Definitive Treatment of PAH (Paradoxical Adipose Hyperplasia)

Definitive Treatment of PAH Paradoxical Adipose Hyperplasia

Definitive Treatment of PAH (Paradoxical Adipose Hyperplasia)

Please see this 51-year-old male who corrected with HD Liposuction and Renuvion skin tightening.

What is Paradoxical adipose hyperplasia (PAH)?

Paradoxical adipose hyperplasia (PAH) describes the development of localized fat growth in areas previously treated with Coolsculpting cryotherapy. Patients are routinely seen at our office who have observed paradoxical overgrowth of fat and the subsequent bulge in the area previously treated with cryotherapy.

Please see the excised area demonstrating the hyperproliferation of fat in the localized area of cryotherapy compared to adjacent fat layers.

Body Lift Incisions - PAH (Paradoxical Adipose Hyperplasia)

Patients with paradoxical adipose hyperplasia often admit to moderate weight gain! This clinical feedback has led us to hypothesize on the mechanism of paradoxical adipose hyperplasia (PAH) and subsequent definitive treatment for PAH that was published in the Journal of American Cosmetic Surgery in 2020.

Cryotherapy is a cosmetic procedure that eliminates fat by freezing the superficial fat layer exposed to external cooling pads. Cryolipolysis treatments result in superficial fat death and subsequent resorption by the body resulting in improved contour in the area under the cryo pad. Overall, a 20 % improvement in contour lines has been described as an alternative to a . Unfortunately, patients must maintain their weight following this treatment or risk the development of PAH.

With moderate weight gain, this area becomes prone to enlargement as the deep fat is vulnerable to overgrowth compared to the deep fat in the adjacent non-treated areas. We have hypothesized that this is due to a concept called pressure apoptosis. Pressure apoptosis prevents cells in your body from overgrowing and suffocating their neighbor cells.

When a cell feels pressure, it stops growing! This makes intuitive sense. Now, since the areas treated with cryotherapy have lost the external compression force from the superficial fat cells, these deep fat cells preferentially start growing, termed paradoxical hyperplasia.

Treatment options for PAH are limited due to the scenario created that involves a) treated areas that possess great deep fat and minimal superficial fat and b) the adjacent site areas that have moderate superficial fat and moderate deep fat. The only option in this scenario is to remove both layers of fat from both areas.

This creates a challenge for corrective surgeries that includes a) repeat cryo lipolysis will only further compound the problem of only removing the protective superficial fat layer, and b) traditional liposuction can only remove little deep fat and cannot remove superficial fat. The only viable option involves using ultrasound-assisted (VASER), which can completely remove both the deep and superficial fatty tissues comprehensively.


The definitive treatment for PAH (paradoxical adipose hyperplasia) is the use of VASER ultrasound-assisted liposuction that allows for the comprehensive removal of both the deep and superficial layer of fat from the cryo-treated areas as well as the non-cryo-treated areas. This is accomplished by cavitating or melting the fat in both layers before siphoning off the fat using conventional cannulas.


This advantage of VASER is that conventional cannulas cannot remove fat in the most superficial layer due to the fat being compartmentalized. The final component of treatment involves the need to tighten the skin in the bulging area, which has occurred due to the overgrowth of the deep fat.

Once the fat has been removed with VASER, the skin’s slack is observed and requires attention. Using the novel technology of Renuvion, the redundant skin can be magically contracted by using combined energies of Helium activated plasma and radiofrequency.

Renuvion Newport Beach

Termed subdermal coagulation, these combined energies allow for the contraction of collagen molecules that subsequently contract the overlying skin without the need for any cutting!

We present a definitive treatment of PAH using combined VASER and Renuvion technologies. If you have observed PAH, we encourage you to make a complimentary virtual consultation to appreciate the available treatment today.

Scroll to Top