Paradoxical Adipose Hyperplasia after Cryoadipolysis: A Colombian Observational Study

Introduction: Cryoadipolysis is a non-invasive technique for fat reduction based on the application of cold temperatures to skin folds and the underlying adipose tissue. It is based on the principle that adipocytes are more sensitive to cold than other cell types. While its non-invasiveness is an advantage in terms of patient experience, it also has some associated complications which are usually temporary and resolve spontaneously. Paradoxical adipose hyperplasia (PAH) is an infrequent side effect where an increase in adiposity is produced 2–5 months post cryoadipolysis. Its exact mechanism is not completely understood, a fact that causes concern for physicians and patients. The objective of this study is to evaluate the causes of this complication, as well as to try to link these cases to pre-existing clinical conditions or problems related to medical praxis and provide good practice recommendations to prevent PAH from occurring. Materials and Methods: 16 patients who underwent cryoadipolysis and presented symptoms compatible with PAH were interviewed by physicians. These 16 patients were among a total of 31 reported cases that occurred following the treatment of 7,588 patients from 2019 to 2020. According to the etiology of the lesions, they were classified as either procedure related, risk factor related or unknown. Results: The incidence of PAH among all patients subjected to cryoadipolysis was 0.41%. Nine (56.25%) patients were classified as having a cause that was risk factor related, four (25%) were attributed to a procedure related cause, while three (18.75%) remained in the unknown category. Six (37.5%) patients showed contraindications, there were six (37.5%) cases with suboptimal practice and three (18.75%) patients presented an increase in weight after cryoadipolysis. Twelve (75%) patients underwent liposuction, which in all cases was able to solve the complications. Among the 10 patients with imaging studies, 7 (70%) cases showed previous lesions. Discussion: Results in this study reinforce the need to establish stringent patient screening which can contribute to reducing the prevalence of complications such as PAH, as more than 50% of patients with a clinical cause presented risk factors and contraindications. Furthermore, incorrect procedures can contribute to complications such as PAH, which is usually associated with trauma caused by suction. Imaging procedures (MRI) were critical to the diagnosis of PAH, as without them PAH may be confused with other lesions. The treatment option for most patients was liposuction, with some patients first using lipolytic enzymes with no positive results. All in all, little is known about the mechanisms involved in PAH from both a cellular and a histological point of view, which is why the etiology is still unknown. Good practice recommendations, from patient screening to post-treatment care, should facilitate the optimal application of treatments, including the procedure itself. By backing up such recommendations with the available empirical data, much more accurate information could be provided to physicians and patients, which may prevent PAH from occurring or help mitigate it if diagnosed. Conclusions: Cryoadipolysis is generally regarded as a safe non-invasive technique for subcutaneous fat reduction. However, further measures are needed to minimize the risk of complications such as PAH, including selective screening, good praxis and appropriate post-treatment care. Therefore, medical training for this technique needs to be intensified.