A Systematic Review of Paradoxical Adipose Hyperplasia (PAH) Post-Cryolipolysis

J Drugs Dermatol. 2017 Jan 1;16(1):62-67.


Background: Body sculpting, or body contouring, is among the fastest growing areas in cosmetic dermatology. Cryolipolysis, or "fat freezing," was FDA-cleared (CoolSculpting System, ZELTIQ Aesthetics, Pleasanton, CA) initially in 2010 for fat removal of the anks, and subsequently received FDA-clearance for other anatomical locations. Over the past several years, there have been increasing published reports and physician discussion regarding paradoxical adipose hyperplasia (PAH) post-cryolipolysis, previously identified as a "rare" adverse effect.

Objective: To review published reports of PAH post-cryolipolysis, expand on previously proposed hypothesis of PAH, and provide rec- ommendations for prevention and treatment of PAH.

Methods and materials: On July 26, 2016, we systematically searched the computerized medical bibliographic databases PubMed, EMBASE, Web of Science, and CINAHL with the search term "cryolipolysis."

Results: A total of 314 records were returned from our search terms and 10 records were found to be suitable for our review. We identi- ed a total of 16 cases of PAH post-cryolipolysis in the published literature.

Conclusions: Based upon the published literature, we identi ed that the current incidence of PAH may be higher than previously re- ported. Although the pathoetiology of PAH is currently unknown, we hypothesize that some adipocytes may be "naturally selected" for survival due to their inherent tolerance to cryolipolysis. We believe that while cryolipolysis is an effective non-invasive treatment option for body contouring, physicians and patients should be aware of PAH as a potential adverse effect and treatment options. <em>J Drugs Dermatol. 2017;16(1):62-67.</em>.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adipose Tissue / metabolism
  • Adipose Tissue / pathology*
  • Adiposity / physiology
  • Cosmetic Techniques / adverse effects*
  • Cryotherapy / adverse effects*
  • Cryotherapy / methods
  • Humans
  • Hyperplasia / diagnosis
  • Hyperplasia / etiology
  • Lipolysis / physiology*
  • Subcutaneous Fat / metabolism
  • Subcutaneous Fat / pathology*
  • Treatment Outcome