PARADOXICAL ADIPOSE HYPERPLASIA

Course overview

PARADOXICAL ADIPOSE HYPERPLASIA (PAH), ALSO KNOWN AS PARADOXICAL HYPERPLASIA, IS A RARE BUT AESTHETICALLY UNAPPEALING COMPLICATION OF CRYOLIPOLYSIS, A POPULAR NONINVASIVE FAT REDUCTION PROCEDURE COMMONLY REFERRED TO BY THE BRAND NAME COOLSCULPTING®. PAH MANIFESTS SEVERAL WEEKS TO MONTHS AFTER CRYOLIPOLYSIS, PRESENTING AS A PAINLESS, FIRM, AND WELL-DEFINED ENLARGEMENT OF ADIPOSE TISSUE LOCALIZED TO THE TREATED AREA, LEADING TO UNINTENDED AND OFTEN AESTHETICALLY UNAPPEALING RESULTS. THE INCIDENCE OF PAH IS HIGHER THAN INITIALLY ANTICIPATED, WITH SOME ESTIMATES SUGGESTING IT MAY OCCUR IN UP TO 2% OF TREATMENTS OR 1 IN 50 CASES.THE EXACT CAUSE OF PAH REMAINS UNCLEAR, BUT PROPOSED MECHANISMS INCLUDE HYPERTROPHY OF PREEXISTING ADIPOCYTES, RECRUITMENT OF PREADIPOCYTES, SYMPATHETIC DENERVATION, ALTERATIONS IN RECEPTOR EXPRESSION OR SIGNALING FACTORS INVOLVED IN ADIPOCYTE METABOLISM, HYPOXIC INJURY, AND NEGATIVE PRESSURE SUCTION. SURGICAL MANAGEMENT, PRIMARILY THROUGH LIPOSUCTION OR DIRECT EXCISION, REMAINS THE STANDARD TREATMENT FOR PAH. HOWEVER, RECENT REPORTS SUGGEST THAT NONINVASIVE OPTIONS SUCH AS DEOXYCHOLIC ACID MAY ALSO SERVE AS ADJUNCTS. THIS ACTIVITY REVIEWS THE RISK FACTORS, PATHOPHYSIOLOGY, PRESENTATION, EVALUATION, AND TREATMENT OF PAH FOLLOWING CRYOLIPOLYSIS. THIS ACTIVITY FACILITATES THE ASSESSMENT AND MITIGATION OF PAH RISK, ENHANCES DIAGNOSTIC ACCURACY, AND GUIDES APPROPRIATE MANAGEMENT, INCLUDING SPECIALIST REFERRALS WHEN NEEDED. THE ACTIVITY ALSO EMPHASIZES THE ROLE OF AN INTERPROFESSIONAL HEALTHCARE TEAM IN APPLYING BEST PRACTICES FOR DISCUSSING THE RISK OF PAH WITH PATIENTS, MANAGING EXPECTATIONS, AND ADDRESSING CONCERNS IF PAH DEVELOPS AFTER THE PROCEDURE.