Earlier this year, 1990s supermodel Linda Evangelista made international news when she featured as a cover story for US People magazine, about how she had been “brutally disfigured” and “permanently deformed” by a popular non-surgical cosmetic medical fat reduction treatment; that it had turned her into a self-loathing recluse and ended her career.
It is a cautionary tale about a booming industry, for both would-be patients and their practitioners.
Linda, 56, regarded as one of the most influential models of all time and who featured on more than 700 magazine covers, alleged a treatment five years ago on her face, bra area, and thighs left her with paradoxical adipose hyperplasia. Also called PAH, this is an abnormal, intense overgrowth of fat
It is regarded as an extremely rare side effect of the technology, cryolipolysis.
Cryolipolysis uses cold temperature to break down fat cells, which are particularly susceptible to the effects of cold, unlike other types of cells. While the fat cells freeze, the skin and other structures are spared from injury.
After an assessment of the dimensions and shape of the fatty bulge to be treated, an applicator of appropriate size and curvature is chosen. A gel pad is placed to protect the skin. The applicator is applied, and the bulge is vacuumed into the hollow of the applicator. The temperature inside the applicator drops and, as it does so, the area numbs.
Patients sometimes experience discomfort from the vacuum’s pull on their tissue, but this resolves within minutes, once the area is numb.
In a tiny minority of cases – studies suggest 0.33 percent – the freezing process causes the targeted fatty tissue to grow thicker and expand, which is the opposite of what the patient has the procedure for.
The Canadian-born, New York-based former model has filed a $50 million lawsuit against the company which markets a brand harnessing the technology. In response, the company has filed a motion to dismiss her suit, which is pending before the court.
“I used to love being up on the catwalk. Now I dread running into someone I know,” Linda told People magazine.
She explained that she was doing the story and sharing photos because “I can’t live like this anymore, in hiding and shame” (see video).
THE COSMETIC MEDICINE BOOM
Non-surgical cosmetic medical procedures have transformed the aesthetics industry for the consumer over the past 25-30 years, with products and technology becoming ever-more advanced and accessible.
Worst-case scenarios often grab headlines, but these procedures generally have significantly satisfactory results – in the right hands.
Further, with the patient having done their due diligence to find a reputable practitioner, made an effort to explore information about the pros, cons and potential risks – and, notably, whether the procedure is suitable for them.
Dr Michael Molton has practised in the field of cosmetic medicine since 1994, is President at and an inaugural foundation member of the Cosmetic Physicians College of Australasia (CPCA) and is Principal Cosmetic Medical Doctor/Senior Medical Officer at Adelaide’s Epiclinic.
Dr Molton spoke to Thrive:
CHECK THE REGISTER
I think it is important to point out first that medical devices in Australia are required to be listed on what is known as the ARTG, or Australian Register for Therapeutic Goods, which is found on the Therapeutic Goods Australia website www.tga.gov.au/artg.
Without reference to any particular case in the media or elsewhere presently, there are devices that are represented as the genuine ARTG listed item but in fact do not appear on that list.
This is particularly the case for some fat freezing devices. The public is not aware of this and there have been serious injuries caused by the directly imported non-listed devices posing as a TGA-approved device.
The devices are registered as Therapeutic Devices precisely because they carry potential risks just the same as prescription medicines, or operations. Just like prescription medicines and operations, complications can occur even in the hands of trained, and experienced health practitioners.
By choosing a trained and experienced practitioner, you are reducing these risks – not completely eliminating them.
The risk escalates significantly when they are in the wrong hands. That would be like a 15-year-old jumping behind the wheel of a supercar with a friend and hooning off, failing to appreciate the dangers to themselves and others.
In the case of fat freezing, there is a relatively rare complication of fat cell growth, instead of fat cell decline, called paroxysmal (adipose) hyperplasia. According to a consensus of international experts, this is most likely with the devices that have not been upgraded; apparently more prevalent in a small group of Hispanic young men and women and of women of Indian descent.
The most common site of this effect is at the lower abdomen. There are claims of this complication occurring elsewhere on the body.
As someone who has performed or delegated fat freezing devices ever since they were first introduced in Australia, I have yet to see a convincing case of PH. I know other experts have had the same experience.
It’s hard to explain this, but the busiest practices who have kept up with device upgrades seem to not have this problem.
INFORMED CONSENT
Then we come to a topic called “informed consent”: patients are entitled to be provided information about complications that can occur in sufficient advance of time before proceeding. The choice to inform or not inform is not to be made by the practitioner.
In summary, all medical devices – even in the most experienced hands – carry risk, just like cataract surgery, or taking medications.
The patient cannot decide if the risks are acceptable to them if not told. If told, and the patient has been given the opportunity to understand and interpret the risks, they are prepared [or not] to accept. For some, the decision will be unacceptable risk.
For example, recently I was consulting a patient for dermal fillers. When I explained that there is a potential risk of injecting an artery causing permanent loss of vision, even though we use ultrasound to identify vessels, the patient declined the procedure.
Why? When she was born, she had no vision in one eye. She had not provided this information on the patient history sheet because she simply had been living with this all her life.
Until I told her about the potential, rare complication, she had not been provided this “material” risk. In this particular case, even of the risk was one in a million, for the patient the risk of losing sight in her one eye was still too high.
CHOOSING THE RIGHT PRACTITIONER
Thrive put to Dr Molton that in the case of cosmetic injectables – eg. anti-wrinkle injections and dermal fillers – they should only be performed by a practitioner who comes from a medical background (doctor, nurse), and is extensively trained in cosmetic injecting.
It comes down to who has the experience, who will place the patient’s wellbeing before their own, acts as a doctor should by taking a thorough but relevant history and perform a thorough and relevant examination, providing the patient with a treatment plan, including information about potential side effects, recovery and complications.
About who will provide alternative options where these exist, especially if the options are beyond the practitioner’s scope of practice which may benefit the patient more, and make the appropriate referral.
Where do we find doctors like that? Fellows of the Cosmetic Physicians College of Australasia (CPCA) are committed to full time practice covering not only a bit of anti-wrinkle injections, but are experienced across all facets of cosmetic medicine, including therapeutic devices, injectables and cosmeceuticals.
The website link www.cpca.net.au/find-a-doctor provides access to Fellows in all states and territories. Another section of the College covers those who are not Fellows but, as Full Members, have focused interests in one or two of the three areas of cosmetic medicine. The choices can be made accessing the individual profiles on the College website.
Please note: As stated in the above text, this information is not related to any individual case and provides general information only
Sources:
www.cpca.net.au
www.epiclinic.com.au
