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Coolsculpting Made Me Bigger: What is Paradoxical Adipose Hyperplasia?

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Since the FDA’s clearance of CoolSculpting, a non-invasive form of cryolipolysis, to get rid of unwanted fat, some patients have experienced a condition known as paradoxical adipose hyperplasia, or PAH. Find out what PAH is, why it occurs, how to prevent it, and what to do about it.

What is Paradoxical Adipose Hyperplasia (PAH)?

Paradoxical adipose hyperplasia is a rare, previously unreported adverse effect of cryolipolysis. Cryolipolysis uses cooling to damage and destroy subcutaneous fat cells, without damaging the skin to reduce the amount of fat in the treated area. This phenomenon of PAH has a reported rate of incidence of 0.0051% of the 1.5 million CoolSculpting procedures performed worldwide. Many physicians see numerous cases in their offices.

PAH causes a gradual enlargement of the treated area. It occurs when the stimulus (the freezing of fat cells) activates a reactionary process in the fatty tissue that thickens and expands the fat cells rather than breaking them down and allowing the body to process and remove them. PAH is only known to occur following a cryolipolysis, or CoolSculpting body contouring treatment. PAH typically cannot be confirmed until about 6 months post-procedure, with patients complaining that they are getting bigger in the exact shape of the applicator, as depicted below. 

coolsculp sculpsureFigure 1: Left: Photo of Man’s Treatment Area Affected by PAH (courtesy of the JAMA Network)

Benefits of SculpSure

SculpSure is the first FDA approved non-invasive, warm laser treatment for fat reduction, utilizing a 1060 nm wavelength diode laser. It is safe for all skin types and ideal for areas of stubborn fat on the abdomen, flanks, bra line, and thighs. The hyperthermic nature of SculpSure uses heat to destroy fat cells, leaving you with up to 25% less fat after treatment. The contact cooling system keeps the surface of the skin cool while the heat treats the fat and surrounding tissue.

Like most non-invasive treatments, most patients require two treatments of SculpSure to achieve desired results. Each treatment takes 25 minutes, and patients experience absolutely zero downtime afterward. Non-invasive treatments like SculpSure or CoolSculpting do not provide immediate results because it relies on the body to process and filter out the damaged fat cells, which can take several weeks. It typically takes about 12 weeks to see full results.

…vs. Cryolipolysis

Unlike cryolipolysis, SculpSure leaves patients with only slight tenderness rather than the intense pain patients can experience as a result of cryolipolysis. Patients have not experienced PAH as a result of SculpSure. Patients seeking a non-invasive fat reduction treatment should consider all of the pros and cons of each procedure and read patient reviews.

What Can I Do if I Have Been Affected by PAH?

Those who have developed PAH can have it corrected. Smartlipo is a great option to correct the effects of PAH. Smartlipo is a laser-assisted liposuction procedure, known as laser lipolysis. It is performed under local anesthesia using a laser to melt the fat while simultaneously tightening the skin. Once the fat is melted, suction is applied to manually remove the fat from the area.

If you suspect you have PAH, WIFH recommends you return to your surgeon to be evaluated. If it is confirmed, they may be able to make contact with the manufacturer on your behalf for resolution.