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Paradoxical Adipose Hyperplasia after Cryolipolysis

A Report on Incidence and Common Factors Identified in 510 Patients

Kelly, Emma B.A.; Rodriguez-Feliz, Jose M.D.; Kelly, Michael E.

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Plastic and Reconstructive Surgery: March 2016 - Volume 137 - Issue 3 - p 639e-640e
doi: 10.1097/01.prs.0000480023.35573.b7
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We read with great enthusiasm the recent article by Ingargiola et al. entitled “Cryolipolysis for Fat Reduction and Body Contouring: Safety and Efficacy of Current Treatment Paradigms.”1 The authors have provided the first comprehensive review on a popular and novel procedure for body contouring, cryolipolysis.

Little emphasis was given to the most challenging and limiting factor we have encountered: paradoxical adipose hyperplasia. Their study reported on only one case of paradoxical adipose hyperplasia, by Jalian et al. in 2014.2 In our experience, 510 patients have been treated over the past 20 months, of whom four have been diagnosed with paradoxical adipose hyperplasia. Our reported incidence is 0.78 percent, more than 100 times higher than the device manufacturer–reported incidence of 0.0051 percent. Ours is not a unique experience, as a dermatology practice in Houston, Texas, recently reported a paradoxical adipose hyperplasia incidence of 0.47 percent.3 Although our treatment numbers are low when considering the popularity of the procedure, we believe that paradoxical adipose hyperplasia is underreported.

Jalian et al. stated that no single, common characteristic was evident among known affected individuals with paradoxical adipose hyperplasia. However, we have identified a few common factors among our patients with paradoxical adipose hyperplasia: all four patients were men of Hispanic background, and they were all treated with a single large applicator in the lower abdomen. The average age was 50 years (range, 38 to 57 years), and the mean body mass index was 26.2 kg/m2 (range, 24 to 28 kg/m2). Notably, one of our patients has a twin brother who was treated at a different practice and also developed paradoxical adipose hyperplasia in his lower abdomen following treatment with the large applicator, raising the question of whether there is a genetic predisposition to this problem. Another patient was taking Propecia (Merck, Kenilworth, N.J.) for hair loss, which is known to block the conversion of testosterone to dihydrotestosterone. It is unknown whether increased levels of androgenic hormones such as testosterone could increase the risk of developing paradoxical adipose hyperplasia.

The following adjustments have been made based in our clinical experience: we have stopped treating the lower abdomen in men until more data are available, and we now use two small applicators to treat the lower abdomen instead of a single large applicator. Since then, we have not seen another case of paradoxical adipose hyperplasia.

The efficacy and safety profile of cryolipolysis have made this a popular procedure. The greatest challenge at this point is to identify common factors that could be associated with paradoxical adipose hyperplasia so that we can continue to identify the best candidates for this novel and efficacious procedure.


The authors have no financial interest in any of the products, devices, or drugs mentioned in this communication.

Emma Kelly, B.A.

Vanderbilt University

Nashville, Tenn.

Jose Rodriguez-Feliz, M.D.

Michael E. Kelly

Miami Plastic Surgery (private practice)

Miami, Fla.


1. Ingargiola MJ, Motakef S, Chung MT, Vasconez HC, Sasaki GH. Cryolipolysis for fat reduction and body contouring: Safety and efficacy of current treatment paradigms. Plast Reconstr Surg. 2015;135:1581–1590
2. Jalian HR, Avram MM, Garibyan L, Mihm MC, Anderson RR. Paradoxical adipose hyperplasia after cryolipolysis. JAMA Dermatol. 2014;150:317–319
3. Singh SM, Geddes ER, Boutrous SG, Galiano RD, Friedman PM. Paradoxical adipose hyperplasia secondary to cryolipolysis: An underreported entity? Lasers Surg Med. 2015;47:476–478


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