This CoolSculpting Side Effect Left Linda Evangelista "Disfigured"

In September 2021, Linda Evangelista opened up about her experience with a cosmetic procedure gone wrong. The '90s supermodel posted a letter on Instagram detailing complications she had following a nonsurgical CoolSculpting treatment, which has drummed up questions from people about its safety and side effects.

In her statement, Evangelista says she was left "disfigured" more than five years ago after a Zeltiq Aesthetics CoolSculpting session that "did the opposite of what it promised," which is to shrink fat cells by freezing them through a process called cryolipolysis. Instead, Evangelista developed paradoxical adipose hyperplasia, or PAH — a rare, delayed side effect of cryolipolysis that causes fat cells to grow.

Almost a year later on July 20, 2022, Evangelista announced in an Instagram post that she had reached an agreement with the company. "I'm pleased to have settled my CoolSculpting case. I look forward to the next chapter of my life with friends and family, and am happy to put this matter behind me. I am truly grateful for the support I have received from those who have reached out," the post says.

Evangelista opened up in an interview with People magazine back in February 2022 about the emotional and physical pain she faced following her procedure.

"I loved being up on the catwalk. Now I dread running into someone I know," she told the publication, adding that after the treatment, she began noticing abnormal growth around her chin, thighs, and rib cage. This was later diagnosed as PAH and required two full-body liposuction procedures to remove, although it eventually came back.

In a statement to People, a CoolSculpting representative claimed that the potential for this side effect has been "well-documented in the CoolSculpting information for patients and health care providers."

Almost all cosmetic procedures, nonsurgical and surgical, come with their own risks that are (albeit rare) very possible. In Evangelista's case, she claims she wasn't made aware of the risks of CoolSculpting prior to undergoing the procedures, which is why on Sept. 21, 2021, she filed a lawsuit against Zeltiq Aesthetics, Inc. "By doing so, Ms. Evangelista is standing up not only for herself but for others who have been similarly injured and ignored by ZELTIQ," said Evangelista's lawyer, Daniel Markham of Wrobel Marham LLP, in a formal statement sent to POPSUGAR.

Ahead, with the help of two doctors, we look deeper into the potential side effects of CoolSculpting and paradoxical adipose hyperplasia.

During a Coolsculpting procedure, "A device is adhered to the body and then a pair of cold paddles quickly freeze and destroy fat cells," Howard Sobel, MD, an NYC-based attending dermatologist at Lenox Hill Hospital, tells POPSUGAR. "This is not a technique I utilize because it can create a demarcation, or intent, on the skin leaving an uneven, bumpy result. In a rare case such as Linda Evangelista, instead of minimizing fat cells, the procedure swelled them (called Paradoxical Adipose Hyperplasia), leaving her with painful, bumpy results and long-term complications."

According to a medical journal published on the condition, PAH is says to be a "rare, previously unreported side effect of cryolipolysis with an incidence of 0.0051%." It most commonly occurs in men but "no single unifying risk factor has been identified." In the case mentioned in the study, it caused "a rectangular, sharply marginated subcutaneous soft tissue mass" in the area of the treatment application. "It is most commonly seen on the abdomen and flanks," says board-certified dermatologist Bruce Katz, MD, of JUVA Skin and Laser Center in NYC.

Dr. Sobel and Dr. Katz say they've seen patients come into their practices with PAH that they've had to correct through a series of procedures, including liposuction. "PAH cannot be treated with non-invasive methods," says Dr. Katz. "I have treated a few of these PAH cases throughout the years successfully, and think these types of cases have gone underreported."

POPSUGAR reached out to CoolSculpting for comment, but at the time of publishing, had not heard back. The website for the treatment currently lists "temporary redness, swelling, blanching, bruising, firmness, tingling, stinging, tenderness, cramping, aching, itching, or skin sensitivity" as the potential risks. It also states in rare cases it can "cause a visible enlargement in the treated area, which may develop two to five months after treatment and requires surgical intervention for correction," but Evangelista's team states that CoolSculpting fails to mention that risk upfront in its marketing material.