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

January 2017 | Volume 16 | Issue 1 | Original Article | 62 | Copyright © January 2017

Derek Ho BSa,b and Jared Jagdeo MD MSa,b,c

aSacramento VA Medical Center, Mather, CA bUniversity of California Davis, Sacramento, CA cState University of New York Downstate Medical Center, Brooklyn, NY

prior to treatment. Regular follow-up visits are important as patients may be self-conscious, however timely diagnosis and surgical management of PAH may yield excellent outcomes. Limitations of this systematic review include lack of published speci cations of applicator size and treatment settings regarding whether suction was applied. Faster (35 minutes), colder (-11°C) applicators and updated recommended treatment settings have been released that function with or without suction. Based upon the published literature, we believe that the current incidence of PAH may be higher than reported.This may be due to a combination of factors: PAH was previously underrecognized or underreported and cryolipolysis is among the fastest growing non-invasive body sculpting procedure employed today. 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 envision future studies may utilize molecular assays and genomic evaluations to characterize involvement of key pathways responsible for PAH. PAH is signi cant as cryolipolysis is becoming more widely available and performed by physicians and non-physician technicians in outpatient clinics, med spas, and aesthetic of faces. 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.


DH has no con icts of interest to disclose. Dr. Jagdeo is a sci- entific consultant for Zeltiq. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.


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Jared Jagdeo MD MS jrjagdeo@gmail.com