Linda Evangelista told British Vogue how she tried to reverse the alleged damage of CoolSculpting.
After liposuction failed, she said "the only way I could think of to fix it was zero calories."
Evangelista's side effect is rare, as is liposuction failing to reverse it, a plastic surgeon said.
Linda Evangelista continues to reveal the extremes she went to try to shrink her body's bulges, which she alleges resulted from a botched CoolSculpting procedure in 2016.
In an August interview with British Vogue, the 57-year-old supermodel said she starved herself after other tactics, including two rounds of liposuction, failed.
"I was so embarrassed, I'd just spent all this money and the only way I could think of to fix it was zero calories, and so I just drank water. Or sometimes I would have a stick of celery or one apple," she told Vogue's Sarah Harris. "I was losing my mind."
Evangelista first talked about the procedure last year after ' years in hiding'
In September 2021, Evangelista, wrote on Instagram that she was suing CoolSculpting's parent company, Zeltiq Aesthetics Inc., for $50 million in damages.
She said the procedure, a less-invasive alternative to liposuction, led to a rare side effect called paradoxical adipose hyperplasia, which causes the targeted areas to grow and harden, rather than shrink.
In February 2020, Evangelista told People more about how the condition, which she said kept her "in hiding" for five years, affected her life.
She told People that she tried to double down on diet and exercise to the point of starvation, but nothing worked. She said she then underwent liposuction twice to try to reverse the damage, but the condition came back.
"I have incisions all over my body. I have had stitches, I have worn compression garments under my chin, I've had my entire body tightly girdled for eight weeks – nothing helped," she told Vogue.
She and CoolSculpting's maker have since settled the suit, but Evangelista said she still can't look in the mirror or handle anyone touching her. "Am I cured mentally? Absolutely not," she said.
Less than 0.1% of CoolSculpting patients experience paradoxical adipose hyperplasia
CoolSculpting is a fat-freezing procedure that involves pinching fat between two paddles that are cold enough to kill fat cells while sparing the skin, according to WebMD. The liver then removes the dead cells over the following weeks and months.
"CoolSculpting is sought after by many people because it is a simple, painless procedure that lasts about an hour," plastic surgeon Dr. Andy Wongworawat wrote for the Advanced Institute for Plastic Surgery. CoolSculpting, which was cleared by the US Food and Drug Administration in 2010, says it's treated more than 8 million people worldwide.
But paradoxical adipose hyperplasia, or PAH, is a possible side effect. Some research suggests it affects just 0.0051% of CoolSculpting patients.
Since it's so rare, experts don't know why some CoolSculpting patients get PAH, though it's more common in men, people of Hispanic or Latino origin, those whose belly is targeted, MedicineNet.com reports.
Any procedure comes with some unpredictability, Franco said.
"Whenever you do some type of controlled trauma to the body, sometimes the body reacts differently to try to protect itself," he said. In the case of PAH, it seems the body develops scar tissue and fibrosis instead of flushing out the dead cells, making the growths firmer than typical body fat, he said.
While treatments for PAH like liposuction usually work well, they can defeat the original purpose of CoolSculpting, Franco said.
"It's a little bit of a journey because most of the people who did CoolSculpting or any of the minimally invasive or non-invasive fat reductions did it because they wanted to avoid surgery," he said.
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