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Former supermodel Linda Evangelista says she has been permanently disfigured by a fat-reduction cosmetic procedure that backfired and caused her to look bloated and unrecognizable.GIUSEPPE CACACE/AFP/Getty Images

Linda Evangelista shocked the fashion world when she revealed in an Instagram post in September that she’d been “permanently deformed” by a fat-reduction procedure gone wrong.

The 56-year-old St. Catharines, Ont., native is one of the most recognizable faces in fashion, so celebrated for her supermodel chops that she notoriously didn’t “wake up for less than $10,000 a day” at the height of her fame in the 1990s. In more recent years though, Evangelista has been noticeably absent from the many career revivals that her model contemporaries – Cindy Crawford, Naomi Campbell, Christy Turlington and Claudia Schiffer – have capitalized on.

In her post, Evangelista wrote that what happened to her body was the result of a treatment called CoolSculpting, which in turn sent her into “a cycle of deep depression,” destroyed her career and left her a recluse. As a result, Evangelista filed a US$50-million lawsuit against Zeltiq Aesthetics, the parent company of CoolSculpting.

According to Evangelista’s statement, the procedure, which is touted for being non-invasive and relatively low risk, triggered a condition called Paradoxical Adipose Hyperplasia (PAH), causing hardened protruding fat masses to form on her body. “It increased, not decreased, my fat cells and left me permanently deformed even after undergoing two painful, unsuccessful corrective surgeries,” she wrote.

CoolSculpting, a non-surgical treatment for fat removal, uses a process called cryolipolysis, which kills fat cells through the application of paddles chilled to minus 10 degrees Celsius to the body. “When fat cells freeze, they crystallize and expand, which kills them,” says Dr. Frank Lista of the Plastic Surgery Clinic and MD Beauty Clinic in Toronto. “Once the fat cells are dead, your body just eliminates them like they would any other dead cell.” CoolSculpting is applied in “cycles” that promise to permanently eliminate up to 25 per cent of fat cells from the treated area (common areas include the belly, buttocks, thighs and arms). Subsequent cycles are separated by six weeks. The treatment is approved by Health Canada and the FDA in the United States.

Common side effects include soreness and bruising, but according to Lista, PAH occurs in approximately one in 10,000 patients – even fewer since Zeltiq upgraded its equipment a few years ago. “This is undoubtedly an old head that caused this in her case,” he says. Evangelista’s treatment took place in 2017, likely before the equipment was changed over. When PAH occurs, instead of the fat cells disappearing, they “hypertrophy,” which means new fat cells are laid down, along with new scar tissue, Lista says. PAH cannot be treated by more CoolSculpting, but instead liposuction. “It’s quite rare, so that this happened to her of all people is shocking,” he says. The remedy, however, is easy, Lista says, leaving him perplexed as to why Evangelista’s corrective surgeries failed.

According to Clarity MedSpa co-founder Linda Murphy, assessing whether someone is the right fit for CoolSculpting is half the battle of achieving a good result. “For us, it’s about making sure that we’re not being predatory in any way, in managing their self-esteem and managing expectations, while keeping them safe,” she says. “CoolSculpting is about treating pockets of stubborn fat, it’s not going to give you the same effect as losing 40 or 50 pounds.” Similarly, the popular muscle-building treatment, Emsculpt, which uses high-intensity focused electromagnetic energy to simulate the effects of doing 20,000 sit-ups in 30 minutes, is for those nearly at their ideal weight.

CoolSculpting is not always the appropriate procedure, Lista agrees. Both he and Murphy have turned clients away from treatments that may seem ideal but aren’t necessarily right for the individual. “One of our hashtags is #sometimeswesayno,” Murphy says.

Following the news of Evangelista’s lawsuit, Lista’s clinic held a webinar, fielding questions from prospective and current clients about the risks associated with CoolSculpting, including PAH. Surprisingly, Lista says that after the sessions, “lots of people were interested in having it done.” Ditto for Murphy, who says demand has never been higher. “I just booked someone in this morning – it’s not changing the flow of my business,” she says.

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