I see quite a few people every year who have failed Cool Sculpting and arrive in my office with complaints about contour irregularities, asymmetry, as well as insufficient shaping and slimming. Although these issues are significant, they are not nearly as problematic as the increasing numbers of people I now treat with Paradoxical Adipose Hyperplasia (PAH).
Never heard of PAH? Let me tell you about a lady I met last week. This woman had visited a Cool Sculpting clinic and had one round of Cool Sculpting to her abdomen and hips. The treatment was about 6 months ago. Although she had undergone tumescent liposuction about 15 years ago to these areas, she had developed a layer of fat again. Although she thought the Cool Sculpting made a subtle difference to her appearance, three months ago she noticed that her slacks were feeling snug and it became obvious to her that her belly was getting bigger and bulging.
And then, over the following few months she developed an obvious football shaped bulge that spread across the center of her belly and along her hips. It was dense, firm and mildly uncomfortable. The mass was well defined and mobile. A phone call to her technician alerted her to the risk of PAH and she came into see me for evaluation and care. I have her scheduled in six weeks for tumescent liposuction to correct the problem.
So, here’s the deal: Paradoxical hyperplasia of fat cells is an overproduction and overgrowth of fat cells. At this time the cause of PAH remains unknown but it’s hypothesized that the injury to fat cells during cryolipolysis triggers any of a number of reactions in the fat tissue, some of which may include: enlargement of existing fat cells, recruitment of stem cells to repair and regenerate fat cells or hypoxia to fat cells which causes fat to hypertrophy.
At this time, there is no evidence of spontaneous resolution of PAH. When necessary, treatment has included liposuction or tummy tuck. This patient will have liposuction and will be at some risk for contour irregularities due to the density of the tissue. Others I have treated have done quite well. The good news is that the manufacturer of Cool Sculpt (Allergan) is reviewing these cases and will sometimes provide reimbursement for the revision liposuction.
The better (and wiser…) news is that if you’re considering body contouring, stick with tumescent liposuction! It remains the gold standard by which all non-invasive technologies are measured and nothing else has met the expectations and results that it delivers. “Do it once and do it right” is my motto!
