Fashion model Linda Evangelista was recently in the news when she took to Instagram to publicize her experience with CoolSculpting several years ago. In her posts, Ms. Evangelista told that she has been out of the public spotlight after suffering a “disfiguring” complication from CoolSculpting treatment in 2016.

What is CoolSculpting?

CoolSculpting is a proprietary technology made by Zeltiq that uses freezing to break up fat cells. This process is known as “cryolipolysis.” Essentially, the CoolSculpting machine has a suction device that draws up a fold of belly or neck skin into the head of the device. Then, it applies cold to the fold of skin for about 45 minutes. The suction is released and the device is removed. What is left over resembles a stick of butter under the skin and this is massaged out by hand. What happens next is that the fat cells break apart, presumably due to the freeze-thaw cycle. The body then absorbs the broken up fat cells, resulting in a skinnier waist or tighter neckline. To see this process, check out this YouTube video.

What happened to Linda Evangelista?

Unfortunately, no treatment is without possible side effects and complications. Late-onset pain following CoolSculpting has been seen. However, in what can only be described as the most ironic complication in medicine, CoolSculpting patients have been known to rarely experience “Paradoxical Adipose Hyperplasia.” This means that the fat cells actually get bigger rather than melting away. This is thought to occur in 0.005% of CoolSculpting procedures. Understandably, this can be a devastating complication when it does happen. The company will typically offer to pay for traditional liposuction when Paradoxical Adipose Hyperplasia occurs.

Are there other fat-dissolving technologies?

In-office “body-contouring” is in high demand. Vanquish and Exilis utilize a different type of technology to dissolve fat. With these instruments, radiofrequency energy is used to heat (up to 113°F!) the unwanted fat. Similar to CoolSculpting, the fat cells are broken up and absorbed by the body. Liposonix, still another body-contouring option, uses high-frequency focused ultrasound energy to target the fat. Like Vanquish and Exilis, Liposonix focuses this energy on the fat to create heat, which destroys the fat cells.

What do I think?

All of the in-office fat-dissolving technologies hold promise, but are definitely not without potential complications, not all of which were mentioned in this post. CU Facial Aesthetic Surgery evaluated these technologies in the early 2010’s and felt that they were an interesting and emerging option, but decided against purchase. The main alternative to these include (1) diet/exercise (of course) and (2) traditional surgical liposuction (with a few variations). Cost seems to be very similar between all treatment choices. The advantage that surgical options have over in-office fat-melting is that liposuction is done directly on the fat and is not as dependent on the body doing what it is supposed to do. Liposuction tends to be more effective as well. That said, liposuction also has its detracting complication risks and decisions should me in conjunction with your doctor.

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