Fat freezing has been the most popular cosmetic tweakment for losing inches for a decade. But since supermodel Linda Evangelista launched a lawsuit against the company that created the procedure, claiming that it left her "brutally disfigured" and "did the opposite of what it promised", many questions have been raised about CoolSculpting.
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What on earth went wrong? Does this happen often? Why had we never heard of this before? Wasn’t there anything that could be done to fix it?
What is fat freezing?
The most popular form of fat freezing is CoolSculpting, a brand of cryolipolysis that works by cooling areas of fat that have been sucked up into a treatment head roughly the size of a block of butter (there are smaller treatment heads for areas such as the jowls and the backs of the arms).
Fat freezing before and after
When the fat cells get near freezing point, around 25% of them die and are slowly dispersed by the body over the following weeks.
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I've had CoolSculpting a few times — on my tummy and my love handles — and each time it has worked just fine. There has been a small but significant reduction in the area and once it's gone, it stays gone.
What are the risks of fat freezing?
I have friends for whom fat freezing hasn't gone so smoothly and they have suffered lengthy bruising or sharp pain in the treated area that takes a week to subside.
This is relatively common but, thankfully, temporary. However, there is a much rarer and more serious potential complication that doesn’t resolve with time, which is what happened to Linda.
It is called paradoxical adipose hyperplasia (PAH). Dr. Sach Mohan, an elite aesthetic practitioner who has been offering CoolSculpting at Revere, his clinic on London's Harley Street, for 11 years, explains: "When a patient develops PAH, initially the procedure looks like it's a success. But after a few months, the results seem to disappear, replaced by a firmer, collagen-rich shape of the applicator used."
How likely are complications of fat freezing?
PAH is rare but well known in the aesthetics industry and, since 2014, has been mentioned as a possible complication on the consent form that every patient must sign before treatment.
A recent article in the Aesthetic Surgery Journal put the occurrence at around one in 2,500 cases, a bit higher than the manufacturer's quoted rate of one in 4,000 cases.
Fat freezing before and after
"It's a very unfortunate situation where [it appears] Linda was unaware of the risks of the procedure and then went on to experience them," says Sach. "But [the risk is] so small that in the 11 years of performing CoolSculpting on thousands of patients, we have only experienced nine cases, out of which five patients opted to have successful corrective surgery [with liposuction, which is paid for by the company that owns the CoolSculpting brand]."
Dr. Selena Langdon, of Berkshire Aesthetics, points out that CoolSculpting is often used as a generic name for fat-freezing, but not all fat-freezing machines are the same.
CoolSculpting is the only cryolipolysis system with approval from the Food and Drug Administration in the US and has 70 peer-reviewed clinical publications demonstrating its safety and efficacy.
"While complications can arise from treatments with CoolSculpting, some of the worst injuries I have referred to me are from devices which are copycat machines,” Selena says.
WATCH: Fat freezing before and after results
"It is important to note that if a complication such as PAH arises, patients are fully supported. For example, I oversee the Complications Expert Panel and assist those that need help.
"This level of support is not offered by unregulated devices," she adds.
"I strongly encourage patients to do their research, ask a lot of questions and only seek treatment from a suitably qualified practitioner who has in place the necessary insurances.
“No treatment is without risk and things can go wrong as with any medical procedure. While aesthetic treatments have become popular, they need to be seen for what they are, which is medical and not a riskless beauty treatment.
Who can have fat freezing?
The procedure is a no-no for anyone with a hernia, lipomas or gynaecomastia (better known as moobs).
"People often think CoolSculpting is a weight-loss treatment, when the reality is that the clue is in the name," says Dr. Selena Langdon.
"CoolSculpting is suitable for those who are very close to their ideal weight but want to target stubborn areas that are resistant to diet and exercise. But while CoolSculpting can be repeated to reduce more bulky areas, the treatment is best suited for people already taking care of their health who see it as an adjunct, not a standalone method," Selena says.
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