CoolSculpting & PAH — what every patient needs to know

Body Shaping

By Dr Mavis Pak · November 2024 · 5 min read

What is CoolSculpting?

CoolSculpting (cryolipolysis) is a non-invasive fat reduction treatment that uses controlled freezing to destroy fat cells. It became enormously popular in the 2010s as a non-surgical alternative to liposuction — and for many patients, it worked well with minimal side effects.

What is Paradoxical Adipose Hyperplasia (PAH)?

PAH is a rare but serious complication of cryolipolysis in which, instead of the fat cells being destroyed, they paradoxically grow larger and firmer in the treated area. The result is a visible, firm mass that is often worse-looking than the original fat pocket — and is notoriously difficult to treat.

PAH gained international attention when supermodel Linda Evangelista publicly disclosed that CoolSculpting had left her "brutally disfigured" and "permanently deformed," requiring multiple corrective surgeries. Her case was settled out of court for an undisclosed sum.

How common is PAH?

Estimates vary, but studies have reported PAH rates ranging from 0.05% to 0.39% of treated areas — which sounds low until you consider that CoolSculpting has been performed millions of times globally. Some researchers believe the true rate is higher due to underreporting. Men appear to be at slightly higher risk, as do patients treated with older applicator designs.

Why I moved away from fat freezing

The existence of PAH — even as a rare outcome — gave me pause. When evaluating body shaping technologies for my patients, I look for the best combination of efficacy, safety profile, and skin-tightening effect. Fat freezing scores poorly on the last two: it has no skin tightening effect, and it carries the PAH risk.

I now use two alternative platforms that I believe offer superior outcomes:

• Miglou (HIRONIC): Uses Coolwave microwave energy — the same technology as the globally recognised ONDA Pro system — to selectively disrupt fat cells without freezing. No PAH risk. Simultaneous skin tightening. Comfortable treatment with no downtime.
• Alma PrimeX Ultrawave: High-intensity focused ultrasound combined with radiofrequency for deep fat disruption and skin tightening in a single session.

What to do if you've had CoolSculpting

If you've had CoolSculpting and are concerned about PAH, or if you notice a firm, growing mass in a previously treated area, please consult a doctor promptly. PAH is treatable — typically via liposuction — but the sooner it's identified, the better the outcome.