Paradoxical Adipose Hyperplasia (PAH) is a condition that is a side effect of male patients who undergo CoolSculpting, a non-surgical procedure that addresses fat deposits using cryolipolysis. When patients undergo CoolSculpting, they seek to decrease the number of fatty deposits (adipose tissue); however, when PAH occurs, these patients experience an unexpected increase rather than a decrease. This PAH condition has been reported to be rare, but when it does happen, it can be troublesome to patients as they experience the opposite effect of what they expected from CoolSculpting. Although this is challenging, Dr. Steinbrech specializes in Paradoxical Adipose Hyperplasia (PAH) treatment in men.
What is Paradoxical Adipose Hyperplasia (PAH)?
Paradoxical Adipose Hyperplasia has only been reported to occur after undergoing CoolSculpting, and not with other fat-loss procedures. This is a breakdown of the medical term:
Paradoxical: The tissues treated with CoolSculpting react to it by growing rather than decreasing—an unexpected, paradoxical effect.
Adipose refers to fatty tissues that contain adipose cells, which are more predominant under the skin, especially in areas like the abdomen, flanks (“love handles”), back, and thighs.
Hyperplasia is a term for the growth of cells in tissues, which is typically stimulated by something.
The reason why CoolSculpting can lead to PAH in some patients is still not apparent to many experts. There have been research studies done that have been able to describe what patients and doctors should look for and also identify which patients may be at greater risk of experiencing PAH. It has been shown to occur within six months post-procedure, and unwanted changes are seen in the area where the CoolSculpting device was applied. These tissues affected by PAH typically appear more swollen and sometimes very firm to the touch.
How Common is PAH?
PAH is considered to be rare, with a reported incidence of 0.005%. Most recent studies have found that it occurs 1 in every 500 to 5000 CoolSculpting treatments.
Who is at Risk of Developing PAH After CoolSculpting?
Research has also identified patient characteristics that have been associated with a greater likelihood of developing PAH. These known risk factors include using a large applicator, male sex, Hispanic background, and abdominal location of treatment. Age is not a factor in the development of PAH.
How Is PAH Treated?
The treatment for PAH involves liposuction once the affected area has softened, which usually occurs a few months after the initial CoolSculpting procedure. Depending on the case, managing PAH with liposuction may require more than one treatment and other more advanced surgical procedures, such as a tummy tuck.
Recovery Time
After undergoing PAH treatment with liposuction and/or other surgeries, the approximate recovery time is 4-6 weeks, and results are typically appreciated around 6 weeks after surgery. During recovery, it is recommended to avoid strenuous physical activity, and an abdominal binder is mandatory until healing has been completed.
How to Determine if You Have Paradoxical Adipose Hyperplasia
The leading indicator that PAH has developed is when the patient notices greater fullness in the area where CoolSculpting was done, which is even more significant than the amount present before undergoing CoolSculpting. It does not improve 4 to 6 weeks after the procedure. One definite indicator that the patient has PAH is when this affected area is limited to the area of skin in which the CoolSculpting applicator was placed. During a scheduled consultation, Dr. Steinbrech can review whether you have developed PAH and make a treatment plan.
Book Your Consultation
Book your consult with us in New York, Chicago, or Los Angeles today. For more information about treating Paradoxical Adipose Hyperplasia, don’t hesitate to contact our office. Prospective patients may set up a consultation or speak with one of our patient advisors. Based on the findings from your visit with Dr. Steinbrech, you can review the treatment options for PAH.
REFERENCES:
Kelly ME, Rodríguez-Feliz J, Torres C, Kelly E. Treatment of paradoxical adipose hyperplasia following cryolipolysis: a single-center experience. Plast Reconstr Surg. 2018 Jul;142(1):17e-22e.
Keaney TC, Naga LI. Men at risk for paradoxical adipose hyperplasia after cryolipolysis. J Cosmet Dermatol. 2016 Dec;15(4):575-577.
Singh SM, Geddes ER, Boutrous SG, Galiano RD, Friedman PM. Paradoxical adipose hyperplasia secondary to cryolipolysis: an underreported entity? Lasers Surg Med. 2015 Aug;47(6):476-
Douglas S. Steinbrech, M.D., F.A.C.S. is a plastic and reconstructive surgeon that specializes in male aesthetics. Dr. Steinbrech is certified by the American Society of Plastic and Reconstructive Surgeons and a diplomate of the American Board of Plastic Surgery. Learn More
Douglas S. Steinbrech, M.D., F.A.C.S. is a plastic and reconstructive surgeon that specializes in male aesthetics. Dr. Steinbrech is certified by the American Society of Plastic and Reconstructive Surgeons and a diplomate of the American Board of Plastic Surgery. 
