Paradoxical Adipose Hyperplasia After Cryoadipolysis Refractory to Tumescent Liposuction

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Current vacuum-assisted cryoadipolysis technology (Coolsculpting; ZELTIQ Aesthetics, Pleasanton, CA) uses controlled thermal diffusion to take advantage of the intrinsic cold-sensitivity of subcutaneous adipocytes, leading to safe, noninvasive localized fat reduction.1 Because triglycerides irreversibly crystallize within adipocytes at around 10°C, a temperature significantly greater than the freezing point of tissue water (0°C), subcutaneous fat can be preferentially targeted while sparing adjacent water-rich cutaneous and muscular tissue layers.2 Adverse events after cryoadipolysis are therefore typically mild and transient and include erythema, edema, pain, bruising, and numbness. Albeit rare, a delayed increase in adipose tissue localized to the treatment site, coined “paradoxical adipose hyperplasia” (PAH), is a recently reported potential significant adverse event after cryoadipolysis.3 The authors report a case of PAH post-cryoadipolysis that recurred after corrective therapy with tumescent liposuction.
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