What is CoolSculpting?
CoolSculpting is a very popular method of noninvasive body contouring. By placing applicators on different parts of the body, CoolSculpting can reduce fatty bulges by an average of 22 to 23% without surgery. Until the introduction of Emsculpt Neo, CoolSculpting was the most effective way to remove fat without surgery. For more information about Emsculpt Neo, which can reduce fat by an average of 30% and simultaneously increased muscle mass by an average of 25%, please click here.
How does Coolsculpting work?
Coolsculpting relies on a process called cryolipolysis to destroy fat cells. Cryolipolysis is demonstrated in the video shown here. During the CoolCculpting procedure, tissue in the treatment area is drawn into the applicator with high suction. The applicator then cools the tissue your critical temperature at which fat cells are selectively destroyed. Specifically, the cold temperature triggers programmed cell death, or apoptosis, and then the body naturally flushes out the dead fat cells.
What is Paradoxical Adipose Hyperplasia (PAH)?
Paradoxical adipose hyperplasia (or PAH) is a process in which fatty tissue grows instead of shrinks in response CoolSculpting and cryolipolysis. Areas affected by PAH often look like raised fatty tissue in the shape of the cool sculpting or cryolipolysis applicator. They tend to be firmer to the touch then surrounding fat. Paradoxical adipose hyperplasia most frequently occurs three to six months after a cryolipolysis or CoolSculpting treatment. The frequency with which paradoxical adipose hyperplasia or PAH occurs is up for debate and likely under reported. Literature review puts the incidence as being from approximately .05% to 0.39% in some studies and as high as .72% or one in 138 treatments in another study. While PAH or paradoxical adipose hyperplasia is not common, it can pose a significant problem for those who are affected.
What causes PAH?
While the exact cause of PAH is not known, there are a few interesting theories. One theory suggests that certain fat cells for whatever reason are more able to withstand cold temperatures than others. These cells are essentially selected for and survive CoolSculpting and cryolipolysis. It is thought that signaling molecules called hypoxia-inducible factors, or HIFs, initiate a cascade in the body that causes blood vessel growth and ultimately the enlargement of existing surviving fat cells and the creation of new fat cells in paradoxical adipose hyperplasia (or PAH). Another interesting theory takes a cue from a different medical device, called BRAVA. BRAVA is a special bra that is worn to treat the breasts with suction or “negative pressure therapy” as a pre-treatment before breast augmentation with fat grafting. The suction from the BRAVA device causes increased blood supply and the upregulation of other growth factors in the treatment area to improve the take of fat that is grafted to the breasts as part of a breast augmentation procedure. For more information on fat grafting or fat transfer please click here. It is thought that like the suction used in the BRAVA device, the suction used in cryolipolysis or CoolSculpting may favor the survival and growth of a certain population of fat cells.
What areas are most frequently affected by PAH?
Any area treated with CoolSculpting or cryolipolysis could theoretically be affected by paradoxical adipose hyperplasia. In Dr. Darren Smith’s experience in treating these patients, the abdomen appears to be the most frequently affected area. However, the abdomen is also one of the areas most frequently treated with CoolSculpting or cryolipolysis, so this finding could be skewed.
How is PAH treated?
Paradoxical adipose hyperplasia can often be completely treated or significantly improved by an expert plastic surgeon. Dr. Darren Smith has significant experience in treating paradoxical adipose hyperplasia from CoolSculpting procedures performed at other practices (Dr. Smith does not offer Coolsculpting as he prefers other noninvasive body contouring options; Emsculpt Neo ).
Noninvasive methods of treating paradoxical adipose hyperplasia generally do not work well. Such methods may include additional treatments with CoolSculpting or cryolipolysis, injections of Kybella, or treatments with other noninvasive fat reduction devices such as SculpSure. In many cases of paradoxical adipose hyperplasia, liposuction alone can affectively treat the issue. In some cases with extremely fibrous or rigid fat deposits, the use of energy such as ultrasound with VASER (read more about VASER or radiofrequency with BodyTite may be indicated. These devices, or in severe cases even a full abdominoplasty, may be necessary to treat skin access that is associated with paradoxical adipose hyperplasia. Given the nuances in designing a customized treatment approach, it is recommended that you consult with a board-certified plastic surgeon that is very familiar with this entity.