Coolsculpting is an incredibly popular noninvasive body contouring technology that can help reduce stubborn fat by 20 to 25% without the need for going under the knife. However, with this treatment type comes with a small risk of paradoxical adipose hyperplasia (PAH) that has occurred in less than 1% of the folks who have this treatment performed. But what is PAH and how do you know if you are experiencing it?

How Does CoolSculpting Work?

CoolSculpting destroys fat cells by a process known as cryolipolysis that uses controlled cold temperatures to trigger programmed cell death (a process known as apoptosis). Once the fat cells are destroyed, the body naturally flushes them out through the liver and the body’s lymphatic system.

What Is Paradoxical Adipose Hyperplasia And What Are The Symptoms?

Instead of causing fat cells to shrink, PAH causes fat cells to expand and grow in the areas treated by CoolSculpting. These expanded fat cells tend to be firmer than the surrounding fat. The areas where PAH occurs often takes on the shape of the CoolSculpting or cryolipolysis applicator and typically occur three to six months after the treatment itself, although it can vary greatly depending on the individual. How often PAH occurs in individuals is somewhat up for debate. Literature states the incidence rate at approximately 0.05% to 0.39% in some studies and as high as 0.72% or at a rate of one in 138 treatments in another study. While PAH is not common, it can greatly affect the quality of life for those who suffer from it as a result of cryolipolysis.

Symptoms of PAH can include the skin in the treatment area/s feeling thicker or firmer, a mass or swelling may be felt under the skin and if often slightly painful to the touch, it may increase in size and severity, and the treatment area may develop hard lumps to the unequal fat distribution under the skin.

What Causes PAH And How Long Does it Take To Present?

The exact cause of PAH isn’t known. However, one theory suggests that certain fat cells can withstand cold temperatures better than others—for whatever reason. These fat cells are essentially selected for and survive cryolipolysis. It is theorized that signaling molecules called hypoxia-inducible factors (HIFs) initiate a cascade in the body that causes the blood vessels to grow and ultimately the enlargement of existing fat cells and the creation of new ones.

How Is PAH Treated?

Unfortunately, PAH does not go away on its own. Most people affected by this rare side effect require corrective surgeries like excision or corrective liposuction. This is unfortunate and flies in the face of the original motivation since most people seeking cryolipolysis are looking for non-invasive treatment options to contour the body and rid themselves of unwanted fat. In some cases, repeated surgeries may be required to address the condition. Typically, any corrective surgery would have to be scheduled a few months after the CoolSculpting treatment to allow for the affected treatment area to soften.

Take Away

While the chance of getting PAH is very low, you can only make informed decisions if you know all the facts. For most people, having a cryolipolysis treatment like CoolSculpting doesn’t result in PAH, and are very happy with the results, which is why this non-surgical body contouring treatment is considered to be a safe option.