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What is Paradoxical adipose hyperplasia (PAH)?
Paradoxical adipose hyperplasia (PAH) describes the development of localized fat growth in areas previously treated with Coolsculpting cryotherapy. Patients are routinely seen at our office who have observed paradoxical overgrowth of fat and the subsequent bulge in the exact area that was previously treated with cryotherapy.
Please see the excised area demonstrating hyperproliferation of fat in the localized area of cryotherapy when compared to adjacent fat layers.
Patients with paradoxical adipose hyperplasia often admit moderating weight gain! This clinical feedback has led us to hypothesize on the mechanism of paradoxical adipose hyperplasia (PAH) and subsequently definitive treatment of PAH that was published in the Journal of American Cosmetic Surgery in 2020.
Cryotherapy eliminates fat by freezing the superficial fat layer that is exposed to external cooling pads. This cyro exposure results in superficial fat death and subsequent resorption by the body resulting in improved contour in the area under the cryo pad. Overall, a 20 % improvement in contour lines has been described. Unfortunately, patients must maintain their weight following this treatment.
With moderate weight gain, this area becomes prone to enlargement as the deep fat is prone to overgrowth when compared to the deep fat in the adjacent non-treated areas. I have hypothesized that this is due to a concept called pressure apoptosis. Pressure apoptosis is what prevents cells in your body from overgrowing and suffocating their neighbor cells.
When a cell feels pressure it stops growing! This makes intuitive sense. Now, since the areas treated with cryotherapy have lost their outer superficial fat compression, these deep fat cells preferentially start growing.
Options for treatment of PAH are limited due to the scenario created that involves:
a) treated area has increased deep fat and minimal superficial fat
b) the adjacent sites have moderate superficial fat and moderate deep fat
The only option in this scenario is to remove both layers of fat from all areas.
This creates a challenge for most providers since; a) repeat cryo lipolysis will only further compound the problem of only removing the protective superficial fat layer
b) traditional liposuction can only remove limited deep fat and cannot remove superficial fat.
The only viable option involves the use of ultrasound-assisted liposuction (VASER) which can definitively remove both the deep and superficial fat comprehensively.
The definitive treatment for PAH (paradoxical adipose hyperplasia) is the use of VASER ultrasound-assisted liposuction that allows for the comprehensive removal of both the deep and superficial layer of fat from both the cryo treated areas as well as the non-cryo-treated areas. This is accomplished by cavitating or melting the fat in both layers prior to the siphoning of the fat using conventional cannulas.
This advantage of VASER is because conventional cannulas cannot remove fat in the most superficial layer due to the fat being compartmentalized. The final component of treatment involves the need to tighten the skin in the bulging area which has occurred due to overgrowth of the deep fat.
Once the fat has been removed with VASER, the slack in the skin is observed are requires attention.
Termed subdermal coagulation, these combined energies allow for contraction of collagen molecules that subsequently contract the overlying skin without the need for any cutting!
We present definitive treatment of PAH using VASER technologies. If you have observed PAH we encourage you to make a complimentary virtual consultation to appreciate how the treatment is available today.
Please see this 51-year-old male who corrected with HD Liposuction.
