DARREN M. SMITH MD FACS
(212) 633-0627
111 East 57th Street, New York, NY 10021
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PAH Coolsculpting NYC

Eliminate Stubborn Fat Deposits with Expert Care

CoolSculpting provides a revolutionary way to get rid of stubborn fat without surgery. However, in rare cases, this treatment can cause Paradoxical Adipose Hyperplasia (PAH)—the opposite of the desired effect. Instead of shrinking the fat, PAH causes it to grow.
Dr. Darren M. Smith is a skilled New York plastic surgeon with extensive experience diagnosing and treating PAH. You can finally achieve your body goals with his expert care and customized treatment plans.
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4.9 from 150+ reviews
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PAH

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True or False: The fat that grows in PAH is more firm than regular fat.

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True or False: In PAH, fat growth occurs only where CoolSculpting applicators were placed.

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True or False: PAH can happen after any body contouring treatment.

4 / 5

True or False: PAH happens right after a CoolSculpting treatment.

5 / 5

True or False: PAH is easy to treat with liposuction.

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Real patients with PAH treated by Dr. Darren Smith. (PAH Before & After Photos)

gal-1Before and 5 days after liposuction to correct paradoxical adipose hyperplasia of waist
gal-2Paradoxical Adipose Hyperplasia Before & After Photo
gal-3Paradoxical Adipose Hyperplasia Before & After Photo
gal-4This patient is shown before and just 1 month after PAH correction with VASER liposuction and BodyTite RF skin tightening. This is just the very early outcome. Full results are generally visible at about 6 months.
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“Dr. Smith and his team are absolutely amazing! I had a breast lift ten days ago, and they exceeded every single expectation throughout the entire process. I was really scared at first, but everyone was super knowledgeable, confident, and caring, and they were there to support me at all times. I would recommend Dr. Smith a billion times. I feel great already!”
— LM
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Dr. Smith tapped as expert to discuss PAH and its treatment by CNN.

What Is CoolSculpting?

CoolSculpting is a leading name when it comes to noninvasive body contouring techniques. By strategically placing applicators on specific areas of the body, it has been known to decrease fatty bulges by an average of 22 to 23%, all without the need for surgical intervention.

Comparing To Other Non-Surgical Methods

While CoolSculpting has long been a preferred method for fat reduction, newer treatments, like Emsculpt Neo, have entered the scene. Emsculpt Neo offers a dual benefit: it can reduce fat by an average of 30% while increasing muscle mass by around 25%. For those interested in exploring more about Emsculpt Neo, a detailed overview can be found here.

The CoolSculpting Procedure

To get a grasp of how CoolSculpting operates, one should understand the procedure’s mechanics:
  1. The target tissue area is suctioned into the device’s applicator.
  2. This applicator then exposes the tissue to cold temperatures, hitting a critical point that is lethal to fat cells.
  3. This cold environment induces programmed cell death, known scientifically as apoptosis.
  4. Post-procedure, the body naturally takes over, working to eliminate the now-deceased fat cells.
CoolSculpting lies in its ability to work with the body’s inherent processes. After apoptosis is induced, the body recognizes these dead fat cells and naturally flushes them out, ensuring a safer and more organic approach to fat reduction.

What Exactly is Paradoxical Adipose Hyperplasia?

Paradoxical adipose hyperplasia (PAH) is a rare phenomenon where fatty tissue grows larger rather than shrinking after cryolipolysis treatments. The enlarged fat cells form noticeable bulges that resemble the shape of the cryolipolysis applicator. PAH lumps tend to feel firmer than the surrounding tissue.

Causes of Paradoxical Adipose Hyperplasia (PAH)

The precise origin of PAH remains a mystery in the medical community. However, researchers and experts have proposed a few compelling theories worth exploring.

Survival of Fat Cells

Some fat cells, due to innate qualities, may have a higher resistance to cold temperatures.
As a result, these robust cells are more likely to survive the cooling process applied during CoolSculpting and cryolipolysis treatments. It is surmised that specific signaling molecules, referred to as hypoxia-inducible factors (HIFs), play a crucial role.
These HIFs are believed to stimulate a sequence of events in the body, promoting blood vessel growth, enlargement of resilient fat cells, and even the growth of new fat cells, leading to PAH.

BRAVA Device

Then there’s the theory stemming from the BRAVA medical device. This specialized bra is worn to treat the breasts with suction, commonly termed as “negative pressure therapy,” as a preparatory measure for breast augmentation through fat grafting.
The suctioning effect amplifies the blood supply and boosts the action of certain growth factors in the target area, enhancing the acceptance of transferred fat in breast augmentation.
There’s a possibility that a similar principle applies to cryolipolysis or CoolSculpting, where the suction might promote the growth and survival of specific fat cells, contributing to PAH.

Curious about the ins and outs of fat grafting or transfers? Follow this trail for more details. 

Signs and Symptoms of PAH

After undergoing cryolipolysis, one might expect reductions in fat. However, the hallmark of PAH is the opposite. Key indicators include:
  • Distinctive Bulges: These tend to mirror the shape of the cryolipolysis applicator, often taking on a “stick of butter” appearance.
  • Unusual Firmness: Lumps affected by PAH have a palpable firmness that contrasts with the soft feel of typical fat.
  • Delayed Manifestation: One puzzling characteristic of PAH is its onset, which typically occurs between 3-9 months after treatment.
  • Enhanced Tissue Size: Contrary to the goal of reduction, the treated area may enlarge.

Why Does PAH Develop Months Later?

It’s perplexing why PAH chooses to make its appearance several months post-treatment. One hypothesis involves signaling molecules called HIFs. HIFs may initiate processes that enlarge surviving fat cells months down the line.

Which Areas Are Most Susceptible?

PAH occurs most often in the abdomen. However, any body area exposed to cryolipolysis could develop PAH. The chin is the sole facial area that is FDA-approved for CoolSculpting.
Some medical practices venture beyond standard guidelines, termed as “off-label” use. If CoolSculpting or cryolipolysis is administered off-label to other facial regions, there’s a theoretical possibility for PAH to develop in those areas too.
If you detect any of the above alterations post-cryolipolysis, reach out to a seasoned professional, such as Dr. Smith. Accurately diagnosing PAH paves the way for effective intervention.
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Real Patient Testimonials

“I Should Never Consider Another Plastic Surgeon!”

My experience with Dr. Darren Smith and his staff made it obvious that I should never consider another plastic surgeon! I had several consultations with other cosmetic surgeons for a breast lift procedure before making the indisputable choice to go with Dr. Darren Smith.

— S.K. / New York

Dr. Smith and his staff are absolutely incredible.

Dr. Smith and his staff are absolutely incredible. They made me feel welcome, comfortable, and listened to from the moment I first arrived for a consultation, all the way to my surgery and afterwards. The care I received from Dr. Smith, Annalise, and Julia was exemplary. I am thrilled with the results of my procedure, and sincerely can’t recommend them highly enough.

— E K

Wonderfully helpful, professional, and caring

Dr. Smith and his entire staff are wonderfully helpful, professional, and caring. From scheduling the appointments and covering billing with his admin (Fotini), to pre- and post-op follow-ups from his head nurse (Casey), to the procedure with Dr. Smith himself, I cannot think of a single thing that could have been done differently to improve my experience here. You can really tell that everyone is invested in making your experience the best it can possibly be. I would highly recommend Dr. Smith to anyone in the area.

— N P
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How Is PAH Treated?

Paradoxical Adipose Hyperplasia (PAH) can be a daunting challenge post-CoolSculpting. However, there’s hope, especially with seasoned professionals like Dr. Darren Smith on your side. Armed with vast experience in treating PAH stemming from CoolSculpting procedures, Dr. Smith stands out in the field.
While CoolSculpting has its merits, Dr. Smith opts for other innovative noninvasive body contouring alternatives, notably Emsculpt Neo, which aligns with his philosophy of ensuring optimal results.

The Limits of Non-Invasive Treatments

The appeal of non-invasive methods for treating PAH is clear, yet their results can sometimes fall short of expectations. Take CoolSculpting or Cryolipolysis, for instance, while they might require additional sessions for optimal outcomes, the end results can vary.
Kybella injections offer another avenue, but the jury’s still out on their effectiveness against PAH. Similarly, while devices like SculpSure are touted for their fat-reducing capabilities, their efficiency in tackling PAH hasn’t been consistently impressive.

Liposuction

Liposuction, in many instances, provides a robust solution to PAH challenges. Its ability to directly target and remove the fat deposits makes it an effective treatment choice. However, PAH can present fat that’s more fibrous or rigid than what’s typically encountered, which can sometimes push the boundaries of traditional liposuction.

VASER

For those particularly stubborn PAH fat deposits, the VASER technology offers an advanced solution. By utilizing ultrasound energy, VASER assists in breaking down and liquefying these tenacious fats, thus facilitating their removal with greater ease.

BodyTite

After the fat is dealt with, the overlying skin might need some attention. Here, BodyTite takes the stage. Employing targeted radiofrequency, it works wonders in tightening and refining the skin, ensuring a smoother, more appealing contour.

Abdominoplasty

In scenarios where there’s significant excess skin post-PAH treatment, an abdominoplasty, commonly known as a “tummy tuck”, could be the answer. This surgical procedure combines the fat removal prowess of liposuction with the trimming of excess skin to produce an aesthetically pleasing result.

4 Stages of Paradoxical Adipose Hyperplasia Treatment

Dr. Darren Smith’s extensive experience in addressing Paradoxical Adipose Hyperplasia (PAH) has led to the creation of a reliable four-step strategy to tackle this challenging issue.

Step 1: Numbing the Treatment Area for Comfort

Standard liposuction begins with the introduction of a tumescent solution to numb the area and minimize side effects like bleeding or bruising. However, when treating PAH, more of this solution is used due to the need for a more assertive approach in extracting the tougher, fibrous PAH fat.

While smaller standard liposuction areas might be managed under IV sedation or even while awake, PAH procedures are best performed under general anesthesia. This not only enhances the patient’s comfort but also allows Dr. Smith the freedom to be thoroughly exhaustive in fat removal.

Step 2: Melting PAH Fat

PAH fat is notably denser and more fibrous than ordinary fat. Simply using a cannula – think of it as a straw attached to a suction mechanism – similar to standard liposuction techniques won’t suffice. An analogy would be trying to sip ice cream through a straw – not very effective.

To address this, the PAH fat is pre-treated with VASER ultrasound energy. Once “melted” or softened, the task of suctioning this fat becomes more akin to drinking a milkshake, proving much more efficient.

Step 3: The Extraction Phase

Post the VASER treatment, the procedure aligns with conventional liposuction. The softened PAH fat is suctioned out from the treated area using the cannula, leaving behind a smoother contour.

Step 4: The Finishing Touches

In instances where the PAH fat has led to significant skin stretching, additional steps might be needed. One option is employing bipolar radiofrequency energy through BodyTite to tighten any loose skin.

BodyTite’s precise heat control offers a safer profile, especially when compared to other methods like unipolar radiofrequency energy (Renuvion Jplasma), which is now less favored due to associated complications.

For pronounced skin looseness, an abdominoplasty, commonly known as a tummy tuck, might be the best course of action.

The Costs of PAH Treatments in NYC

If you’re thinking about PAH treatment in New York City, you’ll want to be aware of the associated costs. Below is an overview of expenses for various PAH treatments.
Procedure Purpose Low ($) Average ($) High ($)
VASER Melt PAH fat before removal 2000 2500 3000
PAH Liposuction Liposuction 6000 8000 10000
BODYTITE Tighten loose skin (if needed) 2000 3000 5000

Note: Prices fluctuate based on several factors, including the facility’s reputation, the surgeon’s expertise, and the geographical area. 

PAH Surgery Recovery Tips and Timeline

The recovery from Paradoxical Adipose Hyperplasia (PAH) surgery is dependent on the individual and the extent of the condition.
The main treatment options for PAH are liposuction or, in more severe cases, abdominoplasty (tummy tuck). The recovery timeline and tips will be based on these procedures:

Liposuction: Post-Procedure Expectations

Time Frame What’s Expected Guidance
Initial 48 Hours Soreness, swelling, and potential bruising. Prioritize rest and avoid strenuous tasks.
Days 3 to 14 A downward trend in pain; swelling begins to diminish. Resume light duties gradually. Hold off on rigorous workouts.
Weeks 2 to 4 Most discomfort diminishes. Preliminary liposuction results become visible. Follow surgeon’s advice before resuming regular activities.
Months 1 to 3 Residual swelling fades, revealing the surgery’s final results. Stay committed to a healthy lifestyle to preserve and enhance the results.

Abdominoplasty (Tummy Tuck)

Time Frame What’s Expected Guidance
Initial 48 Hours Anticipate pain and swelling. Rest is essential. Refrain from engaging in strenuous activities.
Days 3 to 14 Suitability for non-laborious tasks, approached with care. Avoid heavy lifting and intensive exercises.
Weeks 2 to 6 Swelling recedes progressively. Wear compression garments as directed by the surgeon for swelling management and abdominal support.
Months 3 to 6 The full effects of the abdominoplasty are evident. Ensure adherence to post-operative guidelines to maintain and showcase your new physique.

Recovery Essentials: Tips to Enhance Healing

  • Post-Op Guidelines: Strictly follow your surgeon’s instructions. They’re designed for swift, safe recovery.
  • Rest and Hydration: Prioritize sleep. Drink ample water for cellular rejuvenation.
  • Light Movement: Take brief, leisurely walks. It aids in quicker recovery through improved blood flow.
  • Wound Care: Keep surgical sites clean. Avoid abrasive products that may irritate.
  • Lifting Constraints: For six weeks, refrain from lifting anything over 15 pounds to prevent strain.
  • Sleep Position: Sleep on your back. Consider slightly elevating your head for added comfort.
Uncommon but possible, complications may manifest as severe unrelenting pain, unexpected warmth, or marked redness around incisions.
Any sudden swelling, unexpected discharge, or fever crossing 100°F warrants immediate attention. If anything feels off, Dr. Smith is just a call away, ready to guide.

Am I a good candidate for PAH treatment?

Those exhibiting noticeable fat deposits or adipose hyperplasia that remains unresponsive to non-surgical treatment options might be suitable candidates. They should be in overall good health without conditions that impair healing.
Candidates need to be near their goal weight with realistic expectations. A thorough consultation with Dr. Smith will provide clarity on your suitability for the procedure.

New York’s Leading Expertise in PAH Solutions

CoolSculpting left you unsatisfied? Breathe easy.
With Dr. Darren M. Smith’s specialized focus on PAH remedies, turning things around is genuinely possible. It’s not just about correcting an oversight, but about restoring your confidence and comfort in your body.

Booking Made Simple: Whether you’re tech-savvy or traditional, reach out the way you prefer. Book online or give us a ring at + 1 (212) 633-0627.

Frequently Asked Questions About Paradoxical Adipose Hyperplasia Treatment

Considering Paradoxical Adipose Hyperplasia (PAH) surgery? Here are answers to some commonly asked questions.
What results can I expect after PAH surgery?
How long is the PAH surgery recovery period?
What are the risks or complications of PAH surgery?
Will liposuction for PAH leave scars?
Does insurance cover PAH treatment?

What results can I expect after PAH surgery?

After PAH treatment, the vast majority of patients notice a remarkable improvement. Expect smoother, better-proportioned contours and diminished PAH lumps. While some minor irregularities might linger, the true effect becomes evident over a few months as any swelling reduces.

How long is the PAH surgery recovery period?

For the initial week or two, it’s best to take things easy. Most discomforts like pain, swelling, and bruising tend to alleviate within a month. Keeping it light and avoiding heavy activities for about 6 weeks post-surgery is advisable. By the six-month mark, the full beauty of the procedure should be unveiled.

What are the risks or complications of PAH surgery?

As with any surgery, potential PAH surgery risks include bleeding, infection, scarring, asymmetry, numbness, and recurrence of stubborn fat cells. Dr. Smith takes meticulous precautions to minimize risks. He’ll discuss your unique considerations during your consultation.

Will liposuction for PAH leave scars?

Liposuction is a minimally invasive technique that leaves virtually undetectable scars. Incisions are extremely small, usually less than 1 centimeter. Scars are strategically positioned where they can be easily concealed. So, once you’re dressed, those surgical marks should be your little secret.

Does insurance cover PAH treatment?

PAH treatments, being elective cosmetic procedures, don’t usually find favor with insurance companies. This means the costs are out-of-pocket. However, Dr. Smith’s office can provide financing options to make care more affordable.

Schedule a Paradoxial Adipose Hyperplasia Consultation with Dr. Darren Smith

Call Today (212) 633-0627

"Within the first couple of minutes of meeting him, I knew he was the doctor for me."
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4.9 from 150+ reviews
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