CoolSculpting is a non-invasive body contouring treatment that uses extreme cold to reduce the number of fat cells in an area. But it’s also becoming notorious for a side effect called paradoxical adipose hyperplasia–aka the fat cells get larger and harden instead of going away. PAH presents as hard lumps under your skin–because of the treatment applicator shape they can even look like a stick of butter. This happened to supermodel Linda Evangelista and she sued the manufacturer of CoolSculpting for how badly it disfigured her body. They ended up settling out of court. Now a popular YouTuber, Abbey Sharp, is talking about her own experience with this PAH side effect. I watch Abbey’s videos and find them entertaining–she’s a registered dietitian who adapts what celebrities say they eat into more nutritionally balanced meals. (Needless to say, her Gwyneth Paltrow videos are priceless). Here’s what Abbey had to say about her botched CoolSculpting, plus insights from a plastic surgeon:

Abbey was sold on CoolSculpting because it was non-invasive: Sharp — who battled orthorexia, or an obsession with healthy eating, in the past — says she never felt that she had a flat stomach and was told by the med spa that CoolSculpting could help her achieve one. Because Sharp was already slim, she was told that she was an ideal candidate and that her “trouble” spots could be specifically targeted. “That’s how it was sold to me,” Sharp tells Yahoo Life. “It was like, ‘This is a no brainer. It’s less invasive than Botox.’ That’s the vibe I was getting.”

After Abbey’s treatment sessions, things started going wrong: “There were more almost like lumps or bumps that weren’t there before and my body looked uneven,” she explains. “My side started to look more uneven, my lower belly 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 the way CoolSculpting was described to work.”

More CoolSculpting didn’t fix it: Sharp returned to the med spa, where she was given a free extra CoolSculpting session. She noticed no difference in her body — the lumps remained. It wasn’t until a decade later that Sharp came to believe the still-noticeable bulges were from a little-discussed potential risk of CoolSculpting, known as paradoxical adipose hyperplasia (PAH).

PAH may not be as “rare” as the manufacturer says it is: According to manufacturer data, PAH occurs in 1 in every 4,000 treatments — yet that data may not tell the whole story. Not everyone who experiences PAH will report it to their doctors, who can then report it to Zeltiq. Sharp, for example, was initially unaware of PAH and the connection to her CoolSculpting procedure.
We don’t know what causes PAH: New York City-based plastic surgeon Dr. Chris Funderburk regularly treats patients who have had negative outcomes following CoolSculpting and thinks there are too many unknowns right now. “We just don’t have any good data on this,” he says of the reason why PAH occurs. “We don’t know what settings to use to avoid PAH. We don’t know what generation of machine to use, or paddles, in order to avoid it. It’s all still a mystery, unfortunately.”

[From Yahoo]

In Abbey’s video she talks about looking into surgery to get the lumps removed, but opting out of it because the recovery time would prevent her from being as active as she’d like to be with her two small children. I’m really glad Abbey is talking about this side effect because my suspicion is that it’s more common than 1 in 4,000. I think that the risks of this procedure are not always made clear to patients. Abbey says no one told her about the possibility of PAH as a side effect and a similar thing apparently happened to Linda. That isn’t informed consent, as far as I’m concerned. It’s also wild to me that the medspa just gave her more CoolSculpting when she told them about the lumps–if anything, that would make it worse!

I’m not a surgeon or a doctor but I wouldn’t tell anyone to get this treatment done. The results are modest (a 25% reduction in fat cells is the best case scenario) and not worth the risks. A family member of mine did CoolSculpting and she didn’t get PAH but it also didn’t give her any real results. Abbey’s PAH was minor enough that liposuction probably would have fixed it, but for Linda Evangelista, not even liposuction made it go away. The hard lumps came back. I feel for Linda, and for Abbey. If they had known about the risks of this side effect, they could have at least made an informed decision.

photos are screenshots from YouTube, via Instagram and credit People