I had coolsculpture done to my flanks, bra lines, & upper abdomen 11 weeks ago. Any suggestions?

I am worry about this hardened areas where t hey placed the suction cups. Warm to touch and hard. I call my NP that did The procedure so I went to see her today she examined me she took some pictures she palpate the areas but she's not sure what it is at this time.how ever she wants me to follow up with her every other week because she said we need to monitor it closely. Doctor, should I be worried. Is this will go away. I have been massaging it. Is this common. Thank you

Doctor Answers 4

Coolsculpting side effects

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There is a very rare symptom of Coolsculpting known as paradoxical hyperplasia, in which the fat cells actually grow and multiply in the treatment areas.  It is so rare that no one has been able to pinpoint it's cause.  It presents as a gradual enlargement of the treatment area, and is usually firm or hard the way you described.  This is not the same as the temporary swelling that occurs in the weeks following the procedure.  Your provider should know what this is, and monitoring it will do nothing but prolong your treatment, which will likely be liposuction.  Your provider needs to call Zeltique (Coolsculpting manufacturer) so that they can determine if this is in fact paradoxical hyperplasia, and properly guide you as to your next steps.

New York Oculoplastic Surgeon
4.7 out of 5 stars 68 reviews


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I suggest you talk to your doctor. If it is a paradoxical adipose hyperplasia which is really rare, liposuction is the solution.

Coolsculpting is an excellent form of non-invasive  fat reduction for the right patient. Some applicators take 1 or 2 hours but the new advantage applicators take only 35 minutes and have significantly less risk for delayed onset pain (especially in the abdomen). Results are seen at 2 months and typically 1-3 treatments will be necessary on each area to achieve ideal results. The number of treatments depends on the amount of fat there and the patient's goals.  There is not downtime and the results can be impressive in the right patient.  We also use the Zimmer Z-wave for improved patient comfort and added results. The best candidates are those who are in pretty good shape with areas of stubborn fat that won't go away no matter what.

My best,

Sheila Nazarian, MD, MMM

Beverly Hills, Board Certified Plastic Surgeon

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

I had coolsculpture done to my flanks, bra lines, & upper abdomen 11 weeks ago. Any suggestions?

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Thank you for your question. Aside from the warmth, your description sounds like a rare side effect called paradoxical adipose hyperplasia. Massaging may help. I would recommend speaking with your CoolSculpting provider. Regards, 

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 508 reviews

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Hard Lump after CoolSculpting

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it's hard to say without evaluating the area. While there is a rare complication of paradoxical adipose hyperplasia this usually occurs much later, 6 to 9 months after the treatment. The warmth and swelling signify inflammation and could also be related to other etiology such as infection although unlikely due to the non invasive nature of the treatment. Massaging the area may help it to settle down. I would give it a couple more weeks especially with the massage. Check in with your provider for further guidance. If it does persist, options may included laser assisted liposuction or consideration for off label Kybella
All the best
Dr Soni

Hardik Soni, MD (not currently practicing)
Summit Emergency Medicine Physician

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