Paradoxical Adipose Hyperplasia or PAH is the biggest concern with CoolSculpting. This is a rare condition where the fat cells become bigger after CoolSculpting. I perform liposuction on patients who develop PAH and, in my experience, the PAH fat is very tough and fibrous like scar tissue. It is very difficult to remove and requires a special tool called Vaser to break up the fibrous fat. Having looked at the hard fat under the microscope, it looks and feels like scar tissue to me. Most people do fine with CoolSculpting and in most cases it will reduce the fat in the areas where you are treated. Just be aware that there is about a 1% chance that you can develop PAH. You might be better off going straight to liposuction.