Not everything lives up to its promises … CoolSculpting promised an easy fix for stubborn fat without surgery. This device freezes fat cells in targeted areas, causing them to die and to be reabsorbed by the body, purportedly leaving you with a flatter stomach, slimmer thighs/arms and/or a more defined jawline. But, this was unfortunately not always the case. According to a recent New York Times article, in rare cases, treated areas developed paradoxical areas of increased fat, known as paradoxical adipose hyperplasia (PAH). In order to correct this new issue, liposuction/surgery is usually required.
So why do so many people continue to get CoolSculpting? A 2020 study on PAH, found that it is likely underreported and misdiagnosed. One reason is that the side effects of CoolSculpting can take months to become visible, so patients may not attribute the localized areas of increased fat to CoolSculpting. In cases where the effects are subtle, some patients could simply believe it was related to weight gain.
Famous supermodel Linda Evangelista opened up about her battle after her CoolSculpting treatment in 2021. That same year, the FDA received over 1,100 reports of patients with adverse events following their CoolSculpting treatment. In 2022, over 1,900 reports were filed by people experiencing adverse effects.
What now? If you still want to remove stubborn fat (whether or not you’ve had CoolSculpting), but don’t want to undergo general anesthesia/major surgery, tumescent liposculpture is the safest option. Patients having tumescent lipo are treated with just local anesthesia, meaning he/she is awake, but feels no pain. Another benefit of tumescent anesthesia is that the epinephrine in it causes your blood vessels to constrict, which results in less post-procedure bruising! Yes, please! We are also able to use a thinner cannula to remove the fat, which allows us to achieve a more precise result with almost imperceptible scars. Another benefit of tumescent liposculpture is – instead of disposing of the fat – we can easily transfer some/all of the removed fat to other areas of your body, shaping you into your desired aesthetic!
Frequently Asked Questions
What is paradoxical adipose hyperplasia?
An area of increased fat that develops where CoolSculpting was performed — the opposite of what the device is meant to do. A New York Times article reported it in rare cases, and correcting it usually requires liposuction or surgery.
Why might someone not connect it to their treatment?
A 2020 study found PAH is likely underreported and misdiagnosed. The side effects can take months to become visible, so patients may not attribute the localized areas of increased fat to CoolSculpting — and where the effect is subtle, some simply believe it was weight gain.
What does Dr. Kiripolsky offer instead?
Tumescent liposculpture, which she describes as the safest option for removing stubborn fat without general anesthesia or major surgery. Patients are treated with local anesthesia only — awake, but feeling no pain — and the epinephrine in it constricts the blood vessels, which results in less post-procedure bruising.
Monika Kiripolsky, MD, FAAD, FAACS
Board-certified dermatologist and fellowship-trained laser and cosmetic surgeon in Beverly Hills and Newport Beach. Every article is written or reviewed by Dr. Kiripolsky.
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