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Case Report/Case Series |

Paradoxical Adipose Hyperplasia After Cryolipolysis

H. Ray Jalian, MD1,2; Mathew M. Avram, MD, JD2,3; Lilit Garibyan, MD, PhD2,3; Martin C. Mihm, MD4; R. Rox Anderson, MD2,3
[+] Author Affiliations
1Division of Dermatology, University of California, Los Angeles, Los Angeles
2Wellman Center for Photomedicine, Massachusetts General Hospital, Boston
3Department of Dermatology, Massachusetts General Hospital, Boston
4Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Dermatol. 2014;150(3):317-319. doi:10.1001/jamadermatol.2013.8071.
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Importance  Cryolipolysis is the noninvasive reduction of fat with localized cutaneous cooling. Since initial introduction, over 650 000 cryolipolysis treatment cycles have been performed worldwide. We present a previously unreported, rare adverse effect following cryolipolysis: paradoxical adipose hyperplasia.

Observations  A man in his 40s underwent a single cycle of cryolipolysis to his abdomen. Three months following his treatment, a gradual enlargement of the treatment area was noted. This enlargement was a large, well-demarcated subcutaneous mass, slightly tender to palpation. Imaging studies revealed accumulation of adipose tissue with normal signal intensity within the treatment area.

Conclusions and Relevance  Paradoxical adipose hyperplasia is a rare, previously unreported adverse effect of cryolipolysis with an incidence of 0.0051%. No single unifying risk factor has been identified. The phenomenon seems to be more common in male patients undergoing cryolipolysis. At this time, there is no evidence of spontaneous resolution. Further studies are needed to characterize the pathogenesis and histologic findings of this rare adverse event.

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Figure 1.
Paradoxical Adipose Hyperplasia Approximately 5 Months Following Cryolipolysis

There is a sharply demarcated, rectangular enlargement around the umbilicus corresponding to the treatment zone. This soft-tissue protrusion was soft, mobile, and slightly tender to palpation. The overlying skin was unremarkable.

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Figure 2.
Soft-Tissue Hyperplasia Composed of Adipose Tissue

Magnetic resonance imaging reveals increased adipose tissue with normal signal intensity. The fat hyperplasia is greatest on the periphery of the treatment zone.

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Figure 3.
Representative Biopsy Specimens From Abdominoplasty Demonstrates Characteristic Changes to Adipose Tissue

A, Histologic image from an abdominoplasty specimen of paradoxical adipose hyperplasia tissue, demonstrating thickened fibrous septae with increased vascularity (hematoxylin-eosin, original magnification ×2.50). B, Higher magnification revealed an increased vascular network, characterized by capillaries and venules (black arrowheads) (hematoxylin-eosin, original magnification ×10).

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