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What is PAH?

Dec 3, 2018 | Body

Paradoxical Adipose Hyperplasia (PAH) is a delayed side effect from CoolSculpting, which is a treatment that is used to remove fat by freezing and liquefying the fat cells, which are then naturally released or aspirated from the body. Although this treatment is successful 99% of the time, it is possible to get PAH, so it is important to understand what it is, what the symptoms are, and how to treat it.

Patients who believe they may have PAH can be reassured that there is hope and a revision approach can create a normal appearance. Dr. Jaime Schwartz has helped Beverly Hills patients attain a natural look following the side effects of CoolSculpting. While it is rare to get PAH, we believe it is important to understand your options for treatment and that this can be helped.

What happens during PAH?
PAH occurs when the process that freezes the fat cell activates a reactionary process. In other words, your treated fat cells expand instead of breaking down, which can lead to the treated area growing larger and harder. The coldness from the treatment can actually increase the size of the underlying fat tissue instead of decrease the size. When the fat cells increase in size, they require more nutrients and oxygen, which can increase the density of these fat cells, making them harder. You could start seeing the early stages of PAH within 1-2 months of the treatment, but it takes about six months for the diagnosis to be confirmed.

What Causes PAH?
There is not a known cause, though the chances of getting PAH can increase when you get CoolSculpting. Despite affecting only one out of 20,000 people, it is still a risk factor that you should consider. We know that it affects more men than women, but we are unsure of why this trend occurs.

Known Symptoms
There are a few symptoms that you should keep in mind. Paradoxical Adipose Hyperplasia generally looks like a stick of butter, since that is the shape of the applicator, but sizes and shapes can vary. For many people, it can look like you have gained weight. It is possible that you have gained some weight, but if you have maintained a healthy lifestyle, come see us.

Another symptom that can help you identify PAH is light pain in the treated area. The area may feel tender to the touch or you could feel some light pain when it is touched. CoolSculpting should not cause you pain, so this might be a sign of PAH. On the other hand, many cases of PAH do not cause pain, so if you see a growth in the treated area, if the section of skin seems harder, call for a consultation.

Treatment for PAH
Even with diet and exercise, you cannot remove PAH naturally, but there is a way to treat it. Liposuction can remove the hard fat, but it needs to be softened first, so you have to wait about 6-9 months before the area can be treated. In our Beverly Hills plastic surgery center, board-certified plastic surgeon Dr. Jaime Schwartz use the SAFE (Separation, Aspiration, and Fat Equalization) technique to smooth out the skin. First, we will loosen and break down the targeted fat cells. The aspiration step takes the broken down fat cells and removes them from the body using a small cannula, which is a tube. Finally, we will smooth out the remaining fat to create a more sculpted appearance to the treated area. In some cases, if liposuction is not enough to treat the condition, surgery may help remove larger, harder fat cells. This is rare though as PAH typically does respond well with revision liposuction.

The importance of picking an experienced surgeon
Even though CoolSculpting is an easy treatment, plastic surgeons can make mistakes, which is why it is important to research your options and choose the right one for you. When choosing your plastic surgeon, make sure they are board-certified and understand the benefits and risks of the treatment. There is not a way to completely prevent PAH, but finding an experienced surgeon can help decrease the possibility of it affecting you. If you happen to get PAH, make sure they have a plan on how to treat it. Many, like us, will offer financial assistance since there is not a way to prevent it. Make sure you have a detailed discussion about PAH during your initial consultation.

The next steps
If you are affected by Paradoxical Adipose Hyperplasia after a CoolSculpting treatment, we invite you to contact our Beverly Hills plastic surgery office. We understand that PAH is a rare, but significant side effects can occur in a small percentage of patients. Schedule an appointment with us and bring your previous treatment records, including photos that were taken before the treatment. Dr. Schwartz will perform a thorough assessment and create a custom treatment approach so you can look and feel normal again.



Beverly Hills Office

240 South La Cienega Boulevard
Suite 200
Beverly Hills, CA 90211

Phone: 310-882-5454