Is it possible that PAH from CoolSculpting is caused by bad application technique or just a reaction for the specific person?

Question

Like has someone ever had Coolsculpting in one area and seen good results, but PAH in another area? Or do those who suffer from PAH as a result of this procedure generally get it in all treated areas? This procedure has been around a while, so there should be enough cases by now that things like this have been noted.

Michael Loffredo, MD · Answer

PAH is a very troubling potential side effect of coolsculpting .  I have treated four patients with PAH over the past seven years, 2 of them with liposuction and 2 of them with abdominoplasty and liposuction.  The four patients I treated had PAH at all of their treatment sites

Hung William Song, MD · Answer

Because PAH is relatively rare, it is hard to say whether some people are just predisposed to it or if it is due to bad technique. However, I have some personal experience that might shed some light. I had a Coosculpting treatment on one flank years ago when it was new. The rep from the company performed it on me and I developed PAH. I am Asian and I have darker skin. In researching cases of PAH I noticed that a disproportionate number of people seem to have darker skin. (That is just my personal observation). I was able to use a different technology called Sculpture years later to successfully correct the hyperplasia. My opinion is that PAH is due to both genetics and technique. Certain people with denser fat may be predisposed to PAH and incomplete treatment could be enough to stimulate stem cells to grow new fat cells but not enough to destroy the existing fat.  It is important to have the treatment performed by a clinic with a lot of experience and the ability to address the problem if PAH should occur. Vaser Lipo or Tickle Lipo are the best options for correcting it. SculpSure is a non-invasive option to treat  it but it will take multiple sessions.

Christopher J. Davidson, MD, FACS · Answer

Thank you for your question.  PAH, or Paradoxial Hyperplasia is rare.  A small number of patients have experienced gradual development of a firmer enlargement, of varying size and shape, of the treatment area in the months following treatment.  Although this has not happened in my practice, the condition would be resolved by means of a liposuction treatment.  Best of luck.

Isobel Walker, MBBS · Answer

The cause of Paradoxical Hyperplasia is still not fully understood. My latest reading is that it is more common in males, can not be predicted and is exceedingly rare. It can be treated with liposuction. No predictive values apart for males more than females. All the best, Dr Isobel Walker. Brisbane. Australia.

Emerico Csepanyi, MD · Answer

It is possible for PAH to occur in some areas and not others; however, application technique does not factor into the odds. As clinically documented, PAH cases occurred after using the original suction based Coolsculpting applicators. Luckily there have been no reported cases of PAH after being treated with the Cool Advantage applicators or the non suction Cool Smooth and Cool SmoothPro applicators. With that being said, it is entirely possible to have PAH in areas treated with the legacy applicators in certain areas and not in areas treated with the non suctions applicators.

Mary Beth Mudd, MD · Answer

You ask some great questions! Paradoxical adipose hypertrophy (PAH) is a condition where the fat actually grows back following a CoolSculpting treatment. The cause for this is still unknown. Fortunately, it is still relatively rare, which is why it has been difficult to learn a lot from the cases that have occurred. It is possible for a person to have PAH in 1 area and not in another treated area, although it could happen in all treated areas for the same person. I generally recommend not performing additional CoolSculpting treatments if a person is documented to have true PAH. Best wishes, Mary Beth Mudd

Susan Buenaventura, MD, FACS · Answer

PAH results when fat cells become stimulated to grow after Coolsculpting, rather than dissolve.  It is rare and even more rare now with applicators that rely less on suction and more on parallel plates or cups cooling tissue.   It can occur in more than one spot but again is rare.  It is not related to bad technique, it is more the tissues response to the cold stimulation.  The treatment for PAH is liposuction.

Is it possible that PAH from CoolSculpting is caused by bad application technique or just a reaction for the specific person?

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