Originally published 2021-09-25.
In September 2021 Linda Evangelista, one of the most famous models of the 1990s, explained on Instagram why she had disappeared from public life. She said a cosmetic fat-reduction treatment called CoolSculpting had caused a rare reaction that left her, in her words, “brutally disfigured”. Instead of shrinking, the treated fat had grown and hardened.
The condition is called paradoxical adipose hyperplasia, or PAH. Evangelista said two corrective surgeries had not fixed it and that the experience had pushed her into depression and isolation. Below is what she described, what the procedure involves, how rare the complication is, and how her story developed after that first post.
A post shared by Linda Evangelista (@lindaevangelista)
Who Linda Evangelista is
Evangelista was born on 10 May 1965 in St Catharines, Ontario. She became one of the “Big Six” supermodels of the late 1980s and 1990s, alongside Naomi Campbell, Cindy Crawford, Christy Turlington, Claudia Schiffer and Kate Moss. She was known for constantly changing her hair colour and cut, which made her a favourite of photographers such as Steven Meisel.
She also gave fashion one of its best-known lines. In an interview printed in Vogue in October 1990, she said, “We don’t wake up for less than $10,000 a day.” So when someone with her profile said she had stopped working out of shame, the story reached far beyond the fashion pages.
What she said in September 2021
Evangelista, then 56, told her followers that she had undergone CoolSculpting treatments about five years earlier. Rather than reducing fat, the sessions had caused it to increase in the treated areas. She said she had two painful corrective operations that did not succeed, and that the result was why she had not been working while other models of her generation enjoyed revivals.
She described the toll on her mental health in strong terms, saying the experience had wrecked her income and left her in a cycle of depression and self-loathing, to the point of becoming a recluse. She wrote that she wanted to speak publicly so she could move forward, and indicated that legal action would follow.
Many people, including other models and patients, responded with messages of support. Some said they had experienced the same complication.
How CoolSculpting works
CoolSculpting is the best-known brand of cryolipolysis, often called “fat freezing”. It is a non-surgical treatment that cools a targeted area of skin and the fat beneath it to very low temperatures. Fat cells are more sensitive to cold than surrounding tissue, so some of them are damaged and gradually cleared by the body over the following weeks and months.
Zeltiq Aesthetics introduced the device in the United States in 2010, and Allergan acquired the company in 2017. The US Food and Drug Administration has cleared it for areas including the chin, jawline, upper arms, abdomen, flanks, thighs and under the buttocks.
Reviews of the evidence describe it as modestly effective. A 2015 review of 19 studies found skinfold reductions of roughly 10% to 28%, and a 2023 review measured fat-layer reductions of about 2 to 5 millimetres. It is designed for small, stubborn pockets of fat, not for weight loss.
Paradoxical adipose hyperplasia explained
Most side effects of fat freezing are mild and short-lived: redness, numbness, swelling, bruising and some pain, usually fading within weeks. PAH is different. In a small number of patients, the treated area slowly enlarges instead of shrinking, typically becoming noticeable a few months after treatment. The new tissue tends to be firm and can take the shape of the device applicator.
How often does it happen? Published estimates range from about 0.12% to 1% of patients, depending on the study. That is higher than the rarer figures often cited in the procedure’s early years, which is one reason the topic drew so much attention after Evangelista spoke out. Researchers are still unsure why some people develop PAH and others do not.
PAH does not go away on its own. Treatment usually means surgery, such as liposuction or a tummy tuck, and results vary. Evangelista’s experience of two unsuccessful operations shows it is not always simple to correct.
Anyone thinking about a cosmetic procedure should talk to a doctor, ideally a board-certified specialist, about the full list of risks, including rare ones, and about what happens if something goes wrong.
The lawsuit and settlement
Within days of her post, Evangelista filed a lawsuit in New York seeking $50 million in damages from Zeltiq Aesthetics. The complaint said the company had not adequately warned patients about the risk of PAH and that the condition had left her unable to work.
In a February 2022 interview with People magazine she said, “I can’t live like this anymore, in hiding and shame.” In July 2022 she announced that the case had been settled. She said she was glad to put the matter behind her and looked forward to the next chapter with friends and family. The terms were not disclosed, and Allergan did not comment publicly.
A return to work, and later health news
Soon after the settlement, Evangelista returned to modelling. She appeared in a Fendi campaign in 2022 and promoted the brand’s show in New York that September. Her return was widely covered as a sign that she was reclaiming the public life she had stepped away from.
In 2023 she also revealed that she had been treated for breast cancer, first diagnosed in December 2018, and that it had returned in 2022.
The second Instagram post below is an earlier one from her own account, shared while she was still largely out of public view.
A post shared by Linda Evangelista (@lindaevangelista)
What her story taught many readers
Evangelista’s account changed how many people talk about “non-invasive” cosmetic treatments. Non-surgical does not mean risk-free, and a rare side effect is still a real possibility for the person it happens to. Her decision to speak openly also highlighted the mental health side of appearance-related injuries, which can be as hard to live with as the physical change itself.
If you are weighing up a treatment like this, it helps to ask the provider directly about PAH, how often they have seen it, and what they would do if it occurred. A frank conversation with a doctor before any procedure is the best protection.
Sources: Wikipedia: Linda Evangelista; Wikipedia: Cryolipolysis; Glossy, 21 July 2022: Evangelista settles CoolSculpting lawsuit; Linda Evangelista on Instagram, September 2021; BBC News (original tip)
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