CoolSculpting Side Effects

Fat Freezing & CoolSculpting Side Effects

Learn about the common and rare side effects of Cryolipolysis
Last updated on
February 4, 2024

How often fat freezing side effects occur and how you deal with them

This non-invasive, TGA-approved procedure has gained popularity for its impressive results and minimal downtime. CoolSculpting leverages the power of controlled cooling, a technique known as cryolipolysis. 

But like any medical procedure, it's essential to understand the potential side effects before deciding if it's the right choice for you.

Related: Our in depth guide to Fat Freezing.

The Science Behind Fat Freezing

Cryolipolysis is a process that involves the application of controlled cooling to the fat cells beneath the skin, essentially freezing them. This process doesn't harm the surrounding tissues because fat cells freeze at higher temperatures than other cells. Once frozen, these fat cells die and are gradually eliminated from the body through natural metabolic processes.

The procedure begins with a healthcare provider applying a gel pad and applicator to the targeted area. The applicator delivers controlled cooling to the fat cells under the skin. While you may feel an intense cold initially, this feeling usually subsides as the area numbs. Each treatment can take anywhere between 30 minutes to an hour, depending on the area being treated. 

Common Side Effects of CoolSculpting

While CoolSculpting is generally well-tolerated and deemed safe by medical professionals, it's not without its side effects. Like with any cosmetic procedure, understanding these potential side effects is key to making an informed decision. 

Pain or Aching at the Treatment Site

In the days following a CoolSculpting session, you may experience some slight pain, stinging, or aching at the treatment area. This is typically due to the intense cold temperatures applied during the procedure. According to a study reviewing cryolipolysis procedures, any post-treatment pain usually lasted between 3 to 11 days and generally resolves independently.

Temporary Skin Irritation

Exposure to the extreme temperatures used in CoolSculpting may cause temporary skin irritation. This can manifest as:

  • Temporary skin discolouration
  • Swelling
  • Bruising
  • Skin sensitivity
  • Rash

These side effects typically settle on their own within a few weeks. However, it's important to contact your healthcare provider if these symptoms persist or worsen over time.

While these side effects may seem daunting, they're generally manageable and don't last long. 

Rare Side Effects of CoolSculpting: Paradoxical Adipose Hyperplasia 

While common side effects of CoolSculpting are relatively minor and transient, there is one rare but serious side effect that potential patients should be aware of: Paradoxical Adipose Hyperplasia (PAH).

What is Paradoxical Adipose Hyperplasia?

Paradoxical Adipose Hyperplasia (PAH) is a rare and unexpected side effect that can occur following a CoolSculpting procedure. Instead of shrinking, the fat cells in the treated area actually increase in size and volume, leading to more fat in the treated area.

This unusual response to the CoolSculpting treatment doesn't happen immediately but develops over several months after the procedure. The affected area becomes firm and larger over time, often creating a noticeable bulge that can be distinctly felt and seen. The area of PAH is typically well-demarcated, having clear borders that distinguish it from the surrounding tissues. 

While the occurrence of PAH is rare and the exact mechanism behind its development remains unknown, it's believed to be a reactive process to the inflammatory changes induced by the CoolSculpting procedure. It's important to note that PAH, while cosmetically concerning, is not associated with any malignant potential or serious health risks.

Who is at Risk of PAH?

A recent study hinted at a potential underreporting of PAH, observing a markedly higher occurrence rate in the author’s clinic, 0.47% (2 out of 422 patients) versus the rate quoted by the CoolSculpting brand at 0.033% (1 in 3,000 patients).

Interestingly, PAH has a slightly higher prevalence in males as compared to females, though the exact cause remains uncertain.

Additionally, the same study underlined a notable 75% decrease in PAH occurrences when using the latest CoolSculpting machines, hinting at the possibility that the machines themselves may affect PAH risk levels.

Dealing with PAH

While PAH is not medically dangerous, it can be distressing as it leads to a bulge at the treatment area. Correcting PAH typically requires an invasive procedure like liposuction or surgery to remove the enlarged fat cells.

While the occurrence of PAH can seem alarming, it's important to remember that this side effect is rare. The vast majority of CoolSculpting patients will never experience PAH. 

Skin Divots and Ripples

Lastly, fat freezing can also lead to unusual dips or rippling on the skin's surface. However, this is an uncommon side effect, a 2015 review showed that this only occurred in 0.14% of all procedures.

Dealing with Fat Freezing Side Effects

In this section, we'll provide some tips and advice on dealing with common side effects and ensuring your CoolSculpting journey is as comfortable as possible.

Pain or Aching at the Treatment Site

Over-the-counter pain medication can generally manage any post-procedure pain or aching. However, if the discomfort persists or is severe, contact your healthcare provider for guidance.

Temporary Skin Irritation

Post-procedure skin irritation, such as swelling, bruising, or skin sensitivity, can be alleviated with simple care measures. Applying an ice pack to the treated area can help reduce swelling and bruising. Avoiding sun exposure and using gentle skin care products can help manage skin sensitivity and discolouration.

Paradoxical Adipose Hyperplasia

If you notice an unusual increase in the size of the treated area a few months after the CoolSculpting procedure, contact your healthcare provider. They can evaluate the condition and discuss the next steps, which may include corrective procedures like liposuction or surgery.

Remember, it's crucial to maintain open communication with your healthcare provider throughout your CoolSculpting journey. They can provide personalized advice and treatment options based on your individual needs and response to the procedure.

Sources & Studies

CoolSculpting n.d., CoolSculpting® cost, results & info : CoolSculpting®, www.coolsculpting.com.au, viewed 30 June 2023, <https://www.coolsculpting.com.au/faq#id=c4-2>.

Derrick, CD, Shridharani, SM & Broyles, JM 2015, ‘The Safety and Efficacy of Cryolipolysis: A Systematic Review of Available Literature’, Aesthetic Surgery Journal, vol. 35, no. 7, pp. 830–836, viewed 30 June 2023, <https://pubmed.ncbi.nlm.nih.gov/26038367/>.

Jalian, HR, Avram, MM, Garibyan, L, Mihm, MC & Anderson, RR 2014, ‘Paradoxical Adipose Hyperplasia After Cryolipolysis’, JAMA Dermatology, vol. 150, no. 3, p. 317, viewed 30 June 2023, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171727/>.

Keaney, TC, Gudas, AT & Alster, TS 2015, ‘Delayed Onset Pain Associated With Cryolipolysis Treatment’, Dermatologic Surgery, vol. 41, no. 11, pp. 1296–1299, viewed 30 June 2023, <https://journals.lww.com/dermatologicsurgery/Abstract/2015/11000/Delayed_Onset_Pain_Associated_With_Cryolipolysis.12.aspx>.

Nikolis, A & Enright, KM 2020, ‘A Multicenter Evaluation of Paradoxical Adipose Hyperplasia Following Cryolipolysis for Fat Reduction and Body Contouring: A Review of 8658 Cycles in 2114 Patients’, Aesthetic Surgery Journal, vol. 41, no. 8, pp. 932–941, viewed 30 June 2023, <https://academic.oup.com/asj/article/41/8/932/5995602>.

Singh, SM, Geddes, ERC, Boutrous, SG, Galiano, RD & Friedman, PM 2015, ‘Paradoxical adipose hyperplasia secondary to cryolipolysis: An underreported entity?’, Lasers in Surgery and Medicine, vol. 47, no. 6, pp. 476–478, viewed 30 June 2023, <https://pubmed.ncbi.nlm.nih.gov/26096832/>.

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