What is Paradoxical Adipose Hyperplasia?
Paradoxical Adipose Hyperplasia (PAH), otherwise known as paradoxical hyperplasia, is a rare, but noticeable side effect of a popular non-surgical fat reduction procedure known as CoolSculpting®. Basically, PAH happens when the fat in the area treated with CoolSculpting® grows larger instead of smaller. These changes usually happen several weeks to months after the procedure and are mostly painless, though the affected area would feel firmer than usual.
This condition can bring about significant emotional distress to the person experiencing it. Recently, supermodel Linda Evangelista shared her own struggle with PAH, inspiring more conversations about the condition and the effects it can have on a person’s confidence and career.
It appears that PAH happens more frequently than what was initially thought – some studies suggest that it might occur in roughly 1 out of 50 instances of CoolSculpting® treatments. The reasons behind why PAH happens are not entirely clear yet. There are several theories up to now, which include the idea that it might be due to fat cells growing larger, new fat cells being formed, changes in the way our body manages fat cells, or even damage due to lack of oxygen and the suction applied during the procedure. When it comes to treatments for PAH, the thickened fat tissue is typically removed through liposuction, surgical removal, or a combination of both.
What Causes Paradoxical Adipose Hyperplasia?
The exact cause of PAH, or Paradoxical Adipose Hyperplasia, is not fully known. However, it’s very important to try and recognize any potential risks that could lead to developing this condition. This helps to manage patient expectations and understand potential complications. It’s not completely clear what increases a person’s risk of developing PAH, but some studies have shown a connection with different factors, like being of Hispanic descent, being male, using one large applicator, and receiving treatment in the abdominal area. But, it’s also worth noting that many people who develop PAH don’t have any known risk factors.
In an interesting case, a pair of twins both developed PAH after going through a procedure known as cryolipolysis at two different outlets, suggesting there might be a genetic component to this condition. It’s also been suggested that high levels of testosterone could increase the chances of developing PAH. On a different note, a study found that newer models and applicators used in cryolipolysis procedures led to a 75% drop in the number of PAH cases. This suggests there may have been mechanical issues with older models that contributed to more people developing PAH.
Risk Factors and Frequency for Paradoxical Adipose Hyperplasia
It’s important to note that PAH, or Paradoxical Adipose Hyperplasia, is likely more common than what’s typically reported. It was first identified in 2014, where it was estimated to occur in 1 out of every 20,000 treatments. However, as we learn more about this condition, the reported cases have increased.
When we talk about PAH, we usually measure its occurrence per treatment or cycle. But this can hide the actual risk for patients who undergo multiple treatments targeting different body areas. To make it even more complex, patients usually have repeat sessions every 4 to 8 weeks. That means that a patient’s risk of getting PAH could add up with each session and be higher than the reported rate, particularly for patients who go through several procedures. Therefore, it’s important to assess risks and consult with patients while keeping in mind the total number of treatments received.
- The most recent data from the manufacturer in 2021 estimated PAH at 0.033% or 1 in 3000 treatments.
- However, a comprehensive review in 2020 found the incidence to be approximately 0.91% or 1 in 110 treatments, which is 27 times higher than the manufacturer’s estimate.
- Despite these differences in reporting, some estimates even suggest that the actual rate could be as high as 2%.
Signs and Symptoms of Paradoxical Adipose Hyperplasia
PAH, or Paradoxical Adipose Hyperplasia, typically shows up within a year following a procedure known as cryolipolysis. This condition is recognized by a pain-free, solid, and clearly defined increase in fat tissue which is limited to the area that received treatment. The growth of this tissue happens over time and usually settles down after a few months. PAH has been observed in all areas approved for treatment, such as the stomach, chin area, upper arms, sides of the torso, thigh and the area around the bra line.
To accurately diagnose PAH, a detailed medical history and physical examination are necessary. In discussing the patient’s medical history, doctors should ask about certain details pertaining to the cryolipolysis treatment, such as when and where it was conducted, and whether the patient has undergone any previous cosmetic procedures. The physical test should pay special attention to the physical characteristics of the impacted tissue – looking for firmness and a bulging appearance that is typically associated with PAH. The shape of the impacted tissue usually looks similar to a “stick of butter,” reflecting the shape of the applicator used. Furthermore, it is often firmer than the surrounding unaffected areas.
Testing for Paradoxical Adipose Hyperplasia
When a patient is suspected to have PAH, a type of condition where fat grows excessively, a detailed clinical evaluation is necessary to make sure it isn’t some other complication after a medical procedure. If doctors suspect PAH, they use what is known as imaging studies to find out how much fat growth there is and to make sure it’s not another condition like lipomas or just localized fat deposits.
These doctors use an ultrasound, which is a tool that uses sound waves to create pictures of the inside of your body, to study how thick and dense the fatty tissues are. Computed tomography (CT) scans and magnetic resonance imaging (MRI) are also used. A CT scan uses x-rays to make detailed pictures of structures inside of the body while an MRI uses a magnetic field and computer-generated radio waves to create detailed images of the organs and tissues in your body.
These scans often show an increase in the layer of fat under the skin and confirm that these changes are only in the area that received previous treatment. An MRI is particularly helpful in providing a detailed picture of the structure of the tissues. It also ensures there are no signs of inflammation or cancerous changes.
Although it’s rarely necessary, a biopsy might be performed. This is a procedure where a sample of body tissue is removed and studied to rule out other diseases. It gives doctors a closer look at what’s going on inside the fatty tissues, just to make sure they’re not dealing with another condition.
Treatment Options for Paradoxical Adipose Hyperplasia
The impact of non-surgical methods for reducing fat, such as cryolipolysis, on treating PAH (a complication that can happen after procedures such as cryolipolysis which leads to unusual growth of fat tissue) is still not fully understood. Additional sessions of cryolipolysis are not advised, as they might worsen PAH symptoms and lead to more tissue growth.
One suggested treatment for PAH is cytolytic therapy such as deoxycholic acid (DCA), a drug given by injection that was approved by the US Food and Drug Administration (FDA) in 2015. This drug works by breaking down and helping to digest fats in the diet. There has been at least one case where a person with PAH saw a decrease in abdominal volume after treatment with DCA, suggesting that further studies might be needed to fully understand its effectiveness.
Recent findings also suggest that combining cryolipolysis with Extracorporeal shock wave therapy (ESWT) might reduce PAH incidence. ESWT is a non-invasive procedure that utilizes sound waves to treat various conditions, including musculoskeletal and soft tissue conditions such as cellulite. It is thought that ESWT may help guard against PAH after treatment by reducing oxidative stress in the treated tissue and taking on anti-fibrosclerotic effects, which can fight against tissue scarring.
The main treatment for PAH is surgery, usually involving liposuction and/or direct surgical removal of tissue, such as a tummy tuck. A personalized treatment plan should be created for each patient. Liposuction may be carried out on its own or combined with another method such as using ultrasound or radiofrequency waves to help break down the fat. Liposuction using Vibration Amplification of Sound Energy at Resonance (VASER), which is a special type of liposuction that uses sound waves to break down fat, is often used in patients with PAH. This method can be more effective in removing fat and shaping the body in affected areas. But, without understanding exactly why PAH happens, it’s uncertain whether the stress of these invasive surgeries might increase the likelihood of it returning.
When developing the treatment plan, doctors also need to think about how to care for the patient after the surgery and whether other procedures may be needed. Working closely with a skilled plastic surgeon and keeping the patient well-informed is crucial.
If the affected area is inflamed, doctors might want to wait before performing surgery. It’s advisable to wait at least six months after PAH diagnosis before performing surgery to ensure complete recovery from the inflammation. Early treatments, although potentially effective, may increase the risk of relapse if carried out before the inflammation has fully healed.
What else can Paradoxical Adipose Hyperplasia be?
Physicians consider several conditions that may have similar symptoms when diagnosing Pulmonary Arterial Hypertension (PAH). It’s vital to differentiate PAH from these conditions, as each requires a different treatment strategy.
- Seroma (a pocket of clear bodily fluid)
- Hematoma (a collection of blood outside the blood vessels)
- Lipomas (benign fat tissue growths)
- Post-procedure swelling or fibrosis (scar tissue)
- Panniculitis (inflammation of the fat layer under the skin)
- Lymphoceles (a pocket of lymph fluid)
- Hypertrophic scarring (overly thick, raised scars)
- Hernias (an organ pushes through an opening in muscle or tissue that holds it in place)
- Weight gain
What to expect with Paradoxical Adipose Hyperplasia
PAH is generally seen as harmless and it doesn’t directly risk the patient’s life. Nonetheless, there are no cases where PAH has gone away on its own without any treatment. This suggests that patients usually need invasive treatments like liposuction or direct excision to correct the abnormal physical shape caused by the condition.
People diagnosed with PAH often need more than one operation to fix the affected areas. The first step is usually liposuction to remove the unusually large fat. However, because the tissue is hard and fibrous, the results may vary. Thus, patients often need more surgeries. Sometimes, the tissue must be directly cut out, which may cause scarring and may mean more cosmetic changes are necessary. Because PAH is complex and does not respond well to non-surgical therapies, patients usually need multiple procedures, over a long period, to achieve the look they are satisfied with. In addition, patients often have to pay a large chunk of the cost, as insurance companies usually do not cover these types of cosmetic surgeries.
Getting diagnosed with PAH can hugely impact a person’s emotions. This problem often causes distress and frustration, particularly since cryolipolysis (a fat-reducing treatment) is typically used to make a person’s appearance better. Patients may feel a knock to their self-esteem and confidence about their body due to the physical distortions caused by PAH. This can be especially hard for those who went through the procedure to enhance their looks. The lengthy diagnosis process and the potential need for corrective surgery can cause increased feelings of worry, regret, and discontent. Cases of PAH that are in the public eye can also make patients feel alone or misunderstood, and can add to the emotional weight of the condition.
Possible Complications When Diagnosed with Paradoxical Adipose Hyperplasia
PAH can cause both physical and mental issues. Physically, the main problem is an unexpected and localized growth of fat tissue, which can pose an issue for additional non-invasive procedures and often calls for surgical intervention. The tough features of the enlarging tissue make treatment through merely fat removal procedures complex, sometimes requiring further invasive procedures like direct removal. This can lead to scarring, irregular body shape, and longer recovery periods. Multiple surgeries might be mandatory, bringing with it more risks of complications such as infection, large internal bruises, and poor wound healing.
From a mental health perspective, the visible change caused by PAH can trigger substantial emotional stress, leading to anxiety, depression, and lower self-worth. The variable nature of the condition and how resistant it is to treatment can worsen these issues, ultimately affecting the overall quality of life of those living with the condition.
PAH Complications:
- Increase in localized fat tissue
- The need for surgical intervention
- Scarring
- Body contour irregularities
- Extended recovery times
- Possible multiple surgeries
- Complications such as infection, large internal bruises, and poor wound healing
- Anxiety
- Depression
- Diminished self-esteem
- Decreased quality of life
Recovery from Paradoxical Adipose Hyperplasia
If you’ve had surgery for Pulmonary Arterial Hypertension (PAH), it’s important to take certain steps to recover well and get the best outcomes. One of these is taking good care of the surgical wound to prevent infections and to speed up healing. This simply means keeping the area clean, watching out for any signs of infection, and following any directions given by your surgeon.+
Another key aspect to handle post-operation is pain. Your doctor will likely give you certain medications or suggest some methods to help you manage any pain you experience after the surgery, and it’s important to use these as directed.
Patients usually need to wear what are known as compression garments. These can reduce swelling, support the healing process, and help improve the shape of the treated area. Ongoing check-ups with your surgeon are very important too, to ensure you’re healing well, discuss results and manage if any problems arise.
Also, following advice about what activities to avoid is crucial. This includes not doing any intense exercises or movements that might put pressure on the area where you had surgery, all to help your body recover the best way possible.
Preventing Paradoxical Adipose Hyperplasia
Before starting the process of cryolipolysis (a technique to reduce fat by freezing fat cells), medical professionals must clearly explain the risks involved. It’s important to understand there’s a risk of developing PAH (Paradoxical Adipose Hyperplasia), which is an unexpected increase in the size of the treated fat cells. The symptoms can include a firm feeling, swelling, and changes in the shape of the treated area. Additionally, patients should be made aware that, if PAH occurs, they might require a further procedure to correct it.
It’s essential for doctors to explain everything properly, but the challenge lies in the fact that the risk numbers provided by the companies that offer cryolipolysis services might be lower than the real risk of complications. This could lead to patients not fully understanding the true likelihood of complications. Therefore, proper patient education is required to avoid any misunderstandings. Once patients are fully informed, they can make a well-informed decision about treatment and have realistic expectations about possible complications, which can result in a better treatment experience.
Support groups on social media for patients with PAH can play a vital role. They can facilitate a space for patients to share their experiences, ask for advice, and gain emotional support from others in similar situations. These online communities make it possible for people to connect with others who understand what it’s like to live with PAH. They can discuss different treatment options, what to expect after surgery, and ways to manage their condition. Additionally, these groups help to raise awareness about PAH, educate others on this possible complication of cryolipolysis, and advocate for further research and better patient care.
