121 East 60th Street, Suite 8AB, New York, NY 10022

Ph. (212) 285-1110

Long Island

901 Stewart Ave, Suite 240, Garden City, NY 11530

Ph. (516) 512-7616

New York City (212) 285-1110

Garden City, NY (516) 512-7616

Fixing Paradoxical Adipose Hyperplasia (PAH) in New York

For some people, the shape of their body leaves them feeling uncomfortable and ashamed of their physical appearance. Dr. Cameron Rokhsar, our double board-certified dermatologist and laser and cosmetic surgeon, gives you the best advice on how to reshape your body into one that you love. In our Manhattan and Long Island offices, liposuction and CoolSculpting are two options available for body contouring and fat removal.

Liposuction Removes Fat

Internationally renowned Dr. Rokhsar explains that while a CoolSculpting treatment can help reduce fat, liposuction offers a better solution by removing stubborn fat, permanently. The weight loss and body shaping choice largely depends on your appearance goals.

Your weight reduction method and body shaping choice also depends on whether you prefer a non-surgical option like CoolSculpting or a surgical option like liposuction. While both provide permanent fat removal and body contouring, CoolSculpting offers much more subtle results as compared to liposuction.

Dr. Rokhsar talks about liposuction on Good Morning America.

NYC Liposuction Remains The Gold Standard

The American Society of Plastic Surgeons reports that liposuction remained in the top five cosmetic surgery procedures in 2020. According to the study, most patients choose either liposuction or CoolSculpting.

While CoolSculpting is a non surgical alternative to surgical fat reduction, it can only reduce localized pockets of fat by 10-20%. The reason is because localized subcutaneous fat is merely reduced by using fat freezing technology that destroys fat cells in the targeted areas. However, with liposuction, the surgeon is in full control of the treatment areas. Therefore, significant fat removal and body contouring can be achieved only through liposuction.

Dr. Rokhsar is among the first physicians in the United States to have offered CoolSculpting and has treated thousands of patients over the past 20 years with CoolSculpting. Although a majority of patients are very satisfied with their CoolSculpting results, a rare complication of CoolSculpting which has gotten a lot of press recently is paradoxical adipose hyperplasia (PAH).

PAH after CoolSculpting

PAH is a complication of fat freezing, where fatty or adipose tissue increases in the treated areas of fat over time after CoolSculpting. This phenomenon is paradoxical because instead of the fatty areas decreasing in size as a result of CoolSculpting, the frozen fat cells actually become larger. Super-model, Linda Evangelista has recently made the claim that she suffered from this rare side effect of CoolSculpting, where her CoolSculpting treatment area grew in size instead of decreasing in size.

Linda Evangelista discusses the effects of CoolSculpting and PAH.

How is PAH Treated?

The treatment for paradoxical adipose hyperplasia (PAH) is liposuction. Dr. Rokhsar, an expert liposuction surgeon, treats many patients who have suffered from PAH, using liposuction. Dr. Rokhsar performs all his liposuction surgeries using the tumescent technique under local anesthesia where patients are awake.

This is the safest method of liposuction with minimal side effects and the fastest recovery. Compression garments are only worn for one week with this technique as opposed to the 4-6 weeks recommended with other techniques including liposuction under general anesthesia.

Liposuction Vs CoolSculpting

Ultimately, Dr. Rokhsar suggests that you consider not only the benefits but also the risks of liposuction and CoolSculpting. His recommendation to his patients always takes into consideration their long-term weight management, overall health, recovery expectations, and desired outcome.

Liposuction CoolSculpting


Requires surgery, using a cannula Non-invasive fat freezing technology


Performed under local anesthesia Cooling technology makes it virtually painless

Treatment Time

2-4 hours 35-45 minutes per attachment multiple attachments usually needed


Improved shape and contours are visible soon after surgery

Results are dramatic as Dr. Rokhsar suctions the fat out


A healthier body-shape reveals itself over time. Results may not be dramatic

Side Effects

Swelling, bruising, numbness. soreness Numbness, and minimal redness in and around the treatment area, some soreness

PAH- the development of fatty bulges in treatment areas (RARE)


2-5 days none


Results are permanent Results are permanent


Apparent immediately Appear 6-8 weeks later

Number of sessions

One (rarely requires touch ups) 1-2 sessions

*Results may vary.

Both treatment options come with potential risks and side effects. We discuss these options in detail with you when you consult with Dr. Rokhsar at his Manhattan or Long Island practice.

His core focus is patient care and safety. Dr. Rokhsar recommends the best body contouring treatment to meet your aesthetic dreams.

Consult With Dr. Rokhsar For Body Contouring Solutions

Book your appointment with Dr. Cameron Rokhsar. He is internationally recognized for his expertise and skilled technique in the art of body contouring for patients throughout the Manhattan, Long Island, and greater NYC area. His consistently beautiful results boost confidence in those who choose him as their provider for the best fat removal treatments.

Paradoxical Adipose Hyperplasia FAQ

What is paradoxical adipose hyperplasia?

Paradoxical adipose hyperplasia (PAH) is a rare but documented adverse effect of cryolipolysis with CoolScupting, a non-surgical method to remove fat. Cryolipolysis is more commonly known as CoolSculpting, a cosmetic procedure that destroys fat cells by cooling them to a specific temperature. PAH occurs when the cooling effect of cryolipolysis causes the fat cells to expand instead of breaking down, resulting in an increase in the size of the underlying fat. PAH typically appears within one to three months following the procedure and may take up to six to nine months to fully develop.

PAH can occur in anyone who undergoes cryolipolysis, but it is more commonly reported in men and individuals with darker skin types. The condition can cause significant emotional distress and is a challenging problem to treat. Currently, the only way to solve PAH is through liposuction. Dr. Cameron Rokhsar is a world expert in liposuction and has performed liposuction procedures for years in all body areas including the belly, love handles, arms, inner thighs, outer thighs, back, and neck fat. While PAH is a potential risk associated with cryolipolysis, it is a rare complication. The overall rate of PAH is low, with less than 1 percent of patients experiencing the condition. Nonetheless, it is crucial for patients considering cryolipolysis to be aware of the potential risks associated with the procedure, including PAH.

How to avoid paradoxical adipose hyperplasia?

While it is not entirely clear why PAH happens, it is thought to be a reaction to the freezing of the fat cells, which can cause them to expand rather than shrink. There is no known way to completely prevent PAH, but there are some things that patients and doctors can do to reduce the risk.

Firstly, it is essential to choose a qualified and experienced practitioner who will take the time to evaluate your health and discuss the potential risks and benefits of the treatment. CoolSculpting should only be performed on patients who are in good health and have realistic expectations about the results.

Another way to reduce the risk of PAH is to consider alternative body contouring treatments, such as liposuction, which is considered the gold standard for body sculpting and contour changes. Additionally, using cryolipolysis devices with smaller handpieces can also reduce the risk of PAH.

When does paradoxical adipose hyperplasia occur?

PAH can occur after cryolipolysis treatment, but it is a rare complication, occurring in only a small percentage of cases.

The symptoms of PAH can start to appear anywhere from a few days to several months after the cryolipolysis treatment. However, the most common timeframe for PAH to appear is around 3-6 months after the initial treatment. PAH can be identified by a treated area that looks and feels thicker, a mass or swelling that may be felt under the skin and is often slightly painful to touch, and hard lumps or bumps in the treated area. The entire treated area may also appear bigger, not smaller.

It is unknown why PAH takes so long to appear in the body. At this time, there is no evidence of spontaneous resolution for PAH, meaning it does not go away on its own. While the frequency of PAH is up for debate and likely underreported, it is more common in male patients undergoing cryolipolysis.

What does paradoxical adipose hyperplasia look like?

Instead of reducing the amount of fat in the treated area, PAH causes fatty tissue to grow and become firm, creating an irregular and raised lump that is well-outlined and often in the shape of the CoolSculpting or cryolipolysis applicator. The lump feels thicker and firmer than surrounding fat and may be slightly painful to the touch. PAH may appear a few days to weeks after the cryolipolysis treatment and can range in severity from moderate to severe. Patients with PAH may develop visible fat lumps that are often described as “sticks of butter” in the areas of their body that were treated with cryolipolysis. Redness, tenderness, stinging, muscle cramping, itching, and diarrhea are common side effects of fat freezing, but PAH is a less common and more serious side effect. It is important to consult a board-certified dermatologist or cosmetic surgeon if you are experiencing any of these symptoms after a cryolipolysis treatment.

How common is PAH CoolSculpting?

The incidence rate of PAH after CoolSculpting varies, with reported rates ranging from 0.0036% to 2%. The manufacturer of the CoolSculpting device reports a rate of 0.025%, based on post-market consumer data. While PAH is rare, it is always essential to weigh the risks of any cosmetic procedure you undergo. If you are considering CoolSculpting or have concerns about PAH after undergoing the procedure, we recommend consulting with Dr. Cameron Rokhsar, a double-board-certified dermatologist and cosmetic surgeon who specializes in the treatment to discuss your options.

How to prevent PAH after CoolSculpting?

First, it is important to choose an experienced and qualified provider for your CoolSculpting treatment. Look for someone who is board-certified and has a proven track record of successful treatments. Additionally, be sure to have a thorough consultation with your provider to discuss your goals and any concerns you may have.

It is also important to follow all pre- and post-treatment instructions provided by your provider. This may include avoiding certain medications or supplements that can increase the risk of complications, as well as avoiding excessive sun exposure and strenuous activity in the days and weeks following your treatment.

How to treat PAH?

The only solution to get rid of the fat associated with PAH is through liposuction. Dr. Rokhsar performs all his liposuction procedures under local anesthesia. This makes the liposuction procedure more safe. It also allows for rapid recovery. Dr. Rokhsar has treated PAH with liposuction effectively. Any area on the body can be treated with liposuction including arms, legg, abdomen, thighs, knees and the neck.

New York Office Locations

Upper East Side Manhattan Office
121 East 60th Street, Suite 8AB New York, NY 10022
(212) 285-1110

Long Island Office
901 Stewart Ave, Suite 240, Garden City, NY 11530
(516) 512-7616

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About author - Dr. Cameron Rokhsar

Dr. Cameron Rokhsar

Dr. Cameron Rokhsar, MD, FAAD, FAACS, is the founder and medical director of the New York Cosmetic, Skin, & Laser Surgery Center. Dr. Rokhsar is a graduate of Harvard College and NYU School of Medicine. Dr. Rokhsar is double board certified in dermatology and micrographic dermatologic surgery, being one of the few select dermatologists in the country who is also fellowship trained in laser surgery. A researcher and innovator, Dr. Rokhsar is the creator of the non-surgical nose job and has been instrumental in the research and development of laser systems such as the Fraxel, CO2, Mirady, Vbeam, Themitight, and Ulthera devices. An Associate Professor of Dermatology at Mount Sinai Hospital in NYC, Dr. Rokhsar actively teaches the cosmetic dermatology clinic to the resident at Mount Sinai. An expert injector of fillers, and a trainer for many companies, patients fly in from around the world to see Dr. Rokhsar in his Garden City and Manhattan offices in New York.

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