What is the issue with CoolSculpting- PAH-paradoxical adipose hyperplasia?

Counsel cryolipolysis patients about paradoxical adipose hyperplasia is a title I read about online. How common? Chances? I am a 19 year old who thought this was amazing and really wanted to do it,but all I'm reading is bad reviews.

Doctor Answers 3


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I wish we know who was at risk for this but we don't.  I do let my patients know that if hyperplasia occurs (which it never has), I will perform liposuction on them for free... that is how rare it is.  

Best of luck, Sheila Nazarian

Beverly Hills Plastic Surgeon
4.8 out of 5 stars 56 reviews


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I appreciate your question.

There is a very rare chance of getting larger fat cells rather than killing them
This 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

PAH, paradoxical adipose hyperplasia following CoolSculpting

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Dear boodyconscious:

I have replied to you before so I know you are curious and properly reviewing the pros, cons and side-effects of CoolSculpting (CS) and other options for body fat reduction and contouring.

Conceptually, PAH or paradoxical adipose hyperplasia is similar to hypertrophic scarring.  Hypertrophic scars develop when the activity producing collagen (scar) is greater than the enzymes breaking scar down to produce a thin white line. With PAH, the stimulus activates a reactionary process in the fatty tissues to thicken and expand cells rather than breakdown and excrete them. 

This happens rarely, approximately 1 in a million but if it happens to you, I can understand your concern. Should it happen and be properly documented, the Zeltiq company will work with you to have it improved. Further CS will not help, you will need to undergo traditional or "powered" (eg., VASER, ultrasound, other) liposuction. 

Of 500 patients, I have had 1 patient develop PAH which was cared for with traditional tumescent liposuction.

I hope this helps. All the best!

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.9 out of 5 stars 103 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.