“PAH is extremely rare,” says La Jolla, CA plastic surgeon Robert Singer, MD. “Most published reports cite an incidence between 0.05 to 0.39 percent of treatments. PAH was first described in 2014, and focal traditional liposuction has been successfully utilized to treat these rare circumstances with support from the manufacturer.”

“I have had three cases over the last 10 years,” adds Delray Beach, FL dermatologist Dr. Janet Allenby, who has a separate BodySquad practice that features just CoolSculpting technology. “I’ve used noninvastive radio frequency to correct my most severe case, but some patients will opt for surgery because according to the manufacturer the ultimate treatment to address PAH is liposuction or abdominalplasty.”

In her post, Evangelista says that she wishes she knew about the risks prior to her treatment and that she is involved in a lawsuit but that she needed to go public. In her words, the experience has not only destroyed her livelihood, but has sent her into a “cycle of deep depression, profound sadness and the lowest depths of self-loathing.”


“To be comprehensive regarding said rare risks, in medicine we use detailed consent forms to alert patients and customers about these potential issues,” notes Denver, CO dermatologist Joel Cohen, MD. “Sometimes the potential complications in these consent forms can occur— and in many cases, it isn’t due to negligence, but simply bad luck. In the case of PAH, which again is extraordinarily rare, the exact etiology is still unknown why a rare patient has this response but the overwhelming majority do not.”

So, what do you need to know about CoolSculpting in light of the recent news? Dr. Cohen says he still believes that CoolSculpting is a reasonable treatment option for people who have focal areas of undesired fat deposition. “It remains a very viable option typically with very good results for people interested in seeing improvement of localized fat in target areas. The negative press right now about PAH has certainly created heightened concern amongst patients, but nevertheless people still remain interested in treating localized areas of fat. It’s important to point out that the competing option to treat these same concerns, such as liposuction, have potential risks as well.” 

“Like with any procedure, there is always the risk of potential complications,” says Dr. Singer. “Even if the risks are low, they may be significant for the individual and they should be made aware of them beforehand. As far as CoolSculpting goes, which I personally do not do, the vast majority of patients that are having the procedure are not experiencing these problems.”

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