This Not-So-Cool Side Effect of CoolSculpting Isn’t as Rare as We Thought


When CoolSculpting hit the market in 2010, it sounded almost too good to be true: freeze away stubborn fat bulges without surgery or downtime and all you have to do is sit there for an hour? Yet here we are eight years later, and CoolSculpting seems to be soaring in popularity among patients and cosmetic practices alike.

For the most part, CoolSculpting has a good safety record. The majority of patients experience mild side effects such as redness, tingling, and numbness, which go away after a few days. However, one more serious CoolSculpting side effect appears to be more common than we originally thought. I am talking about a complication called “paradoxical adipose hyperplasia (PAH)” or, in layman’s terms, the “stick of butter” effect.

What is paradoxical adipose hyperplasia and why does it sometimes happen after CoolSculpting?

The technology behind CoolSculpting, cryolipolysis, is designed to chill tissue to the point where fat cells crystalize, disintegrate, and leave the body as waste, helping a treated area marginally slim down. Usually, this is exactly what happens. In a small number of cases, however, the fat in the treated area expands and hardens into an unnaturally shaped lump in response to the extreme cold.

This is called paradoxical (abnormal) adipose (fat) hyperplasia (unusual increase in a structure), or PAH for short. Instead of gradually shrinking, the bulge after CoolSculpting actually gets bigger and usually becomes firmer than surrounding tissues, sometimes having a “stick of butter” appearance that resembles the shape of the CoolSculpting applicator.

Example of patient receiving cryolipolysis treatment; tissue is suctioned into the applicator. (Note: CoolSculpting brand applicators differ in design.)

Is PAH after cryolipolysis happening more than we think?

We don’t exactly know why PAH happens to certain patients, and recent studies suggest that PAH occurs far more often (1 out of 138 treatments) than the manufacturer has previously reported (1 out of 4,000 treatments). While this is still an incidence rate of less than 1%, it concerns me as a physician any time we see a rise in complication rates with a procedure—particularly one with such strong claims of safety and ease. And, with a proliferation of other devices and at-home fat freezing belts on the market, PAH is something we need to pay closer attention to.

Over the years, I have treated a number of patients in the Seattle and Bellevue area who developed PAH after cryolipolysis, and I have been aware of the condition for quite some time. It is one reason why I continue to eschew non-surgical fat reduction technology in favor of tried-and-true liposuction.

Now the good news: PAH can be treated with liposuction

Fortunately, PAH is not life-threatening, and it is fully treatable with liposuction. However, patients who develop the condition have to live with a conspicuous bulge for about six to nine months until the fat softens enough to remove safely. This can be hard on a patient both emotionally and physically, especially considering they sought out fat reduction in the first place to address a bothersome issue that now appears worse.

Moreover, this means the patient ends up having to undergo and pay for two procedures to address unwanted fat that liposuction could have taken care of the first time—with more precise, predictable sculpting than what’s possible with any non-surgical option.

Liposuction remains your best option for fat removal & sculpting

Non-surgical cosmetic treatment options continue to improve, and many are safe, suitable alternatives for patients wishing to make changes without significant downtime. Yet sometimes surgery remains the superior option. I believe this is case with liposuction vs CoolSculpting.

When performed by an experienced, skilled cosmetic surgeon, liposuction can safely, thoroughly, and precisely remove fat to strategically sculpt a beautiful, natural shape to an area. In contrast, fat reduction achieved with non-surgical technologies is only predictable down to a general area and provides minor improvements. For most patients, the more detailed, dramatic results possible with liposuction are well worth taking a few days off and having a couple of very tiny scars that fade in time.

Moreover, liposuction can end up costing less than non-surgical alternatives in the long run. A cosmetic surgeon can determine exactly how much fat to remove to achieve your desired results in one procedure. It’s common for patients to need three or more CoolSculpting treatments to achieve a similar amount of reduction as one liposuction procedure, and you don’t even get the benefit of detailed sculpting.

Considering fat reduction in Bellevue? Let’s talk.

You have many options to reduce fat and improve your shape, and that’s a good thing. During your consultation, we can talk about the expected results with different procedures and together discuss the pros and cons of each. My priority is to help you make the right decision for your needs and goals.

Coolsculpting for stomach works by freezing the fat cells in your stomach, thereby causing a natural fat elimination process. The coolsculpting procedure uses some special hand applicators to apply the necessary low temperature directly to the stomach area where the fat reduction is required. Once the fat cells in the stomach are frozen, the fat cells would begin to die and the body would immediately get rid of the dead fat cells.

This follows a natural process, where the body’s metabolism removes the dead fat cells from the stomach, filtering them out of the body via the lymphatic system. Coolsculpting procedure effectively eliminates the stubborn fats in the stomach naturally, thereby reducing the thickness of fat layers and pockets. With this process, cool sculpting can dramatically reshape your stomach within months.

How Much Is The Cost Of Cool Sculpting In Boston?

According to Realself.com, the normal cost of cool sculpting in Boston is about $600 to $4,000 with an average cost of coolsculpting as $1,625 and $2,400 from all other locations. The cost of cool sculpting depends on your desired fat reduction goals, the number of cool sculpting treatment cycle to achieve your desired results, and the number of body areas you wish to treat.

Being a personalized treatment, you can try just a treatment cycle to see what the result would be before you undergo more coolsculpting treatments. More treatments are sometimes recommended for one area to reach your desired goals. Coolsculpting treatment can help you to cut down about 25 percent of fat cells per treatment from the target area. If you want to undergo coolsculpting treatment in multiple body areas, you should plan to pay about $1000 to $4000.

  • Coolsculpting for Stomach, Abdomen, Tummy $1200 – $3600
  • Coolsculpting for Mid and Lower Back                               $1200 – $2400
  • Coolsculpting for Love Handles or sides                               $1200 – $2400
  • Coolsculpting for Inner Thighs                                               $1200 – $2400
  • Coolsculpting for Outer Thighs                                               $1500 – $2400
  • Coolsculpting for Back of Arms                                               $1200 – $2400
  • Coolsculpting for Double Chin                                               $700 – $1200

If you want to cut down the amount of fat in any area of your body without surgery, schedule an appointment with your physician for a free consultation to learn more about how cool sculpting treatment can be so useful.

Areas of Treatment and Average Cost by Area

Coolsculpting is a patented fat reduction treatment that has been approved by the FDA for treating the following body areas: outer thighs, inner thighs, the back, chin, upper arms, love handles, lower stomach, and the abdomen. The coolsculpting Boston prices are mostly based on the number of the treatment cycle. More so, your coolsculpting treatment cost would be determined by the targeted body area, and your desired results, which will, in turn, determine the number of the treatment cycles required. For a better price quote for coolsculpting treatment, you need a personal consultation with your physician, who will examine your fat reduction needs, create a bespoke coolsculpting treatment plan, and determine the cost of cool sculpting your stomach.

Coolsculpting for Stomach, Abdomen, Tummy

The CoolMax applicator is useful for eliminating bulky fat deposits in the lower abdomen area, while the CoolCore application is useful for precision cool sculpting on the upper abdomen. The average number of recommended cool sculpting treatments for the stomach is about 1 to 3 and the price ranges from $1200 to $3600 per session. For the treatment, two visits may be required to the cool sculpting physicians.

Coolsculpting for Mid and Lower Back

The CoolCore applicator can be effectively used to reduce heavy fat cells around the lower back region, while the CoolPetite Advantage applicator can be used to eliminate fat from the mid-back section of the body. Depending on your desired goal, you may need an average of 2 treatments cycles.

Coolsculpting for Love Handles (Flanks or Sides)

The CoolCurve applicator is typically used to eliminate stubborn fat in the contoured area of the flanks or sides, while the CoolCore applicator is used for precision cool sculpting in this body area. A single treatment session may be enough to achieve the desired feat reduction goal, but most patients usually opt in for a second treatment session to help achieve the desired results. The average number of recommended treatments is about 1 to 2.

Coolsculpting for Inner Thighs

Getting rid of cellulite from the inner thighs is one of the major reasons for undergoing the cool sculpting procedures. Normally, coolsculpting the inner thigh requires a single treatment of about 35 to 40 minutes per thigh using the CoolFit applicators. The CoolFit applicator is designed for long body areas and also body areas that are difficult to access while CoolCurve applicator is used to address small body areas on the inner thighs. Cool sculpting procedures can be carried out on both legs at the same appointment, but if you wish, you can schedule 2 cycles. The average number of recommended treatments is about 1 to 2.

Coolsculpting for Outer Thighs

Eliminating stubborn fat cells from the outer thighs uses the CoolSmooth PRO applicator. This applicator gives the outer thighs a slimmer appearance that cannot be achieved using workout or diet. If you wish, you can have both thighs treated in a single session or you may schedule different appointments for each thigh. This, however, depends on the number of fat cells required to be removed from each thigh. The average number of recommended treatments is about 1 to 2.

Coolsculpting for Back of Arms

The CoolFit applicator is suitable for freezing the fat cells in your upper arms. This procedure doesn’t take a long time as both arms can be sculpted in a single session. The average number of recommended treatments is 1.

Coolsculpting for Double Chin

Do you wish to restore your youthful appearance? This can be made possible and easy by cool sculpting your double chin. The Coolsculpting Mini applicator will eliminate excess fat in your chin and neck area. Depending on the number of fat cells in your double chin, you may need single or multiple visits to your physician to achieve your desired results. The average number of recommended treatments is about 1 to 2.

Are you planning to undergo a coolsculpting treatment for your stomach? Schedule an appointment with your physician today to know if you are eligible for the treatment and how much your estimated cool sculpting cost for stomach would be.