How Worried Should I Be About Paradoxical Adipose Hyperplasia? Learn More About the Rare “Stick of Butter” Side Effect of CoolSculpting®

Technically known as cryolipolysis, Fort Worth CoolSculpting® is one of the fastest-growing non-surgical procedures to spot-reduce stubborn pockets of fat. While it can be used on many parts of the body, it is perhaps most commonly used on the abdominal wall. The skin and underlying fatty tissue are gently suctioned into a specialized applicator, which then lowers the temperature of the tissue between two cooling plates to -10ºC, freezing fat cells without harming surrounding skin, nerves, or blood vessels. The fat cells crystalize, disintegrate, and permanently leave the body as waste. 

While the treatment delivers dependable results for the vast majority of patients, there is a rare potential complication called paradoxical adipose hyperplasia (PAH), which you should be aware of before undergoing the procedure. Thankfully, it is both rare and treatable. Here’s an explanation of PAH and what to do if it happens to you. CoolSculpting® is FDA-cleared to treat visible fat bulges in 9 areas of the body. Some common side effects include temporary numbness, discomfort, and swelling.

What is paradoxical adipose hyperplasia?

Paradoxical adipose hyperplasia is a rare complication of CoolSculpting that gets its name from the unexpected, paradoxical result: overgrowth (hyperplasia) of fatty (adipose) tissue. This complication, which can appear 8 to 24 weeks post-procedure, is when the treated area becomes hardened and visibly enlarged. The term “stick of butter” refers to the shape the affected tissue takes, which reflects the shape of the CoolSculpting applicator.

Based on manufacturer data, PAH has been estimated to occur in 1 out of every 4,000 CoolSculpting treatment cycles.

A 2014 study published in JAMA Dermatology describes the appearance of PAH as “a sharply demarcated, rectangular enlargement around the umbilicus corresponding to the treatment zone.” The soft tissue protrusion is pliable, mobile, and slightly tender to the touch.

How common is the “stick of butter” side effect of CoolSculpting?

The “stick of butter” side effect is not common, but no firm statistic has yet been established. According to the 2014 study published in JAMA Dermatology, this side effect has an incidence of 0.0051% or about 1 in 20,000 treated patients. Based on manufacturer data, PAH has been estimated to occur in 1 out of every 4,000 CoolSculpting treatment cycles, which is an incidence rate of 0.025 percent. One small 2018 study found the incidence could be as high as 0.72%, however, this was based on an overly small sample of only 11 patients.

While more tracking and study is needed, we are not sidelined by this rare complication here in our medical spa for a few reasons. Our practice has been offering CoolSculpting in Fort Worth for several years, and we have not had any cases of PAH, among many hundreds of patients. While the condition is unappealing and takes time to resolve, it is quite treatable with liposuction. There are also no known negative effects on the health of patients after PAH has resolved.

Does paradoxical adipose hyperplasia go away?

Paradoxical adipose hyperplasia is not physically dangerous, but it will not go away without treatment. Typically, patients have to wait up to six to nine months for the fat in the affected area to soften enough to be removed safely using liposuction—otherwise, there is a risk that PAH could recur. If you have had a CoolSculpting procedure and feel you may be experiencing the “stick of butter” side effect, it is important to inform your provider so that they can examine the area and recommend next steps.

Kalos Medical Spa stands behind CoolSculpting

Kalos Medical Spa has been named a Top 500 practice by Allergan, the makers of CoolSculpting due to board certified plastic surgeon Dr. Emily Kirby and her team’s years of experience, knowledge, and expertise in using this treatment.

If you would like to learn more about CoolSculpting or any of the state-of-the-art services we offer for your skin, face, and body, please contact our Fort Worth med spa today at (817) 292-4200.