“This is the THIRD case within a month! I thought it is supposed to be a rare complication!”
That was the thought I had when I was assessing a young lady who had fat freezing, also known as cryolipolysis, on both arms 8 years ago, presented with disproportionately enlarged fat ‘lumps’ on both her treated areas soon after. The fat ‘lumps’ had grown in size over the past years, making her arms looked rather strange. It had affected her so much that she dared not wear any short sleeve or sleeveless attire all these years.
She suffered from what I called Paradoxical Adipose Hyperplasia or PAH in short. Paradoxical adipose hyperplasia is a rare delayed side effect following a fat freezing treatment. In this condition, the treated area becomes larger rather than smaller in the weeks after the procedure.
The cause of this phenomenon is unknown. What is known is that it is a rare delayed side effect following cryolipolysis due to possible unintended stimulation of tissue growth, following a treatment that injures the target tissue. The risk of PAH is reported to be 1/4000 by the manufacturer and apparently higher in males.
It is supposed to be rare, but I had seen my fair share of patients over the years. A recent study done by Dr. Michael Kelly and Dr. Jose Rodríguez-Feliz in Plastic and Reconstructive Journal in 2018, showed that the complication rate is, in fact, much higher at 1/138. While this is still an incidence rate of less than 1 percent, it concerns me as a physician —particularly one with such strong claims of safety and ease. And, with a proliferation of cryolipolysis devices and at-home fat freezing belts on the market, PAH is something we need to pay closer attention to.
Unfortunately, PAH, once developed, is PERMANENT and can only be treated with liposuction. I had successfully treated these patients over the years and patients were usually very relieved to be able to look normal again.
I still remembered a patient suffered from PAH who came with his father for consultation not too long ago. During the consultation, his father mentioned that he was distraught with guilt since his son developed this condition a few years ago, as he was the one that brought him for the fat freezing treatment. His son suffered from depression after that. He blamed himself ever since.
PAH is an uncommon complication, and most patients are not informed of this when they underwent for fat freezing treatment. So when patients suffered from this, they are usually very distressed and unprepared, often unaware of the available treatment options.
Patient education and counselling are critical before treatment. It is essential that the doctors thoroughly explains the condition and addresses concern and worry of the patients. Fortunately, PAH is highly treatable, and most patients are extremely pleased with their end results.
