Stomach bloated and bigger at 6 weeks after coolscuplting even after seeing a reduction at 4 weeks. (photo)

I had coolsculpting done 6.5 weeks ago. I had both sides of my mid to lower abs done in the v-shape. I had swelling that lasted about 1 week. At 4 weeks I started seeing results. At 6 weeks I developed a hard ridge and my belly is actually getting bigger! I have an appointment with my clinic next week but I wondered if anyone can reassure me that this is normal? Is swelling up at 6 weeks normal? I have actually lost 5 pounds since having the procedure done so I know it's not my diet at all.

Doctor Answers 5

Stomach bloated and bigger at 6 weeks after coolscuplting even after seeing a reduction at 4 weeks

Thank you for your question. If you are noticing a hard ridge and an increase in size I would recommend speaking to your provider and board certified plastic surgeon to make sure it is not Paradoxical Adipose Hyperplasia. 


Toronto Plastic Surgeon
4.9 out of 5 stars 457 reviews

CoolSculpting and Increased Swelling

The swelling from the CoolSculpting treatment should usually subside after a few weeks, and usually gradually gets better rather than worse.  There are rare cases in which CoolSculpting patients develop paradoxical adipose hyperplasia.  It is best to see a Board Certified Plastic Surgeon to see if this is what is happening to you.  Best of luck!

Jeffrey Hartog, MD
Orlando Plastic Surgeon
4.5 out of 5 stars 60 reviews

CoolSculpting post procedure

It's hard to make a diagnosis based on photos. However, at 6.5 weeks post procedure, all inflammation and swelling should have resolved. In rare instances, patients can actually experience increased fat from CoolSculpting. This is known as Paroxysmal Adipose Hypertrophy. It is often described as a hard area of increased fat in the same position as where the CoolSculpting applicator was placed. I would recommend you keep your appointment with your clinic next week. At that time you can discuss your concerns with your provider. 

Shaun Patel, MD
Miami Physician
5.0 out of 5 stars 55 reviews

Increased swelling and CoolSculpting

Good Afternoon,
I am sorry to hear things are not progressing as you had anticipated. Generally speaking by 4 weeks post procedure much of the inflammation, numbness and skin sensitivities will be gone and you will start to see the results anticipated. Some people do take longer than this depending on many factors. Unfortunately from photos alone we cannot make a determination of normal or abnormal regarding hardness or other tissue qualities. There are some more rare circumstances where the fat tissue can in fact become hard. In cases of "subcutaneous induration" (swelling and hardness of the underlying tissue) you may look and feel as described and may even appear like little nodules. This is typically treated conservatively and will resolve on its own. I would urge you to keep the appointment you have coming up and discuss all with your treating professional for increased clarification and direction. 
Be well

Paul Pietro, MD
Greenville Physician
5.0 out of 5 stars 3 reviews

Swelling after Cool Sculpt

There has been rare incidence of INCREASED fat after Cool Sculpting, it is called Paradoxical Adipose Hyperplasia. Here is a reference:
JAMA Dermatol. 2014 Mar;150(3):317-9. doi: 10.1001/jamadermatol.2013.8071.
Paradoxical adipose hyperplasia after cryolipolysis.Jalian HR1, Avram MM2, Garibyan L2, Mihm MC3, Anderson RR2.
Author information
AbstractIMPORTANCE: Cryolipolysis is the noninvasive reduction of fat with localized cutaneous cooling. Since initial introduction, over 650,000 cryolipolysis treatment cycles have been performed worldwide. We present a previously unreported, rare adverse effect following cryolipolysis: paradoxical adipose hyperplasia.OBSERVATIONS: A man in his 40s underwent a single cycle of cryolipolysis to his abdomen. Three months following his treatment, a gradual enlargement of the treatment area was noted. This enlargement was a large, well-demarcated subcutaneous mass, slightly tender to palpation. Imaging studies revealed accumulation of adipose tissue with normal signal intensity within the treatment area.
CONCLUSIONS AND RELEVANCE: Paradoxical adipose hyperplasia is a rare, previously unreported adverse effect of cryolipolysis with an incidence of 0.0051%. No single unifying risk factor has been identified. The phenomenon seems to be more common in male patients undergoing cryolipolysis. At this time, there is no evidence of spontaneous resolution. Further studies are needed to characterize the pathogenesis and histologic findings of this rare adverse event.


It's also possible that you have a "shelf" of untreated tissue overlying an area of lipolysis. You are doing the right thing to consult with your service provider. You may need to have a different type of procedure done to correct this (SculpSure Laser, Liposuction, etc...)
Lisa Vuich, MD

Lisa Vuich, MD
Nashua Physician
4.7 out of 5 stars 11 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.