Could Coolsculpting make you bigger? CoolSculpting is a fat reduction procedure that has grown increasingly popular since its introduction in 2010. It works by freezing away stubborn bulges of fat without the need for invasive cosmetic surgery such as liposuction.  

CoolSculpting treatment has an excellent safety record. The only side effects patients experience include mild tingling, redness, and numbness that go away after some days. But one noticeable effect that has begun to appear more commonly than previously assumed is that of Paradoxical Adipose Hyperplasia (PAH). 

PAH is sometimes called the “stick of butter” phenomenon and it is now recognized as one of the adverse effects of CoolSculpting. Virginia Institute of Plastic Surgery, led by board certified plastic surgeons Dr. Burton M. Sundin and Dr. Reps B. Sundin, provides CoolSculpting to patients in Richmond, Fredericksburg, Northern Virginia, and surrounding locations. 

How is PAH Related to CoolSculpting? 

CoolSculpting is based on cryolipolysis which is the breaking down of fat cells by the use of very low temperatures. In this procedure, the doctor chills the tissues in the area to be treated. The fats cells form crystals and then disintegrate and get removed from the body as waste. As a result, the treated area loses fat and appears slimmer than before.  

While this is the expected outcome, in some cases, the fat cells that receive such treatment start expanding instead of breaking down. They grow harder and form an unnatural lump in response to the extreme cold temperatures used in the treatment. This is called PAH and it gives the treated area the appearance of a “stick of butter” that mimics the CoolSculpting applicator shape.  

How Common is PAH after CoolSculpting? 

The reason why PAH happens to some patients and not others is unclear. Recent data shows that it to be more common (1 in 138 treatments) than previously reported by the manufacturer (1 in 4,000 treatments). The incidence rate is less than 1% but patients must be alert to the possibility of this complication so that they can make informed decisions considering that there are other fat reduction procedures and devices available.  

Pick an Experienced Cosmetic Surgeon 

CoolSculpting is a simple procedure but if not performed right, it can lead to problems. Make sure you choose a cosmetic surgeon who is board-certified and discuss the risks of the procedure. No one can predict which patient can develop PAH, but a skilled and experienced surgeon is better prepared to decrease the risk of it happening to you. Talk to your surgeon about what they plan to do if you happen to develop PAH. 

What is the Remedy for PAH? 

PAH is not a threat to life and fortunately, it can be treated by liposuction. In this procedure, an experienced plastic surgeon can remove the fat that has been enlarged and return the treated area to its natural shape. Although liposuction is a surgical procedure, it is worth the temporary discomfort to give you back the sculpted, perfect look. 

Cosmetic surgeons at the Virginia Institute of Plastic Surgery (VIPS) receive patients from Richmond, Fredericksburg, Northern Virginia, and nearby areas for CoolSculpting fat reduction treatment.  

Contact Virginia Board Certified Plastic Surgeon Dr. Sundin Today for a Consultation

For more information on the surgical and non-surgical procedures and treatments by Board Certified Cosmetic Plastic Surgeons Dr. Reps Sundin and Dr. Burton Sundin please visit

Serving Richmond, VA, Fredricksburg, Williamsburg, Charlottesville, Hampton, Newport News, Norfolk, Tidewater, Sullfolk, Virginia Beach, Northern Virginia, Washington DC, Vienna, McLean, Fairfax, Loudoun County, Ashburn, Tysons Corner, Reston, Arlington and surrounding communities.

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