Commentary on: Paradoxical Adipose Hypertrophy (PAH) After Cryolipolysis

Extract

Paradoxical adipose hypertrophy (PAH) after cryolipolysis is a common and concerning complication associated with cryolipolysis body contouring. Body contouring, or body sculpting, procedures are the fastest growing procedures in aesthetic medicine. According to the American Society for Dermatologic Surgery (ASDS), approximately 387,000 body sculpting treatments were performed in the United States in 2016.¹ The number of body sculpting treatments has risen 68% since 2015, which was the largest year-to-year growth of all cosmetic procedures.¹ Within body sculpting procedures, cryolipolysis, or “fat-freezing,” accounted for 177,000 treatments or 45.7% of all body contouring treatments. In fact, cryolipolysis surpassed the growth rate of body sculpting treatments by increasing 76% from 2015 to 2016.¹

While cryolipolysis has grown in popularity as a noninvasive approach to body contouring, it also has common potential adverse effects (eg, erythema, edema, and neuralgia). Most of these common side effects are mild to moderate and transient, often lasting several weeks to months. However, a fraction of patients in clinical studies and clinical practice have developed firm, nontender, well-demarcated areas of increased fat volume in treated areas approximately two to six months after cryolipolysis. This side effect is termed paradoxical adipose hypertrophy (PAH). PAH is a concerning, clinically significant complication because patients undergo cryolipolysis to remove fat, but instead the volume of fat increases at a treatment site, resulting in a completely opposite, undesirable outcome.