This Not-So-Cool Side Effect of CoolSculpting Isn’t as Rare as We Thought


When CoolSculpting hit the market in 2010, it sounded almost too good to be true: freeze away stubborn fat bulges without surgery or downtime and all you have to do is sit there for an hour? Yet here we are eight years later, and CoolSculpting seems to be soaring in popularity among patients and cosmetic practices alike.

For the most part, CoolSculpting has a good safety record. The majority of patients experience mild side effects such as redness, tingling, and numbness, which go away after a few days. However, one more serious CoolSculpting side effect appears to be more common than we originally thought. I am talking about a complication called “paradoxical adipose hyperplasia (PAH)” or, in layman’s terms, the “stick of butter” effect.

What is paradoxical adipose hyperplasia and why does it sometimes happen after CoolSculpting?

The technology behind CoolSculpting, cryolipolysis, is designed to chill tissue to the point where fat cells crystalize, disintegrate, and leave the body as waste, helping a treated area marginally slim down. Usually, this is exactly what happens. In a small number of cases, however, the fat in the treated area expands and hardens into an unnaturally shaped lump in response to the extreme cold.

This is called paradoxical (abnormal) adipose (fat) hyperplasia (unusual increase in a structure), or PAH for short. Instead of gradually shrinking, the bulge after CoolSculpting actually gets bigger and usually becomes firmer than surrounding tissues, sometimes having a “stick of butter” appearance that resembles the shape of the CoolSculpting applicator.

Example of patient receiving cryolipolysis treatment; tissue is suctioned into the applicator. (Note: CoolSculpting brand applicators differ in design.)

Is PAH after cryolipolysis happening more than we think?

We don’t exactly know why PAH happens to certain patients, and recent studies suggest that PAH occurs far more often (1 out of 138 treatments) than the manufacturer has previously reported (1 out of 4,000 treatments). While this is still an incidence rate of less than 1%, it concerns me as a physician any time we see a rise in complication rates with a procedure—particularly one with such strong claims of safety and ease. And, with a proliferation of other cryolipolysis devices and at-home fat freezing belts on the market, PAH is something we need to pay closer attention to.

Over the years, I have treated a number of patients in the Seattle and Bellevue area who developed PAH after cryolipolysis, and I have been aware of the condition for quite some time. It is one reason why I continue to eschew non-surgical fat reduction technology in favor of tried-and-true liposuction.

Now the good news: PAH can be treated with liposuction

Fortunately, PAH is not life-threatening, and it is fully treatable with liposuction. However, patients who develop the condition have to live with a conspicuous bulge for about six to nine months until the fat softens enough to remove safely. This can be hard on a patient both emotionally and physically, especially considering they sought out fat reduction in the first place to address a bothersome issue that now appears worse.

Moreover, this means the patient ends up having to undergo and pay for two procedures to address unwanted fat that liposuction could have taken care of the first time—with more precise, predictable sculpting than what’s possible with any non-surgical option.

Liposuction remains your best option for fat removal & sculpting

Non-surgical cosmetic treatment options continue to improve, and many are safe, suitable alternatives for patients wishing to make changes without significant downtime. Yet sometimes surgery remains the superior option. I believe this is case with liposuction vs CoolSculpting.

When performed by an experienced, skilled cosmetic surgeon, liposuction can safely, thoroughly, and precisely remove fat to strategically sculpt a beautiful, natural shape to an area. In contrast, fat reduction achieved with non-surgical technologies is only predictable down to a general area and provides minor improvements. For most patients, the more detailed, dramatic results possible with liposuction are well worth taking a few days off and having a couple of very tiny scars that fade in time.

Moreover, liposuction can end up costing less than non-surgical alternatives in the long run. A cosmetic surgeon can determine exactly how much fat to remove to achieve your desired results in one procedure. It’s common for patients to need three or more CoolSculpting treatments to achieve a similar amount of reduction as one liposuction procedure, and you don’t even get the benefit of detailed sculpting.

Considering fat reduction in Bellevue? Let’s talk.

You have many options to reduce fat and improve your shape, and that’s a good thing. During your consultation, we can talk about the expected results with different procedures and together discuss the pros and cons of each. My priority is to help you make the right decision for your needs and goals. To make an appointment, please call 425-453-9060 or contact us online.

18 Comments Posted to "This Not-So-Cool Side Effect of CoolSculpting Isn’t as Rare as We Thought"

  • April 20, 2019 at 8:01 pm • Posted by Meow | Reply

    What is the best way which is a non surgical, non liposuction, non cool sculpting type of treatment to get rid of or reduce fat deposits that wont go away with exercise? I think you mentioned this in the article. I have lower arm fat pads I think from a thyroid condition that do not respond to exercise etc. I was thinking of cool sculpting but I will not do it after reading the numerous bad side effects such as pain/ bruising and pah.

  • April 20, 2019 at 1:23 am • Posted by Kiera L. | Reply

    Hi Maria,

    I am interested. Coolsculpting is not safe. The side effects are not as rare as you think!

  • April 20, 2019 at 1:21 am • Posted by Kiera L. | Reply

    Hi Lisa,

    If you don’t mind can you share your story with me. I had a very similar situation, my stomach is BOTCHED with painful lumps and bumps and a huge bulge in the area. I am in the process of working with Allergan, but I really want to start a class action. One for false advertising and two, for pain and suffering. This machine needs to be off the market. The doctors also need to learn how to thoroughly use it.

  • April 14, 2019 at 10:59 pm • Posted by Lori Lardie | Reply

    This was the biggest waste of money, it does not work, alot of pain after. I had the procedure a year ago, zero results, abdomen still feels bruised a year later. I am not going to waste my time or money having the same procedure.

  • April 14, 2019 at 12:20 pm • Posted by Diane | Reply

    I had what could only be called fat clots several of them in my legs that worked their way down y thighs to my ankles took 6 months to go away I would never ever ever ever do this again

  • April 14, 2019 at 8:52 am • Posted by Susanna | Reply

    I never had upper between chest fat before coolsculpting. The pain of them coolsculpting that area during & After was horrendous. I should’ve told her no need for it. My partner noticed hernia like bulging shortly after my coolsculpting that I never had before too. It’s gotten increasingly worse over last yrs! Has affected my self confidence terribly. Don’t know what to do. Have been too ashamed to show my doctor even.

    • April 26, 2019 at 11:00 am • Posted by Anderson Sobel Cosmetic |

      Hi Susanna, We are so sorry to hear that you and so many others hear have had such a poor experience. There is no reason to be ashamed of your body—this is not your fault. We do encourage you to see a doctor whom you feel comfortable with, as this is the best way to learn about your options to correct the problem. Best of luck!

  • April 13, 2019 at 4:04 pm • Posted by Olivia | Reply

    I had CoolSculpting done just over a year ago. My skin is now lumpy and swollen. I have bars of fat just above there they placed applicators that weren’t there before. I feel terrible about myself and don’t want to be in a swimsuit ever again. I have not been able to get a hold of the original providers.

  • April 5, 2019 at 9:19 pm • Posted by Jessica | Reply

    I had two rounds of CoolSculpting under chin area and have no results. I am going request my money back. Liposuction will be my next procedure.

  • March 27, 2019 at 4:05 am • Posted by Dawn | Reply

    Can it cause acute arthritic pain and swelling of joints during during 2 to ? Months after treatment as your body eliminates the fat cells??? I would guess it does from my experience. Worth looking into.

  • March 23, 2019 at 5:58 pm • Posted by Johnna | Reply

    I too was sucked into coolsculpting. Worse thing I ever did to myself. I’m twice as big and look hideous! I will never let Any touch my body again!

  • March 13, 2019 at 5:31 pm • Posted by Diana | Reply

    Can someone share how to access the program that Lisa referred to where Coolsculpting has a program for botched procedures?

  • March 7, 2019 at 11:20 pm • Posted by Maria N. | Reply

    I had coolsculpting in May 2018, my abdomen grew a lot, it was so deformed, they told me to go back, they said was impossible that the fat freezing wasn’t working, so in September I did again, my belly grew more. They first said that I could go for a liposuction, than the day before the surgery they told me that I have to wait 4 months more. I was so depress, I looked as a pregnant woman with a deformed belly, I posted pictures in instagram, they blocked me and they refused two times to pay for my liposuction. Be aware don’t do Fat freezing, I truly regret it. If anybody want to do a lawsuit please contact me.

  • February 15, 2019 at 11:46 pm • Posted by Joe | Reply

    I had coolsculpting paradoxical adipose hyperplasia in 2018. I regret ever getting cool sculpting done, the provider is now telling me I have to wait month before I get a refund until they hear back from the provider so that I can get a refund and possibly get liposuction. This is very depressing I m to the point of sueing them for selling me something that did not work.

    • February 28, 2019 at 2:04 pm • Posted by Dr. Sobel |

      Hi Joe, Thank you for sharing your story. I’m sorry to hear that you were among the few who’ve suffered this side effect. If you are unable to come to a solution with your provider, I suggest consulting with a board certified cosmetic surgeon in your area to help you correct the problem; as you said, liposuction may be the best way to treat the issue. Best of luck, Dr. Sobel

  • February 11, 2019 at 6:12 pm • Posted by Lisa | Reply

    I have a pretty sever case of this on my entire abdomen from a procedure preformed in July 2017. New suctions paddles were used on me but still not sure what caused it. Worst case my plastic surgeon says he’s seen. Lipo will not fix it. I’ve consulted with 5 board certified plastic surgeons. All have said a tummy tuck is the only fix. Cool Sculpting has a program for botched cases but they will only pay for lipo suction.

  • January 8, 2019 at 2:06 am • Posted by Emerson | Reply

    Hi. I had coolsculpting paradoxical adipose hyperplasia in 2017. I really regret having done it on my body and its depressing at times. What form of liposuction procedure you suggest to solve the pah? Thanks so much

    • February 28, 2019 at 2:12 pm • Posted by Dr. Sobel |

      Hello Emerson, Thank you for your question. I cannot provide direct medical advice without seeing you in person, but I do suggest you schedule an appointment with a board certified cosmetic surgeon near you, preferably someone who is very experienced in multiple liposuction techniques. Whether traditional liposuction or a power-assisted technique (i.e., ultrasound-assisted or laser-assisted lipo) is more appropriate really depends on the amount, location, and condition of the fat to be treated. I wish you the best of luck treating your issue.

Leave a Comment: