Would a thigh lift help me achieve a smooth and even appearance? 19 y/o female with bulging after CoolSculpting (photos)

Question

I’ve always had thick thighs since I was a kid, so I got cool sculpting done in 2020 in hopes of it making my thighs appear smaller. I think I have paradoxical adipose hyperplasia from it. Please take a look and let me know if this looks like PAH or something else like loose skin from weight loss. I don’t remember my thighs ever having a buldge like this until months after the coolsculpting. I just want my thighs to be smooth and even with no buldges. F, 19, 5’6, 170pounds. recommendations plz!

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your question regarding how to smooth and even out the appearance of thigh bulging after CoolSculpting in a 19-year-old female, and whether a thigh lift would help you achieve better results. Thank you for your detailed history and your photos.

From your description and images, paradoxical adipose hyperplasia (PAH) is a strong possibility. PAH is a known complication of CoolSculpting, and although rare, it typically presents as firm, bulging areas of tissue that become more prominent several months after the treatment. These areas often look enlarged or more projected than before and can feel hard or dense to the touch. The condition can occur regardless of your age, and unfortunately, it does not resolve on its own.

If the bulges you’re noticing feel firm or dense, especially in areas where fat was frozen, this may suggest PAH rather than loose skin. Loose skin typically appears soft, wrinkled, or saggy — not firm and raised.

Regarding your treatment options: at your age and with your current concerns, a thigh lift is a reasonable and effective option, especially if you're dealing with skin redundancy or tissue irregularity following CoolSculpting. Based on your photos, most plastic surgeons would likely recommend either a modified longitudinal vertical medial thigh lift or a full vertical medial thigh lift. The distinction depends on how much skin and fat needs to be removed and how extensive the bulging is.

A modified vertical thigh lift involves an incision from the groin that extends partway down the inner thigh — typically to the point where the thigh begins to contour inward again.

A full vertical thigh lift includes a longer incision from the groin to just above or below the knee. This approach provides maximum smoothing and tightening, especially if the bulge extends further down the thigh.

In both cases, liposuction is often performed alongside the lift to further contour the medial, anterior, and lateral thigh areas. The incisions are carefully placed along the inseam, so they’re discreet when your legs are together. The procedure is performed under general anesthesia and takes approximately 3 to 4 hours, with 2 weeks of initial recovery and 6–8 weeks in a compression garment to help minimize swelling and improve scar healing.

It’s also important to consult a board-certified plastic surgeon with significant experience in both thigh lifts and PAH. Not every surgeon is familiar with how to identify or treat paradoxical adipose hyperplasia, so choosing someone who has experience with CoolSculpting complications is key.

Thank you again for your insightful question. I hope this information gives you clarity and direction as you move forward. You are young, healthy, and a motivated patient — all great signs for a successful outcome with the right treatment.

Sincerely,
Dr. Katzen

Camille Cash, MD · Answer

I encourage you to begin by visiting with a board certified plastic surgeon.  Depending on the degree of skin laxity you may be a candidate for liposuction with J Plasma for skin tightening.  If there is too much excess skin then a thigh lift should give you more contoured results.  I've included a video I hope you find helpful.

Would a thigh lift help me achieve a smooth and even appearance? 19 y/o female with bulging after CoolSculpting (photos)

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Would a thigh lift help me achieve a smooth and even appearance? 19 y/o female with bulging after CoolSculpting (photos)

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Everything you need to know about Thigh Lift

Our mission is to create a world where every investment in modern beauty is Worth It.