4 Cosmetic Procedures That Can Go Wrong and What To Do About Them

2. CoolSculpting

This popular alternative to liposuction uses freezing temperatures to destroy fat cells and recontour such areas as the belly, thighs and waist. CoolSculpting made headlines in 2021 when supermodel Linda Evangelista claimed the procedure had created hardened lumps of fat that left her “permanently deformed.” Last July, Evangelista announced on Instagram that she had settled a lawsuit with CoolSculpting. This side effect, called paradoxical adipose hyperplasia (PAH), happens when fat builds up at the treatment site after the procedure. PAH is very rare, affecting fewer than 1 percent of people who have CoolSculpting. Allergan cites a PAH rate of 1 out of 3,000 treatments, or 0.033 percent, on the company website. Rokhsar has seen it less than a handful of times in his practice. Yet it can be devastating when it does happen. 

Fortunately, PAH is treatable by a doctor, either by injecting the drug Kybella into the area to destroy the unwanted fat cells or by performing liposuction to suck them out. PAH is unlikely to happen to you. It’s more likely the procedure won’t produce the look you were seeking, Rokhsar adds. “If people are looking for dramatic results, they’re going to be disappointed with CoolSculpting. It’s very subtle contour improvement.”

3. Fillers

The most serious risk with fillers is intravascular injection. “We have arteries that supply blood to our organ systems, including our skin,” Rokhsar says. “If you inadvertently inject into an artery, you’re going to block the blood supply in that area.”

Starved of its blood supply, the area of tissue dies, which doctors call necrosis. The skin can peel off, possibly leaving you permanently disfigured. A blockage in the blood supply to the eye can cause blindness.

Although this rare complication can happen with any doctor, an experienced provider will know how to recognize the symptoms and treat them quickly, Rokhsar says. The doctor will stop the injection, try to remove the filler and improve blood flow to the affected area of skin. Hyaluronic acid fillers are reversible with injections of the enzyme hyaluronidase.

Over-plumped lips and cheeks are a less serious but aesthetically unpleasant side effect of fillers. “A lot of injectors don’t understand facial anatomy and they don’t understand how the face ages,” says Theda Kontis, M.D., facial plastic surgeon at the Aesthetic Center at Woodholme in Baltimore and president of the American Academy of Facial Plastic and Reconstructive Surgery. “If you put bulges where bulges don’t belong, it looks odd.”

Some fillers fade on their own in a few months. Others take years to disappear, underscoring the need to find a doctor who understands the contours of your face and the results you’re seeking.

Top photo: The lumps under this patient’s eyes are from misplaced filler. Bottom photo: Rokhsar corrected the problem by dissolving the filler, moving it into the right places, and then tightening the woman's skin using a laser.

Courtesy Dr. Roshkar

4. Laser skin resurfacing

This procedure uses intense beams of light to remove damaged layers of skin, reducing the appearance of fine lines and wrinkles, acne scars and age spots in the process. The biggest risks with laser skin resurfacing are burns, scarring and infection.

Some lasers, like the carbon dioxide (CO2) laser, require an especially skilled hand. “CO2 laser resurfacing can give very dramatic results for patients in terms of wrinkles and skin tightening, but you have to have somebody who is very experienced,” Rokhsar says.

If you do end up with a scar, another type of laser treatment or cortisone injections can help improve its appearance. Still, it’s better to avoid scars in the first place by seeing a doctor who knows what they’re doing, Kontis says.

These procedures, though minimally invasive, are still medical. Having them done by an aesthetician or another provider who doesn’t have the right training and expertise can be risky.

“Unfortunately, there are a lot of doctors who dabble in this field,” says Rokhsar. “These people take a weekend course, often taught by a dermatologist or plastic surgeon, and then they open a website and call themselves experts in aesthetic medicine.”

His advice if you want good results? “Always look for a board-certified dermatologist or plastic surgeon to do your procedures.”

Ask how many procedures the doctor has performed. Look at before-and-after photos of the procedure you’re planning to have (and make sure they’re from your doctor, not the device manufacturer). Talk to other patients.

Finally, be wary of pushy providers. “An ethical doctor is not going to be pushy,” says Rokhsar. “They’re going to tell you the risks, benefits, if you’re truly a good candidate, and what the alternatives are. You shouldn’t be forced to sign up right away.”