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PAH and CoolSculpting – Linda Evangelista’s Story

Linda Evangelista has reported that she experienced Paradoxical Adipose Hyperplasia (PAH) as a result of a non-surgical body contouring treatment with a CoolSculpting (CS) device. PAH is a long-known albeit rare adverse and not particularly well understood adverse event that can occur following a CoolSculpting treatment. Any patient that suffers an adverse event because of a medical procedure presents a learning opportunity. At the same time, they can pose physical and emotional challenges to the patients that experience them. I am disappointed to hear of Ms. Evangelista’s experience and the distress it has produced for her.

Canadian supermodel Linda Evangelista claims she was ‘disfigured’ by paradoxical adipose hyperplasia as a result of CoolSculpting and is suing after she says she was “brutally disfigured”.

CoolSculpting utilizes a technology that cools targeted subcutaneous (below the skin) fat to -27 degrees Celsius, while protecting the surface of the skin from trauma. The resulting cold injury to the targeted fat cells causes them to enter a state of apoptosis (cell death) and slowly become absorbed over 2-3 months, resulting in the reduction of unwanted and aesthetically displeasing collections of fat.

As with any medical procedure, unwanted and adverse events can and do occur. Millions of CoolSculpting treatments have been performed worldwide and it has proven to be a safe and effective treatment as described above. As expected, adverse events associated with CoolSculpting have uncommonly occurred. The rarest of these events is Paradoxical Adipose Hyperplasia. PAH results in an increase in the volume of fat being targeted by the CoolSculpting device as opposed to the desired outcome of fat reduction. This is a well-documented, rare adverse event associated with CoolSculpting procedures. The risk of PAH is included in our CoolSculpting consent form and is a part of the discussion we have with patients when reviewing risks and benefits prior to the procedure. Identifying patients at greater risk of experiencing PAH is not possible currently. There are not any readily identifiable patient features associated with PAH

Incidences of PAH often require surgical correction via liposuction. In the rare instances where PAH has occurred, it has been my understanding that Zeltiq was, and Allergan is now, committed to reimbursing the cost of the corrective procedure.

At Preventous, we have 4 CoolSculpting devices and have performed 1000’s of treatment cycles with no cases of PAH to date. CoolSculpting has proven to be an effective and safe non-surgical body contouring procedure at Preventous. I have personally had CoolSculpting treatment sessions and have been pleased with the results.

It is difficult to comment on a medical adverse event without stressing the importance of ensuring that the health care provider you are dealing with has expertise in the device and/or procedure being performed.

Dr. Rohan Bissondath


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