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Paroxysmal Adipose Hypertrophy (PAH)

Paradoxical adipose hyperplasia is a rare complication of cryo-lipolysis (commonly known as “CoolScullting”), that results in the overgrowth of fatty tissue. In PAH, the zone of tissue under the cryo-lipolysis pads increases the size of the fat cells, instead of shrinking them. This adverse outcome typically occurs about 8-24 weeks after treatment and appears as firm fatty tissue that enlarges under the treatment area. The shape the enlarged tissue takes often reflects the shape of the topical applicator. The enlarged area can be firm, movable, and tender to the touch.

Some of the warning signs to look out for after cryo-lipolysis treatment include:  the treatment area looking and feeling thicker, hard lumps or bumps, and a specific area of swelling that is tender to the touch.

While PAH is not dangerous, it is often upsetting to many patients. The complication will not go away on its own and requires further treatment.

Corrective Treatment for PAH in Vancouver

The best treatment for PAH is liposuction, but there is a waiting period that needs to take place to ensure the PAH doesn’t come back after surgery. Patients typically need to wait 9-12 months for the fat in the affected area to soften. This ensures it is safe to remove.

The Surgical Experience: 

Post-PAH liposuction treatment is performed under general anesthesia in an accredited private surgical facility. The procedure takes 1-1.5 hours, depending on the number of zones to be treated. A small (3-5 mm) incision will be made by Dr. Demianczuk adjacent to the affected area. Due to the increased fibrosis and scar tissue related to PAH, Dr. Demianczuk will utilize Power Assisted Liposuction to emulsify the fat and break down the scar tissue. Great care needs to be taken in this procedure as the area is often scarred and can be challenging to recontour. Dr. Demianczuk has experience in treating this complication of cryo-lipolyis. Liposuction will remove the abnormal fat cells, to optimize the contour of the affected area.  Once the fat is removed, the incision will be closed with dissolving stitches, and you’ll be ready to begin the recovery process. Following the surgery, clients will need to wear a compression garment for 6 -8 weeks. 

You will notice some results immediately, but full results will take several months to appear, and the swelling and bruising subside, and the skin tightens around the new contour.

Frequently Asked Questions
  • Who is at risk for PAH?

    Patients who have had prior non-invasive cryo-lipolysis treatment are at risk of developing PAH.  This can affect both men and women and can affect any body part. 

  • How Common is PAH:
    • According to 2024 data from Allergan, the manufacturer of CoolSculpting, PAH occurs in 1 out of every 3,000CoolSculpting treatment cycles, which is an incidence rate of 0.033 percent based on all reported PAH cases since 2015.
    • 2021 review published in Aesthetic Surgery Journal found that PAH occurred in 1 in 256 cases performed at 8 Canadian medical centers between January 2015 and December 2019.
  • Is PAH painful?

    Some individuals with PAH have noticed tenderness or pain in areas of swelling, but this is not always the case.

  • Is PAH dangerous?

    No, PAH is not considered dangerous, but it can be upsetting to patients. It’s why treatment can improve not only your physical appearance but also your mental well-being.

  • Can PAH recur after treatment?

    Unfortunately, PAH can recur, but that typically only occurs when the 6-9 month waiting period is not observed.

  • Is there a way to prevent PAH?

    Beyond avoiding cryolipolysis, or seeking out other body contouring procedures, there are currently no strategies for preventing PAH.

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