As a Plastic Surgeon with over 25 years of experience optimizing body contours, both surgically and non-surgically, I have seen the “good”, the “bad” and the “ugly” of cosmetic surgical & non-surgical trends and the associated eye-catching headlines that go along with them. The recent headlines associated with a social influencer suing the makers of CoolSculpting™ is another example of the “ugly” side of the industry. Headlines are designed to catch your attention, but they often do not tell the entire story.
In my practice I chose to not offer CoolSculpting™ for a variety of reasons. A small, but important reason, was the potential side effect profile that includes Paradoxical Adipose Hyperplasia (PAH). We have known for over a decade that PAH occurs infrequently following CoolSculpting™ treatments and that the vast majority of patients do not experience this unfortunate side effect. Historical data has shown that only between 0.3% and 3% of patients experience PAH, which results in the growth of fat tissue instead of shrinkage. If we exclude the dis-reputable and often poorly credentialed CoolSculpting™ providers from the list, it is highly likely that every patient electing to have this treatment was educated on the associated risks, including the risk of PAH and other rare complications, prior to treatment. No patient expects a complication will happen to them, but every patient is made aware that these events could occur.
When PAH does occur, it presents as a defined area of fat tissue growth, often in the geometrical shape of the applicator used. If it does occur, liposuction or other fat reduction treatments can be successful at correcting or minimizing the appearance of the excess volume. With that being said, not every liposuction or treatment provider has the necessary experience to effectively treat PAH. The characteristics of PAH make liposuction a more complex procedure and therefore clients looking for a provider should do their research and ask the right questions to determine the best physician for their procedure.
Over the last decade, only ‘fat -freezing” body contouring technologies have been associated with PAH. This is one of the reasons why in our facility we offer two non-surgical, fat reducing platforms that use either laser or radiofrequency energy to selectively damage superficial fat with heat, to sculpt the body. PAH has not been associated with CynoSure’s Sculpsure™ or InMode’s Evolve™ Trim treatments but the clinical studies also show these treatments to be as effective or even more effective at reducing fat when compared to CoolSculpting™.
Although we sympathize with the mental and physical distress associated with PAH, we do not know all of the details of this former supermodel’s story. The sensational headlines surrounding this story do not accurately represent the patient experiences that I’ve encountered when I have been asked to help correct PAH in patients from other clinics. At the end of the day, stories & articles like this one should not cause patients to fear or boycott treatments, but instead encourage them to ask more questions. This includes asking about all risks of the procedure as well as whether or not their provider has the credentials and experience to manage the complications that could occur. We encourage our patients to be an informed consumer and to work with their physicians when rare complications or disappointments occur in order to get the best outcomes possible.