What Is Paradoxical Adipose Hyperplasia?

Medically Reviewed on 10/28/2021
paradoxical adipose hyperplasia
Paradoxical adipose hyperplasia is a rare side effect of the cosmetic procedure called cryolipolysis, resulting in mass or swelling under the skin.

Paradoxical adipose hyperplasia is a rare side effect of the cosmetic procedure called cryolipolysis.

It is called so because the cryolipolysis procedure is expected to reduce the fatty or adipose tissue deposits, which are paradoxically increased (hyperplasia) in this side effect.

The symptoms of paradoxical adipose hyperplasia may appear a few days to weeks after cryolipolysis.

  • The treated area feels thicker and firmer.
  • A mass or swelling may be felt under the skin and is often slightly painful to touch.
  • It may gradually increase in size although the severity of hyperplasia may vary from moderate to severe.
  • The treated area may develop hard lumps due to unequal fat distribution under the skin.

What is cryolipolysis?

Cryolipolysis, popularly called CoolSculpting, is a popular cosmetic procedure that uses very cold temperatures to destroy fat cells. It is a minimally invasive procedure requiring no sedation and is generally done in outpatient settings to safely remove stubborn fat deposits without any downtime.

Millions of cryosculpting procedures are performed globally and most have minimal side effects, such as:

  • swelling,
  • redness,
  • bruising,
  • tingling,
  • numbness, or
  • darkening of the treated area.

Most of these side effects completely resolve in a few months. 

A rare, but serious, side effect of this procedure is paradoxical adipose hyperplasia that increases the number of fat cells in the treated area.

Is paradoxical adipose hyperplasia cancerous?

No, paradoxical adipose hyperplasia is a benign (noncancerous) condition. It may, however, cause significant disfigurement. Thus, the affected person may have considerable emotional stress due to this side effect.

What are the risk factors of paradoxical adipose hyperplasia after cryolipolysis?

Paradoxical adipose hyperplasia is a rare side effect seen in less than one percent of the patients undergoing cryolipolysis. The definitive causes and risk factors of paradoxical adipose hyperplasia are not well understood.

Some of the potential risk factors of this condition include:

  • Male gender (males are about three times more likely to be affected than females)
  • Genetic predisposition
  • Use of a large handpiece during the procedure
  • A cryolipolysis procedure done in the past
  • Hispanic or Latino origin
  • Cryolipolysis done on the abdominal region

Can paradoxical adipose hyperplasia be reversed?

Paradoxical adipose hyperplasia does not go away on its own. Most affected people require corrective surgeries, such as excision or corrective liposuction. Because these procedures are invasive, many people do not appreciate them, since most people chose cryolipolysis in the first place because of its noninvasive nature.

An abdominoplasty or tummy tuck procedure may be needed along with liposuction surgery in some people with paradoxical adipose hyperplasia affecting the abdomen. Repeated surgeries may be needed in severe cases.

Some people may choose to undergo the additional laser lipolysis or a repeat cryolipolysis procedure, but the results may not be satisfactory. Often, the corrective surgery is delayed for a few months after cryolipolysis to allow the treated area to soften.


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Medically Reviewed on 10/28/2021
Image Source: Daniel Chetroni / Getty Images

Nikolis A, Enright KM. A Multicenter Evaluation of Paradoxical Adipose Hyperplasia Following Cryolipolysis for Fat Reduction and Body Contouring: A Review of 8658 Cycles in 2114 Patients. Aesthet Surg J. 2021 Jul 14;41(8):932-941. https://pubmed.ncbi.nlm.nih.gov/33216910/

Kelly ME, Rodríguez-Feliz J, Torres C, Kelly E. Treatment of Paradoxical Adipose Hyperplasia following Cryolipolysis: A Single-Center Experience. Plast Reconstr Surg. 2018 Jul;142(1):17e-22e. https://pubmed.ncbi.nlm.nih.gov/29952891

American Society of Plastic Surgeons. Nonsurgical Fat Reduction. https://www.plasticsurgery.org/cosmetic-procedures/nonsurgical-fat-reduction/cryolipolysis