The Coolsculpt Controversy

By George Bitar, MD, FACS

IS COOLSCULPTING SAFE?

The short answer is: YES!

We talked last year about the facts and benefits of Coolsculpting. However, Coolsculpt has made a recent splash in the news with ‘90s supermodel Linda Evangelista publicizing that the fat freezing procedure left her “brutally disfigured.” The New York Times article reports that Evangelista developed paradoxical adipose hyperplasia (PAH) after receiving seven treatments of Coolsculpt to the abdomen, flanks, back, inner thighs, and chin between 2015 and 2016.^[1] The 50-million-dollar lawsuit alleged that she was not “adequately warned” of the risks.

QUICK FACTS:

• Coolsculpt is the 4th most popular noninvasive cosmetic procedure in the U.S.^[2]
• Coolsculpt cools and destroys fat cells to reduce the fatty layer in unwanted areas such as the abdomen and flanks
• Some patients may experience short term redness, swelling, and mild numbness, which resolves spontaneously
• PAH is a rare side effect, estimated to occur in between .025 – 0.05% of cases ^[3]
• PAH isn’t associated with any known health risks, but can be cosmetically unflattering

WHAT IS PAH?

PAH is a rare side effect of Coolsculpting, whereby the adipose tissue in the treated area gradually enlarges, instead of being reduced. This is “paradoxical” since the effect is the opposite of what is desired from the procedure. The estimated incidence is between 0.025 – 0.05%. In other words, it happens between 1 in 4,000 to 1 in 2,000 cases.

WHO IS AT HIGHER RISK FOR PAH?

• Possibly more common in men
• Use of larger applicator
• Use of older Coolsculpt systems

WHAT SHOULD I DO IF I HAVE PAH?

Consult a plastic surgeon. A board-certified plastic surgeon should examine you to determine if it’s normal post-treatment changes, true PAH, or another adverse reaction. The standard treatment for PAH is liposuction (or surgical removal of the fat), or cutting out the excess fat (such as a tummy tuck).

WHY CHOOSE THE BITAR COSMETIC SURGERY INSTITUTE?

• State-of-the-art equipment
• Licensed, highly trained estheticians who have performed hundreds of procedures
• Our estheticians review all the risks and benefits of Coolsculpt to keep our patients well-informed
• Dr. Bitar is an on-site plastic surgeon who is very knowledgeable about PAH and can treat this rare complication
  While PAH is a rare side effect of Coolsculpt that can be unsightly or distressing, it is not dangerous. It is important to know the facts, know your provider, and know who to turn to if you do experience a side effect.

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^[1] Hauser C. Supermodel Linda Evangelista Says Cosmetic Procedure Left Her ‘Disfigured.’ The New York Times https://www.nytimes.com/2021/09/23/us/linda-evangelista-lawsuit-paradoxical-adipose-hyperplasia.html

^[2] The Aesthetic Society’s Cosmetic Surgery National Data Bank: Statistics 2019. Aesthet Surg J. 2020;40(Supplement_1): 1-26. https://www.surgery.org/sites/default/files/Aesthetic-Society_Stats2019Book_FINAL.pdf

^[3] Nikolis A, Enright KM. A Multicenter Evaluation of Paradoxical Adipose Hyperplasia Following Cryloipolysis for Fat Reduction and Body Contouring: A Review of 8658 Cycles in 2114 Patients. Aesthet Surg J. 2021;41(8):932-941.