47 yr old male, possible PAH after CoolSculpting? 3 weeks post. Please help.

Question

CS on the flanks and lower stomach 3 wks ago. Aesthetically, I'm seeing improvements in right side & stomach. However, my left flank area is bigger than before. Front view isn't noticable but it's apparent from the rear. I still feel slight numbness & that deep bruised feeling remains. Concerned that it either didn't work on the left, or perhaps I'm experiencing the PAH? The shape is still the same as my original love handle-it's just bigger than before and much bigger than the right side.

Jason Emer, MD · Answer

You may have some swelling, which can last for several weeks after your procedure. Venus Legacy treatments and lymphatic massage can give improvement. If it persists, I recommend following up with your Doctor for a formal evaluation.  It will take about 3-6 months to see your final results. For best results with Coolsculpting, I recommend a combination approach. I recommend adding radiofrequency treatments like Vanquish, Venus Legacy, Exilis Ultra for skin tightening and with Z wave/Cellutone for skin smoothing. VASER with ThermiRF is a great alternative. See an expert. Best, Dr. Emer

John Tang, MD · Answer

It sounds like you may still have swelling on the left side.   I would recommend waiting at least another 3 weeks and for all the numbness and bruise feeling to go away before deciding whether it is PAH or not.

Monika Soni, MD · Answer

Thank you for your question. You may still have some swelling on the left side, which can last for several weeks after treatment. Having a lymphatic massage ma help give improvement. However, if this persists I recommend following up with treating physician for an evaluation and treatment. Please remember it can take 3-6 months to see your final results. Best of Luck!

Hardik Soni, MD · Answer

Thank you for your question. You may still have some swelling on the left side, which can last for several weeks after treatment. Having a lymphatic massage ma help give improvement. However, if this persists I recommend following up with treating physician for an evaluation and treatment. Please remember it can take 3-6 months to see your final results. Best of Luck!

Edward Stokes, MD · Answer

Hi Georgia Anne 15, thank you for your question. Coolsculpting treatments will most always be followed by swelling, numbness and a sensation that the skin in the treated areas is firm or thick.  This usually last for a few weeks to possibly a month.  It is very common that one area will be more swollen than another, and that one area may show results prior to another area that was also treated at the same time. PAH is known to only present in about 1 out of ten thousand people.  It is very rare, yet many patients call in and ask if they have it because they are experiencing inflammation.  The inflammation is normal and is necessary, in order for the body to flush away the dead fat cells. PAH will not begin to present until several months post treatment, so I do believe that you are most likely fine.  Three weeks post treatment is way to early to determine if what you are experiencing is PAH.  I would recommend that you schedule a followup visit with you provider to be sure that everything is moving along in a healthy and expected way.  Just give this a little time.  After three months, you should be able to see and feel your results, and most likely everything will have evened out completely.  Good luck with your CoolSculting journey!

Dean P. Kane, MD, FACS · Answer

Dear Georgia Anne 15:
CoolSculpting works by the controlled cooling of the fat cells causing 20-25% of the fat cells within the applicator to “self-destruct”; a process called apoptosis. With any injury to the tissues, inflammation also occurs developing swelling followed by firmness of the skin and underlying tissues.  
  
As with any injury, the process of healing peaks at approximately 3 months when the firmest collagen formation (also termed scar) occurs; this is when you should expect your tightest results.  Remodeling of that collagen from a bulky irregular ball to a more smooth and flat, imperceptible scar occurs thereafter. At 6 to 12 months or longer when all tissue repair has completed is when you may expect your thinnest results. 
  
PAH or paradoxical adipose hyperplasia is considered a contrary response to cooling the cell and signaling the DNA to involute. This is when the cell grows instead. With collagen formation, the tissues becomes fuller and firmer. Therefore, PAH cannot be distinguished from normal healing until after 3 months when the tissues treated should reduced in size. 
  
You may wish to revisit your CoolSculpting physician for reassurance and close follow-up. You may also consider a second opinion with a Board Certified Plastic Surgeon to evaluate your results after 3 months (bring along your medical file from the first MD) as the options for improvement of PAH include:
  
Observation and massage, 
  Steroid injection, 
  Lipocontouring. 
  I hope this has been helpful. All the best!

Jack Berdy, MD · Answer

PAH is very rare but would appear 2-3 months after the CoolSculpting treatment.  Three weeks is just too soon to evaluate PAH.  It is possible to have PAH in one distinct treatment area while not having a similar response in all areas as I have observed in my practice.  While you wait, and observe don’t try a second treatment to the affected area.  Re-treatments has not been shown to improve PAH.  If you are diagnosed with PAH down the road keep in mind that liposuction appears to be a viable method of correction the area of PAH.  In the meantime, I wish you good luck and be patient before jumping to the diagnosis.  
  
Dr. Berdy

Drew Varano, MD · Answer

You do not have PAH... It takes longer to develop PAH then 3 weeks, secondly it would affect all treated areas not just one isolated spot or flank. If it happens all 3 treated areas would show enlarged well demarcated firm tissue.  The statistics are 1 in 20,000 treatments

47 yr old male, possible PAH after CoolSculpting? 3 weeks post. Please help.

Answers (8)

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