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Complications of CoolSculpting: Paradoxical Adipose Hyperplasia

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What is Paradoxical Adipose Hyperplasia?

A very rare complication of non-invasive fat reduction procedures like cryolipolysis or CoolSculpting, Paradoxical Adipose Hyperplasia (PAH) causes the opposite of the intended result. Rather than a reduction of fat cells, there is an unexpected increase in both their size and quantity, resulting in the enlargement of the treated area. PAH can manifest weeks or potentially months after the initial cryolipolysis treatment sessions.

Is Paradoxical Adipose Hyperplasia painful?

For many patients, this condition is not painful. For others, tenderness, sensitivity, or discomfort may occur. This could be when the area is touched or when there is no contact. The affected area could also feel lumpy or firmer than surrounding, untreated areas. While this condition is obviously frustrating, aesthetically unwanted, and sometimes uncomfortable, it is not dangerous, and it is not harmful to your health overall.

Post-CoolSculpting Paradoxical Adipose Hyperplasia

PAH is essentially unexpected tissue growth stimulation. Instead of fat cells dying and being naturally removed by the body, the procedure causes the fat cells to multiply, enlarge, or both. Although the exact cause of PAH is unknown, it is widely believed to be associated with inflammatory irregularities or a genetic predisposition.

Is Paradoxical Adipose Hyperplasia common?

This condition is very rare, but the exact rate of occurrence is difficult to determine. According to clinical data information from the CoolSculpting manufacturer, it is estimated that PAH occurs in just 0.025 percent of treatment cycles given or 1 in 4,000. Another dermatology study performed in 2014 put the number at 1 in 20,000 patients. In short, while it’s always good to be aware of possible side effects, it’s not something cryolipolysis patients should be overly concerned about. The good part is that it is entirely treatable if it should happen.

How is Paradoxical Adipose Hyperplasia treated?

PAH can be treated by removing the fat cells that are in the enlarged area. Removal is typically done using either liposuction, tummy tuck, or both. Which method or combination is used depends on how extensive the PAH is and where the problem area is located. PAH will not go away on its own without treatment, so if it’s something you would like to address, it’s good to have as much information as possible about the options for correction. A skilled and experienced plastic surgeon will be able to effectively eliminate the issue and restore the problem area to your aesthetic goal.


For many patients, a minimally invasive liposuction is all that’s necessary to correct PAH. As long as there is good skin elasticity and no excess skin needs to be removed, liposuction should be a suitable option. However, addressing PAH is a different technique than traditional liposuction. Although the incisions and instruments are very similar, the surgical technique involves breaking up the dense, fibrous connections, present in the scar tissue as opposed to simply trying to remove the fat. Attempting to use traditional liposuction techniques will very well result in an inadequate correction. This is where experience counts. Since this is less invasive than surgery, recovery is shorter, and healing typically happens faster.

Tummy Tuck

If the PAH is more severe and in your abdominal area, a full tummy tuck or abdominoplasty may be necessary. In nearly every tummy tuck, liposuction is used in combination with surgical removal of excess skin and tissue. Typically liposuction is performed first in the abdominal area via small incisions, and then the stomach is tightened and excess skin removed via a separate larger incision. Abdominoplasty is a more extensive surgery, so recovery is longer and usually more challenging.

Benefits of Paradoxical Adipose Hyperplasia Correction

Those who are struggling with PAH know that it is a frustrating and uncomfortable experience. Hoping to lose some unwanted fat and then ending up with the opposite can drain confidence and cause lots of stress. With PAH correction treatment, you can ease your mind and end the stress of this unwanted cryolipolysis side effect. Liposuction or a tummy tuck can address and eliminate excess fat due to PAH and give you the improved appearance that was your original aesthetic goal.

Will Paradoxical Adipose Hyperplasia Correction cause scarring?

There will be some unavoidable scarring in order to correct paradoxical adipose hyperplasia. The extent of scarring will depend on which method is used. With liposuction, there will only be very small incision scars that usually fade and blend in to be nearly unnoticeable. In the case of a tummy tuck, a significant incision does need to be made, however, with a skilled surgeon and proper healing, this scar will be hidden very low on the abdomen and will eventually become lighter and less obvious.

It’s Time To Make It Right

Unexpected side effects can be discouraging but consulting with an experienced plastic surgeon like one of our team at The Aesthetic Center can turn your situation around. We have the knowledge, skill, and commitment to patient care that you need to guide you through your PAH correction journey.

If you are considering plastic surgery in Fairfield County or anywhere in Connecticut, contact us to schedule a one-on-one consultation with one of our expert plastic surgeons.

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