10 days post op-CoolSculpting. Extreme pain and the area treated has gone hard.

Thank you for your question.  Some soreness and swelling in the weeks following a CoolSculpting treatment is appropriate and generally resolves as healing progresses.  Since the area is becoming more painful and hard, my advice is to have the physician in your CoolScupting office evaluate you.  Best of luck.

Paradoxical adipose hyperplasia, a very rare complication of cool sculpting, is (as you described) a hardened uncomfortable area of fat. If this is truly the problem, best to discuss with your surgeon, then the recommended treatment is liposuction. If this is a localized area of inflammation, then this area will go away after the inflammatory reaction subsides (6 weeks to 6 months).Hope this finds you improving.

Paradoxical adipose hyperplasia, a very rare complication of cool sculpting, is (as you described) a hardened uncomfortable area of fat. If this is truly the problem, best to discuss with your surgeon, then the recommended treatment is liposuction. If this is a localized area of inflammation, then this area will go away after the inflammatory reaction subsides (6 weeks to 6 months).

Hi! It is normal for the skin to be red, firm, sore, and tender to touch after treatment for a couple of weeks, but it should not be “hard,” or getting “worse.” If the area is becoming harder, and your symptoms are worsening, then you need to be assessed by the medical director of the clinic that performed the treatment.

This is a well documented phenomenon and not necessarily related to paradoxical adipose hyperplasia.  The firmness is swelling and likely an exaggerated inflammatory response to Coolsculpting.  Typically the degree of fat loss might be more than average.  This is thought secondary to the exuberant body response.  Often coincident with (but not necessarily) the inflammation is the development of extreme pain, usually 3-4 days after the procedure.  The pain will usually subside rather suddenly, by 12-14 days if you can tolerate it.  Typically this is thought to be nerve pain and does not respond to heat, cold, aspirin, narcotics, or  Advil (nsaids).  It requires a course of Gabapentin, if the patient elects for this.  This medication has potential side effects which should be prescribed after reviewing your medical history.   Typically, if you are not sleeping due to the pain, the drug will relieve the discomfort rather quickly but  must be slowly tapered as per the instructions of your treating physician.
Best regards,
Dr. Christopher Dannaker
Fellow, American Academy of Dermatology
Certified, American Boards of Dermatology and Preventive Medicine