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Paradoxical Adipose Hyperplasia 

10/2/2014

9 Comments

 
Picture
from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171727/
This past week I saw a patient with Paradoxical Adipose Hyperplasia (PAH).  What is PAH? It’s an extremely rare complication of CoolSculpting where the treated area gets larger rather than smaller.  It was the first time I had seen a case like this, but something I had read about before.  We have been performing CoolSculpting since March 2010, long before anyone else in San Antonio, and I have never had a case of PAH.  So far, the causes for PAH have not been found, so it doesn’t seem that this is a preventable complication.  Although unavoidable, it is treatable by a qualified Plastic Surgeon

The patient is a healthy lady who went to a Dermatologist in San Antonio to have her upper back/bra fat treated.  After her first treatment, the area felt hard.  When she went for a follow up, they decided to treat her again, since she didn’t have any reduction.  After the second treatment, the treated areas became even larger.  Now the skin has stretched and she looks worse than when she started.   We talked about options and discussed either cutting out the areas, or trying laser liposuction in an attempt to get some skin contraction.

Unfortunately, she did not go to a Plastic Surgeon first for her CoolSculpting.  Sure, I’m biased, but I think that the best person to evaluate and recommend treatments is a Board Certified Plastic Surgeon.  We have extensive training on body contouring and can recommend the best treatment whether it is surgical or non-surgical.  Not to say I would have recommended anything different at the beginning, but now that there is a complication, she NEEDS to see a Plastic Surgeon.  At least if she had seen a Plastic Surgeon first, she would not have the delay in treatment that she has now.  There are many places out there to get your CoolSculpting, you want to make sure that the provider you see is a Board Certified Plastic Surgeon.  To learn more about the training of plastic surgeons, refer to this info from the American Society of Plastic Surgeons.

This patient said she did not see a Plastic Surgeon first because she did not want surgery and figured if she went to a Plastic Surgeon they would have just wanted to operate.  I get that perception, but the best Plastic Surgeons know when to operate and when not to operate.  It is important to see a Plastic Surgeon who offers the full spectrum of treatment.  Some place like Advanced Concepts in Plastic Surgery where we offer CoolSculpting, Cellulaze, and Traditional Liposuction.  All of our patients are seen by me before any procedure and we have a thorough discussion about your goals and if they are realistic.  If I don’t think CoolSculpting is for you, I’ll let you know.  Similarly, if you are not a good surgical candidate or if you just need to lose weight, I will let you know.

There is an old saying often quoted in Plastic Surgery that goes something like this: “If the only tool in your box is a hammer, then all the world is a nail”.  So, if you go to a provider who is not a Plastic Surgeon and the only tool they have to reduce fat is CoolSculpting, then all the world is one big FAT nail.  If you are considering CoolSculpting, see someone that has many tools in their toolbox.

One other thing to consider when choosing a CoolSculpting provider is: “Can the Physician handle all of the complications?”.  If the provider you visit cannot perform excision or liposuction of the area should PAH occur, you should keep looking for someone who can.

I hope I have convinced you of the importance of choosing wisely when looking into CoolSculpting.  You need someone with Experience who has been doing CoolSculpting for several years.  They should have the Expertise to be able to handle any complications.  Make sure they have a Reputation for Excellence as evidenced by reviews and recommendations.  Finally, they should provide Personalized Care and choose the treatment that is right for you and in line with your goals.  If you need help finding someone who fits all these criteria, just give Linda or Hilda a call and they’ll set you up with the Plastic Surgeon who is right for you!
9 Comments
samrita link
2/1/2015 01:43:03 am

Hi,

I had been to a board certified plastic suregeon for my coolscultping treatment in the first place to get my upper and lower abdomen treated. Initially I saw a reduction and then four months down the line my horror story started. I say increase in size in my stomach. A year latet my treated areas are double the size of what it was before. No diet no exercise has helped and I also have developed a lump near my left rib bone. I dont think there is anything that will help with the side effects. I hoped the side effects were temprorary but a year later I am pretty sure I am wrong and I made a call to make a permanent damage to my body. I am disappointed and depressed about the fact that coolsculpting is not so cool and the side effects are irreversible. Let me know if you can help

Thanks

Reply
Dr Koneru
2/9/2015 11:36:45 pm

Sorry to hear of your troubles. I would recommend returning to the surgeon who treated you and seek their opinion. They may be able to provide some simple solutions for you.

Reply
educated decision link
4/23/2015 04:12:06 am

Agreed that you should see a board certified physician but to only recommend a plastic surgeon for this shows simple ignorance or arrogance. This complication of PAH has mainly been described by dermatologists (Paradoxical Adipose Hyperplasia After Cryolipolysis. JAMA Dermatol. 2014 Mar; 150(3): 317–319 and Jalian HR, Avram MM, Anderson RR. Rare Side Effects of Cryolipolysis. American Society for Laser Medicine and Surgery; Boston, MA: 2013. ).

Did you know that a dermatologist revolutionized liposuction? It is now safer than ever before using tumescent technique (JA Klein. The tumescent technique for liposuction surgery. Journal of the American Academy of Cosmetic Surgery, volume 4, pages 263-267,1987).

Thank you to all the great plastic surgeons AND dermatologists!

Reply
Suresh Koneru link
5/7/2015 01:42:03 pm

Thanks for the comments. I guess you can call it arrogance on my part, but I did mention that I was biased ;).
Actually, Dermatologists, like Dr. Klein, have contributed a lot to the treatment of fat. Popsicle panniculitis on which cryolipolysis is based was first described by Dermatologists. In fact, the CoolSculpting technology was developed by a brilliant Dermatologist who was one of the authors of the PAH article that you re-cited in your comments (Anderson RR).
The point of my post is that patients should
1. seek a physician with experience
2. make sure the physician they choose can handle any complications.

These are 2 basic things I believe patients should always look for before undergoing any procedure.

Reply
Need Help finding a qualified doctor!!!!
9/29/2015 12:47:43 pm

Love the banter between you both, but neither offer advise to someone going thru this scenario as to determine who would be a qualified doctor to help me fix my problem. I did have the procedure done in a board certified dermatologists office, but this side affect never mentioned nor does the doctor do plastic surgery, so how do I find a qualified doctor to avoid more bad experiences?

Reply
Dr. Suresh Koneru link
9/29/2015 03:36:26 pm

Thanks for your question. Sorry I was not more clear in the post.
If you are in the San Antonio area, we would be happy to see you. Just give the office a call.
If you are not in S.A. then I would recommend you first visit the Dermatologist where you had the procedure done so that they can document the reaction. Then, they may have a Board Certified Plastic Surgeon that they work with and can refer you there. If not, I would choose a Board Certified Plastic Surgeon who also performs CoolSculpting. The best place to search for a Plastic Surgeon is at the American Society of Plastic Surgeons site: http://www1.plasticsurgery.org/find_a_surgeon/

I hope this helps.

Reply
Sammy link
11/9/2016 11:08:52 am

I recently has this done and it was a great decision. Very little pain and I was back at the gym in 3 days.

Reply
Amy link
11/2/2018 12:00:53 pm

I have PAH and was wondering is the only way to get rid of it is by getting Traditional Liposuction? I have had it since 2015. I have had no results with working out. Its awful.

Reply
Dr. Koneru
11/4/2018 09:05:54 am

Sorry to hear that you have had problems. Right now, the recommended treatment for PAH is liposuction.
I would recommend you contact the center that performed the CoolSculpting treatment on you. Let them see you and document that this is in fact what you have. They are your best resource. If you are in the San Antonio, Texas area, we would be happy to see you in our office.
Good Luck!

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    Suresh Koneru, MD

    Dr. Koneru is a Board Certified Plastic Surgeon and the first physician to offer Coolsculpting in South Texas.
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