Paradoxical Adipose Hyperplasia after Cool Sculpting?

Cool Sculpting ruined my body, where the machine was is now bigger and hard. I had it over 6 months ago. I suspect I have PAH. are their any fixes for this? I thought to lose weight, but I would think the same shape (protruding upper abdomen caused by Zeltiq machine) would still be there just on a smaller scale. Also, I'm at a optimal weight, it is not realistic for me to maintain a small weight to fix this. What can be done, short of invasive surgery. I'm so upset.

Doctor Answers 10

PAH and CoolSculpting is quite disturbing to have PAH but fortunately, liposuction can be of assistance.   You have options and those should be discussed with your plastic surgeon.  Once you have reached a 6 month mark or so, then you can assume that the hard fatty tissue is PAH and then move forward.  We have seen once case of this on a patients upper back.  It responded nicely to liposuction.  The abdomen has several approaches for the PAH.  

  I hope you and your doctor are able to work this out.  

Albany Plastic Surgeon
5.0 out of 5 stars 18 reviews

Paradoxical Adipose Hyperplasia After CoolSculpting

True Paradoxical Adipose Hyperplasia (PAH) is a rare delayed side effect of CoolSculpting. It happens in approximately 1 out of every 20,000 people who get CoolSculpting and for some reason is more common in men. At this time, there is no evidence of spontaneous resolution of PAH. When necessary, treatment of PAH has relied on liposuction or abdominoplasty.

A little more common is prolonged induration and firmness of the treatment area which is caused by an exaggerated inflammatory response. This usually does resolve on its own, although it may take several months. 

I would make sure you have close continued follow up with your treating physician. Your physician should report this occurrence to the device manufacturer. Best of luck to you.

Michael A. Zadeh, MD, FACS
Sherman Oaks General Surgeon
5.0 out of 5 stars 10 reviews

Paradoxical Adipose Hyperplasia after Coolsculpting!! This sucks....

We could not agree with you more. While it is not clearly understood, the few patients who have such a condition when it is well documented with good pre and post procedures would do well to be in the treatment plan of a plastic surgeon. If your treating physician (and ask to see the physician) is not able to take your care to the next level with liposuction or a tummy tuck then you have limited options. 

Plastic surgeons who are board certified have been well trained and are experienced at caring for patients whose have complex and varied medical outcomes and can adapt to multiple scenarios. Coolsculpting has treated millions of patients and have a very strong track record of delivering on improved abdominal contours with non surgical treatments. The best way to ensure that you are comfortable with your is to be with a physician who can treat you non surgically as well as surgically.

R. Brannon Claytor, MD, FACS
Bryn Mawr Plastic Surgeon
5.0 out of 5 stars 41 reviews

PAH Following CoolSculpting.

This is a rare but recognized occurrence following CoolSculpting in some patients.  Losing weight Oor performing other noninvasive procedures unfortunately will not address this condition.  Fortunately it has been highly responsive to liposuction.Again, I am sorry to learn of your experience.

Brian Biesman, MD
Nashville Oculoplastic Surgeon
4.8 out of 5 stars 41 reviews


I appreciate your question.
This is rare but is treated with liposuction

The best way to assess and give true advice would be an in-person exam.
Please see a board-certified plastic surgeon that specializes in aesthetic and restorative plastic surgery.

best of luck!

Dr Schwartz

Jaime S. Schwartz, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 93 reviews

Paradoxical Adipose Hyperplasia

This growth of fat after coolsculpting is very rare but does happen. The only treatment that we know works at this time is liposuction. I have done 3 cases so far and have used vaser liposuction to treat with good results.

Jason Pozner, MD
Boca Raton Plastic Surgeon
4.7 out of 5 stars 45 reviews

Paradoxical Adipose Hyperplasia after Coolsculpting is a rare event

Last I heard, there were about 20 cases of this reported.  I believe the only "cure" for this is liposuction.  If this is an isolated area, it could be done under local with minimal downtime.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.7 out of 5 stars 41 reviews

Paradoxical Adipose Hyperplasia

Paradoxical Adipose Hyperplasia (PAH) is a condition where there is local increase in subcutaneous adipose tissue at the treated area. Generally develops four to five months post treatment but can be seen as early two months after. The effected tissue is firm compared to non treated tissue/ There is no evidence of spontaneous resolution of PAH and surgical intervention such as liposuction or abdominoplasty may be required.

Michael L. Workman, MD
Portland Plastic Surgeon
4.7 out of 5 stars 36 reviews

Increased Fat After CoolSculpting, Only Treatment Is Liposuction

The best option for this condition is body contouring/liposuction.  I have seen cases and treated these successfully with body contouring but trying other types of non invasive options may be helpful -- ultrashape, velashape, liposonix etc.  Best, Dr. Emer

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 196 reviews


So sorry that you had to be the unlucky one.  You can have liposuction to correct the area of fat hyperplasia.

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 56 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.