I have to get better at this.
While I’m always grateful for paying gigs, I do wish I had more hours to devote to AU. I’m thinking, when time is tight, I need to make an effort to post at least quick, informal musings, just to share ideas and stay connected. Alas, quick and informal are not my strong suits. And, honestly, I often find myself semi-paralyzed by the breadth of topics I could tackle here. So tell me: What are you wanting from this space? Q&As with doctors? More news and related commentary? Honest takes on trending procedures? The comment section awaits!
On the beauty-news front, I can’t not mention The New York Times CoolSculpting exposé: “A Beauty Treatment Promised to Zap Fat. For Some, It Brought Disfigurement.” Did you all see it? (Paywall, I know.) The headline alludes to paradoxical adipose hyperplasia, or PAH, which occurs when the popular fat-freezing procedure backfires, causing fat in the treated areas to grow and harden into sometimes-painful bulges that can be fixed only with surgery (typically liposuction and/or a tummy tuck, depending on where the issue presents). Supermodel Linda Evangelista shined a global spotlight on PAH in 2021 when she confessed to suffering from the controversial CoolSculpting complication.
According to the NYT, the first recorded case of PAH dates back to 2011. Since then, the author states, “the company behind CoolSculpting has retained consultants who have written about low risks of P.A.H. in medical journals and online channels. It has also restricted patients from talking about the problem through confidentiality agreements and, at one point, stopped reporting the side effect to federal regulators after an auditor from the Food and Drug Administration determined that it did not qualify as a life-threatening or serious injury.”
The true incidence of PAH has been the subject of great debate, especially in the wake of the Linda lawsuit, with CoolSculpting supporters commonly citing rates from old company-funded studies and otherwise manipulating the numbers and playing dumb.
In 2014, the makers of CoolSculpting estimated PAH’s prevalence to be 1 in every 20,000 treatments. In the years following, doctors have reported far higher incidences, ranging from 1 in 4,000 treatments to 1 in 100 patients. (1 in 100!) CoolSculpting’s manufacturer now calculates the risk to be about 1 in 3,000 treatments.
The Times did a fantastic job piecing together the truth about who knew what of this risk, and when. I found this snippet to be damningly poignant:
In 2017, Dr. Jared Jagdeo, a dermatologist who was then a consultant for CoolSculpting’s manufacturer, and two co-authors wrote in a journal article that the side effect should be reclassified. Its increasing incidences, they wrote, met the World Health Organization’s criteria for a “common” or “frequent” adverse event, instead of a “rare” one.
Yet, here we are, six years later, and CoolSculpting proponents are still insisting (in interviews with media and on their own social channels) that this problem is exceedingly rare. (Some continue to cite the grossly inaccurate 1 in 20,000 rate.) These providers often deny having ever seen a case of PAH.
There is money to be made, of course. Profits to be protected. Still, these displays should give us pause.
Fortunately, their claims are being countered by a growing group of vocal plastic surgeons and dermatologic surgeons, who are routinely treating people plagued by PAH. Dr. Karan Lal, a dermatologist in Scottsdale, Arizona, tells me he’s currently managing the care of five such patients. San Francisco plastic surgeon Dr. David Sieber repeatedly posts about the CoolSculpting complications he’s correcting — see here, here, and here, for example — while warning his followers about the difficulties involved for both the surgeon (to seamlessly remove the scarred, stubborn fat) and the patient (to recover from the whole ordeal).
Can we please stop pretending that CoolSculpting is a) reliably effective and b) predictably safe? PAH is not rare. It is, in fact, a “common,” maybe even “frequent,” side effect of the fat-freezing treatment — and those who are offering it in practice should be disclosing the reality of this risk.
The other day, I was discussing with an editor what the public should take from the NYT story, particularly those who are interested in body-contouring interventions. Should they continue to chip away at trouble spots with noninvasive devices — ideally ones with cleaner track records? Or should they just get the damn lipo?
I tend to lean (theoretically) toward the latter option, believing it to be more predictable, if — big if here — if you choose the right doctor for the job. My editor, on the other hand, expressed strong reservations about liposuction, based largely on the bad outcomes that some friends endured decades ago.
Such experiences can be scarring, physically and mentally, and it’s easy to see how they’d cast a pall — but they don’t define modern liposuction. While lipo complications, like contour irregularities, can absolutely happen, the surgery has advanced tremendously in recent years, especially since the advent and widespread adoption of the gold-standard technique known as SAFELipo (first described in 2010 by Shreveport, Louisiana plastic surgeon Dr. Simeon Wall Jr.).
Some will argue that negative experiences don’t necessarily capture the modern CoolSculpting treatment either. And that’s fair.
The fact remains: Bad results — whether linked to a human or machine — tend to leave an indelible impression. And bad results coupled with apparent deception — that legacy is even harder to shake.
If you’re considering any sort of fat-reduction procedure, consult with a physician who has experience with multiple body-sculpting modalities (surgical and non) and isn’t financially motivated to push one procedure on every patient. You want a specialist who tailors their approach to your individual anatomy and needs. And remember: The nonsurgical path isn’t inherently safer or smoother.
What did you think of The New York Times report? Did it sway your opinion of CoolSculpting? I’d love to hear from you. xx