Liposuction defines the ability to remove fat from your body to improve your body contour. The only liposuction alternative available today involves the elimination of fat from the superficial layer of skin by the use of a topical cooling appliance. Using cooling paddles on your skin, Coolsculpting can expose the most superficial fat layer to cold or hypothermia. In essence, the fat cells are frozen like getting frostbite which results in fat cell death and resorption. Once the fat cells have died, they are removed by the body resulting in fat elimination. Patients will typically undergo several treatments ranging from 2 to 4 sessions lasting one hour each. Coolsculpting claims to be painless although patients subjectively have expressed that there is discomfort. Finally, Coolsculpting claims to result in approximately 25% improvement in contour concern.
Coolsculpting is a liposuction alternative that can be performed in the office setting and will result in improvement in localized areas treated in the short term. The problem with Coolsculpting outcomes occurs when there is weight fluctuation in the long term. If there is moderate weight gain following treatments, there can be an overgrowth of the area that results in a contour abnormality far worse than the initial concern. The overgrowth of volume in the area is related to the overgrowth of the fat in the deep fat layer that was not amenable to removal by cryotherapy and is called paradoxical adipose hyperplasia (PAH). Instead, cryotherapy can only remove the superficial fat. A discussion of fat anatomy and physiology is needed to appreciate why removal of the superficial fat only is not prudent and why we do not recommend this liposuction alternative.
Fat is located in two layers; the superficial fat located under the skin and the deeper fat located above the muscle layer. The superficial layer is thinner in height and not dynamic; this means it is not dramatically affected by weight gain or loss. The deep layer is thicker and dynamic so that it is the layer dramatically affected by weight gain or loss. In PAH, the superficial and more protective layer is removed. It seems that when the superficial layer of fat is eliminated, the deeper fat will grow preferentially to other deep fat that is still covered by superficial fat. This will result in aggressive overgrowth of fat cells in the area of treatment paradoxically. Thus, the PAH deformity describes the unnatural overgrowth deformity previously described. As such, patients that have undergone cryotherapy and subsequently experienced weight gain are going to observe unnatural changes in their contour. Fortunately, using a combination of VASER ultrasound-assisted liposuction and excisional surgery, these deformities are being definitively treated today. If you are experiencing complications related to PAH following completion of liposuction alternative Coolsculpting, we urge you to contact our office for a complimentary consultation.