whether this proposed phenomenon stems from the -10°C cooling effects or from the physical injury due to negative suction requires further investigation. Currently, the treatment of choice for PAH is liposuction. Other treatments of cryolipolysis are not recommended for PAH as this may worsen the condition.17 We recommend the use of small applicators (with a smaller surface area treated per treatment) as many instances of PAH have been associated with large applicators, particularly in patients who may be predis- posed to developing PAH (male sex and of Hispanic or Latino descent). We encourage patients to consult body contouring experts, such as dermatologic surgeons who are experienced with cryolipolysis, as they are trained in non-invasive procedures and have made the largest clinical and scienti c research contributions to cryolipolysis.29 We believe that all patients should be fully informed of the potential adverse effects from cryolipolysis, and realistic expectations should be discussed 
