CoolSculpting Side Effect - What to Know about PAH

No matter how much some people diet and exercise, there are times when stubborn fat just refuses to be eliminated from the body. In order to try and gain a more contoured look to the body, many patients turn to CoolSculpting which is a nonsurgical fat reduction procedure. While the use of an applicator and gel pad on the treatment area freezes the targeted fat enough that a suction device is able to remove it, there is a side effect that has caused some concern in the last year. Anyone who is interested in having CoolSculpting needs to know about the condition known as paradoxical adipose hyperplasia (PAH).

PAH – What is This Side Effect?

PAH is a condition that activates the stem cells that are responsible for growing new fat in the area of the body that is being treated. The new fat growth is tighter and denser on the body which makes the fat harder to eliminate.

Paradoxical adipose hyperplasia will start to gradually appear around a month or two after a CoolSculpting treatment. The fat can continue to enlarge for up to a year even though the BMI (body mass index) of a person can remain stable throughout the process. Overall, the results of PAH can be painful and unsightly and include the appearance of skin that is bulging and bumpy.

PAH – How Did it Enter the Public Discussion?

The possible side effects of PAH entered the public realm when Linda Evangelista, a supermodel who rose to fame in the 90s, filed a $50-million lawsuit against the parent company of CoolSculpting, Zeltiq Aesthetics.

In September of last year, Evangelista shared photos on Instagram detailing the side effects she suffered from CoolSculpting procedures she had between 2015 and 2016. She described the results of having CoolSculpting as leaving her “brutally disfigured.” According to the supermodel, her treatment triggered PAH which resulted in hardened, protruding fat masses on her body (instead of the desired slimmer look to the body) as well as a substantial amount of weight gain.

Even though the company behind CoolSculpting claims that the occurrence of PAH only develops in less than .1% of patients, there has been a growth in interest regarding PAH due to the news reports about Linda Evangelista.

PAH – What Causes it to Occur?

In general, PAH is most commonly seen in the treatment areas on the body of the patient. As to what causes paradoxical adipose hyperplasia to form on the body, nobody really seems to know the answer to that question. It is also unknown why PAH develops in some patients and does not appear in others that undergo CoolSculpting. Without knowing why PAH randomly develops in some patients, there is not a clear way to mitigate the risk in those who decide to have the treatment.

However, there are multiple contributing factors that seem to be responsible for increasing the risk of developing PAH. These contributing factors include the duration of the CoolSculpting session, the use of a negative pressure suction and also the use of a large handpiece during the treatment. It has been speculated that the idea behind the negative pressure suction being a cause of PAH can be supported by the decrease in the reported incidence of PAH related to the use of newer handpieces that lack suction.

PAH – Can it Be Fixed?

Once PAH has developed on the body, a patient should not have another CoolSculpting treatment as this will result in additional fat cells growing on the body. The best way to treat the issue is either liposuction or an excision procedure to remove the impacted areas.

Even if these treatment options deliver the desired results, that does not mean the issue of PAH has been successfully dealt with on the body. There have been reports of PAH occurring again in the areas of the body where it was removed. Plus, liposuction that is performed on this type of fat has proven to be difficult to remove along with results that have proven to be unpredictable.

As mentioned earlier in this article, the inventors behind CoolSculpting have said the occurrence of PAH only develops in less than .1% of patients. This number is based on the number of cases in a first report, published back in 2014, as opposed to the number of treatments administered by medical professionals. However, as more reports are gathered, the total incidence has also increased, and current estimates reported by the manufacturer are .025% which equals one per four thousand cycles. In addition, another analysis has put the incidence rate closer to .15% or one per 666 cycles.

Patients interested in having CoolSculpting need to remember that medical procedures always have the chance of side effects occurring during, or after, the treatment. They should take the time to discuss possible risks and adverse effects that can be part of having CoolSculpting (with a doctor) in order to make an informed decision about having the treatment.

- MA