Can paradoxical adipose hyperplasia come back again after doing lipo?

Great question. PAH is a very mystified diagnosis. The remaining fat cells overcompensate and get larger. It is very hard to predict if it will ever really stop, but in my opinion if you remove more fat, again (by suction assisted liposuction), then you will have a better chance of balancing out the results than non-surgical means. Best of luck!

Paradoxical Adipose Hyperplasia can be unpredictable, causing your remaining fat cells to enlarge. While the fat cells that you had removed with liposuction cannot return, it is possible that some of your remaining fat cells are still enlarged. If you are fully healed from liposuction and know you aren't just experiencing swelling, talk with your plastic surgeon about a possible second procedure to further treat your condition.

Unfortunately yes that is why it is called "paradoxical" I have seem a few of these recurrent issues. I usually re liposuction with KyBella injections during the healing phase. Sometimes I try KyBella (off label use) first, depending upon the severity of the recurrences.