What are the Problems with CoolSculpting?

What is PAH? (Paradoxical Adipose Hyperplasia)

The medical definition broken down into non-medical terms:

Adipose is fat tissue

Hyper means high, beyond or excessive and plasia means growth or cellular multiplication

so Hyperplasia means an increase or excess in the number of cells or amount of tissue

A Paradox is something contradictory

So…Paradoxical Adipose Hyperplasia is a complication of CoolSculpting™ in which the opposite of what is intended happens; rather than decreasing fat cells, the patient experiences an increase of fat cells and tissue.

PAH is specifically a complication of Cryolipolysis, or attempting to destroy fat cells using freezing (“Cryo”) temperatures. It does not happen with body sculpting by laser, which uses heat to remove fat cells. (WarmSculpting™ or SculpSure™)  

With PAH, the increased fat cells in the treated area become firm over the few months following the treatment, leaving a hard, defined mass.  PAH appears to be permanent unless removed by surgery or a special type of liposuction.


What happened to Linda Evangelista?

Linda Evangelista recently revealed where she has been and why.  She reported having CoolSculpting™ treatments in 2015 and developing Paradoxical Adipose Hyperplasia that caused an increase in body and chin fat rather than a decrease. The supermodel has filed a lawsuit against the company, claiming it left her “permanently deformed” and ruined her career. “PAH has not only destroyed my livelihood, it has sent me into a cycle of deep depression, profound sadness, and the lowest depths of self-loathing,” she shared, adding, “In the process, I have become a recluse.”


How Common is Paradoxical Adipose Hyperplasia?

PAH seems to be more common than originally suspected.  The American Society of Aesthetic Plastic Surgeons recently reported (Nikolis,MD Nov 2020) in a multi-center study from January 2015 to December 2019 that the incidence may be as high as 0.039% This means that as many as 1 patient in 256 treatments may experience paradoxical adipose hyperplasia from CoolSculp™ treatments.


What are the Problems with CoolSculpting?

Other than PAH, there are other negative complications with CoolSculting™.  Because the device kills fat tissue by freezing it, the nerves under the skin can also be frozen, causing long-term numbness or pain.

CoolSculpting™ freezes only the tissue that is sucked into the treatment applicator which means tissue surrounding the area is unaffected.  This often leaves what people refer to as “the ridge”, “sharkbite” or “stick of butter” in which the borders of the treated area are sharply defined. It can appear as a sharp drop-off so that the margins remain permanently visible.


Is CoolScupting Safe?

Although there are problems with CoolSculpting™, the side effects are uncommon and not life-threatening.  Nerve damage and pain can be long-lasting and PAH is permanent unless further treatment with surgery is done, but the effects of PAH are cosmetic (and, as in Linda Evangalista’s case, possibly emotionally traumatic). Each patient must evaluate the risks.


Does PAH happen with WarmSculpting™ (SculpSure™)?

Paradoxical Adipose Hyperplasia does NOT occur with WarmSculpting™ (SculpSure™). PAH is a paradoxical reaction of adipose (fat) tissue specifically in response to extreme cold (Cryolipolysis). WarmSculpting™ utilizes heat to disrupt the fat cells and does not cause PAH.


Is WarmSculpting™ Safer than CoolSculpting™?

Both devices are effective, non-invasive body-sculpting devices.  Both are great options for targeting stubborn areas of fat that persist despite clean eating, regular workouts and even weight loss.  Both can destroy up to 24% of fat in the treated areas, per treatment. However, CoolSculpting™ carries the risk of some very unpleasant and even debilitating side effects that SculpSure™ does not cause.  WarmSculpting™ does not cause nerve damage, long-term pain, long-lasting painful lumps, “shark-bite” or paradoxical adipose hyperplasia (PAH).

Because WarmSculpting ™ (SculpSure™) is almost as easily accessible as CoolSculpt™ now, and is usually a more affordable option, why would you risk PAH and other complications?



At Skin Deep Laser MD, serving Fort Worth, Weatherford, Benbrook, Burleson, Mansfield, Granbury, and Arlington, Texas, Dr. Laura Riehm offers a range of aesthetic and age reversal options. 

To learn more about body sculpting and more, schedule a consultation with Dr. Riehm or her Team.  They will examine your skin and explain each treatment to help you decide which ones are right for you. You can schedule an appointment by calling 817-263-7546 or book online

Dr. Riehm Several years ago I dedicated myself to researching aesthetic medicine and anti-aging science to find the safest, most comfortable, most effective and best value options for skin and bring them all to Fort Worth. I started a new aesthetic laser practice (Skin Deep Laser MD) where I could safely offer the medical, more effective aspects of "med-spas" in a safe environment. I hope to start changing the industry to keep patients safe while we all benefit from advancing technology.

You Might Also Enjoy...

Signs of Premature Aging

Sun exposure, smoking, and stress can all lead your skin to begin wrinkling early. Here are the signs of premature aging you should be watching and how a good aesthetician can help.

How Can You Improve Your Skin Texture?

Ever wonder how you can regain the smooth, even skin texture you had when you were younger?  There are multiple ways to improve the quality, look and feel of your skin, improve texture and have your skin looking better with and without makeup.

What Are Chemical Peels?

Looking for a way to refresh your complexion? A chemical peel can get rid of old skin, reduce signs of aging, and even treat certain chronic conditions to improve skin quality.

Why is Melasma More Common in Women?

Nine out of ten people with melasma are female, which begs a few questions. What causes melasma in the first place, and why are women so much more prone to this skin condition?

Laser Hair Removal for Men

Laser hair removal is often marketed towards women for their legs, underarms, and bikini line, but men have plenty of places that can be cleaned up using laser hair removal techniques.