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An Unfortunate Series: Characteristics Of Patients Diagnosed With Paradoxical Adipose Hyperplasia After Cryolipolysis
Elizabeth A. Cox, BA1, D. Spencer Nichols, BS1, Joshua Ricklan, BS1, Jaime Rafanan, PA-C2, Dawn Daigen, PA-C2, Anne Staples, PA-C2, Sarah S. Virk, MD2, Harvey W. Chim, MD, FACS2, Bruce A. Mast, MD, FACS2.
1University of Florida College of Medicine, Gainesville, FL, USA, 2University of Florida, Department of Surgery, Division of Plastic & Reconstructive Surgery, Gainesville, FL, USA.

Purpose: Coolsculpting™ or cryolipolysis, is one of the most popular minimally invasive cosmetic procedures. Cryolipolysis circumvents the risks of surgery by utilizing cold temperatures to destroy adipocytes. This has become an attractive alternative to liposuction for its lack of recovery time and superior safety profile. However, this procedure is not devoid of risks. Paradoxical adipose hyperplasia (PAH) is a rare, but observed side effect that is characterized by dense, fatty enlargement of the treatment area months after the procedure. This study sought to further describe this phenomenon through a retrospective case series of patients diagnosed with PAH at our institution.
Methods: After Institutional Review Board permission was obtained, all participants that had been diagnosed with PAH at a large academic center from November 2017 were identified using procedural codes. Data including demographics, medical history, procedure details, PAH diagnosis, and treatment of PAH were collected from the electronic medical record of these patients. Mean duration of time from cryolipolysis treatment to diagnosis of PAH was calculated.
Results: Four patients who had been diagnosed with PAH after cryolipolysis were identified. Mean duration of time from cryolipolysis treatment to diagnosis of PAH was 9 months (SD 7 months and 12 days). Details for each patient are included in Table 1. The progression of bilateral flank PAH in one of these patients is illustrated in Figure 1. All patients were treated with liposuction and/or abdominoplasty and did not have residual deformity.
Conclusions: This study described four patients diagnosed with PAH to increase available data about this condition. Counseling patients about this rare and devastating consequence is essential. Conventional tried and true surgical interventions are effective in combating this unfortunate side effect. Additional studies are needed to further characterize this diagnosis and determine non-invasive treatment options for patients diagnosed with PAH.

AgeSexRace/EthnicityBMIDM (Y/N)Tobacco use (Y/N)Cryolipolysis treatment areaTotal number of treatmentsTotal number of cyclesDiagnosis of PAH from cryolipolysis (months)BMI at PAH DiagnosisDefinitive PAH TreatmentResidual Deformity
62FBlack31.6NNAbdomen & flanks265.531.2LiposuctionN
61MHispanic25.1NNAbdomen & flanks164.324.7Abdominoplasty &LiposuctionN
52FBlack29.8NNAbdomen, mid-back, flanks, thighs, and arms2146.329.2LiposuctionN
64FWhite26.83NNAbdomen & thighs21020.125.9Abdominoplasty & LiposuctionN
Table 1. Characteristics and outcomes of patients diagnosed with PAH after cryolipolysis. Abbreviations: M, male; F, female; BMI, body mass index; DM, diabetes mellitus.

Figure 1. Progression of bilateral flank PAH in patient 2. A) Prior to cryolipolysis treatment. B) Four months after treatment. C) Six months after treatment.

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