Nutritionist Abby Sharp is best known for her YouTube channel Abbey’s Kitchen, where she deconstructs diet culture, talks about “hunger squash groups” and tries her healthy spin on popular celebrity diets. But earlier this month, the Toronto-based food personality took to her channel to talk about something else: her negative experience with CoolSculpting, which, she said, caused pockets of fat to grow in areas she hoped to remove.
What is CoolSculpting?
Sharp’s experience with CoolSculpting was about a decade ago—when the procedure was still new to the market, having been approved by the Food and Drug Administration in 2010. Sharp said she was getting a facial at a medical spa when she saw advertisements for it. CoolSculpting, body sculpting This procedure aims to reduce fat via a method called cryolipolysis.
During the procedure, which lasts about an hour, suction-like paddles are placed over the area being treated. Popular areas including the abdomen, flanks and under the chin. The goal of the treatment is to freeze and crystallize the fat cells under the skin so that they are eventually destroyed, making you slimmer in the treated areas. Although full results are not noticeable for months and multiple treatments are often required, the procedure is often hailed as a safer and less invasive alternative to liposuction, due to its less downtime. CoolSculpting has received praise from Khloé Kardashian’s website Goop and Gwyneth Paltrow’s.
Sharp—who has struggled with orthorexia, or an obsession with healthy eating, in the past—says she never felt like she had a flat stomach, and a spa med told her CoolSculpting could help her achieve that. Since Sharp was already thin, she was told that she was the ideal candidate and that her “problem” areas could be specifically targeted.
“That’s how it was sold to me,” Sharp told Yahoo Life. It was like, ‘This is a no-brainer. It is less invasive than Botox. “That’s the vibe I was getting.”
Sharp says she’s had two or three sessions, but after a few months, she noticed something strange in the areas treated by CoolSculpting.
“There were more lumps or bumps than there were before and my body looks uneven,” she explains. “My side started to look more uneven, and my lower stomach had a bulge that wasn’t on the other side. So I thought, let’s go back and see what we can do about this. I was never told that CoolSculpting could cause any of this—it made absolutely no sense.” In the context of how CoolSculpting works was described.”
Sharp went back to the med spa, where she got an additional free CoolSculpting session. She didn’t notice any difference in her body – the lumps remained. It wasn’t until a decade later that Sharp came to believe that the still-noticeable bulges were caused by a little-discussed potential risk of CoolSculpting, known as paradoxical adipose hyperplasia (PAH).
Sharp isn’t the first to talk about PAHs. In fact, the YouTuber says she first linked CoolSculpting, PAH, and lumps left on her stomach thanks to model Linda Evangelista. In 2021, Evangelista reported that she suffered severely from PAH after a CoolSculpting procedure, and was suing Zeltiq Aesthetics, the company behind the procedure (now owned by Allergan).
“Not only has PAH destroyed my livelihood, but it has sent me into a cycle of deep depression, deep sadness, and the deepest depths of self-loathing,” the supermodel said on social media at the time. “In the process I became reclusive.”
Evangelista settled the lawsuit against Zeltiq, CoolSculpting’s parent company, in July 2022 for an undisclosed amount.
What is a polycyclic aromatic hydrocarbon?
PAH indicates an overgrowth of adipose tissue. The official CoolSculpting website lists paradoxical hyperplasia as some additional “rare” side effects of CoolSculpting, along with “tardy pain, freezing burning, vague vascular symptoms, subcutaneous sclerosis, hyperpigmentation and hernia.”
According to manufacturer data, PAH occurs in 1 in 4,000 treatments – however this data may not tell us the whole story. Not everyone who suffers from PAH will report it to their doctors, who can then report it to Zeltiq. For example, Sharp was initially unaware of PAH and the connection to her CoolSculpting procedure.
In 2017, Dr. Jared Jagdeo, a dermatologist who was a consultant for Zeltiq at the time, co-authored a journal article noting that PAHs are a more common risk.
The under-reporting of PAHs may be due to the higher volumes of cryolipolysis treatments occurring in medical spas or body sculpting centers with patients not closely supervised by physicians or well-trained medical professionals who can identify PAHs. rings and inform the manufacturer of PAH cases,” the article reads. “Also, PAHs may be subtle, so detection may be difficult depending on the degree of PAH. We speculate that as the number of lipolysis procedures increases over time and becomes more widely available, the incidence of PAHs may also increase. With increased awareness among medical providers and patients, it may lead to diagnosis and reporting.”
The cause of PAHs occurring after CoolSculpting treatments is not clear, and more research is needed to evaluate whether PAHs are caused by the technique of the procedure, the type of device used, or even a biological reaction in specific patients. A 2020 study says that over 76% of PAH cases studied were related to older models of CoolSculpting units.
New York plastic surgeon Dr. Mark Epstein says he uses CoolSculpting in his practice with good results. He told Yahoo Life that he has yet to see a patient with PAH.
“CoolSculpting isn’t like taking a photo on your iPhone. It’s very dependent on the technician,” he says. “The people at my organization who do CoolSculpting come to a CoolSculpting University and have the highest level of certification performing the procedure, so you can properly screen patients to minimize complications and perform the procedure in the best way to minimize complications.”
He adds that there are also two different CoolSculpting systems: the Legacy system and the newer Elite system. He uses the latter in his practice, adding, “If you’re dealing with older equipment, you’re not going to get the same results.”
However, not every plastic surgeon is sold on CoolSculpting, in part because of the potential of PAHs. New York City plastic surgeon Dr. Chris Funderburk regularly treats patients who have experienced negative results after CoolSculpting and believes there are a lot of unknowns right now.
“We don’t have any good data on this,” he says of why PAHs occur. “We don’t know what settings to use to avoid PAHs. We don’t know which generation of machines to use, or paddles, in order to avoid it. It’s all still a mystery, unfortunately.”
His advice to those looking for CoolSculpting?
“I would say, either don’t do it, or pause and let the dust settle so we can figure out that complication rate,” Funderburk told Yahoo Life. “The literature is going to evolve very dramatically in the next year or two. I wouldn’t rush into CoolSculpting right now until it’s better understood. And then I’d say they should go into it with the understanding that PAHs are probably the most common than previously reported.”
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