A doctor in a white coat marks guidelines on a woman's bare abdomen with a purple marker, likely preparing for a cosmetic or medical procedure.

Paradoxical Adipose Hyperplasia (PAH) Treatment

Paradoxical Adipose Hyperplasia, or PAH, is a rare phenomenon that can occur after cryolipolysis — the fat-freezing technology marketed as CoolSculpting®. Even non-invasive cosmetic procedures carry a small risk of complications, and while cryolipolysis is well documented as a safe and effective way to spot-reduce fat, in a very small number of patients it has the opposite effect, causing fatty tissue to grow rather than shrink. The reassuring news is that PAH is treatable, and patients across Reno and Lake Tahoe turn to Avance Plastic Surgery Institute to correct it.

PAH correction is performed by Dr. Erez Dayan, a board-certified plastic and reconstructive surgeon and Medical Director of Avance Plastic Surgery Institute known for his research, advocacy for the highest-caliber surgical techniques, and skill in corrective and revisional procedures. Harvard-trained — where he served as Chief Resident in Plastic and Reconstructive Surgery at Massachusetts General Hospital — and fellowship-trained in aesthetic surgery at the Dallas Plastic Surgery Institute, Dr. Dayan firmly believes in using the least-invasive method that will achieve the desired result. Because every PAH case is different, that judgment — paired with his full command of liposuction and energy-based technology — allows him to tailor correction precisely to each patient.

What Is Paradoxical Adipose Hyperplasia (PAH)?

Understanding PAH starts with how cryolipolysis works. Special applicators cool the targeted tissue to the precise point that destroys fat cells without harming surrounding tissue, and the body then clears those destroyed cells through its natural processes, leaving a slimmer, more toned area. With PAH, the body unexpectedly produces excess fatty tissue instead of eliminating it. It typically takes three to six months to develop and is recognizable by its presentation: an expanded area of fatty tissue that is firm to the touch and often shaped like the applicator used during the original treatment.

“It’s understandably distressing when a procedure does the opposite of what was intended. My job is to correct it with the least-invasive approach that will fully restore the area — and to make sure the patient understands every step of the plan.” — Dr. Erez Dayan

Why Does PAH Occur?

There is no confirmed cause of PAH, though several theories are being studied. One possibility is that certain fat cells are resistant to cold temperatures, and because they survive, they prompt the body to overcompensate and produce more resistant cells. Another is that the body reacts to the suction component of cryolipolysis, with the negative pressure encouraging certain fat cells to grow. There are no known identifiable risk factors, and while the overall risk is understood to be low, PAH can affect any area treated by cryolipolysis.

PAH Treatment Options in Reno/Tahoe

Paradoxical Adipose Hyperplasia is treatable, but it does not respond well to non-invasive methods — correcting it requires a highly trained plastic surgeon with the right surgical tools. Depending on the degree of fat regrowth, Dr. Dayan’s options include liposuction, a combination of radiofrequency, ultrasound, and liposuction, or — in the most severe cases — a full surgical revision in which the excess tissue is removed and loose skin is tightened. The right approach is determined by the specifics of each case.

Correcting PAH After CoolSculpting

Since every PAH case is unique, Dr. Dayan begins with an in-depth consultation, drawing on his extensive education and experience to identify the techniques best suited to correcting and minimizing its effects. His attentive, caring approach means you’ll always understand why he recommends a particular plan, along with the goals and expected outcomes of any procedure. If you developed PAH following cryolipolysis, rest assured the appearance can be improved — and the team is here to help.

Frequently Asked Questions About PAH Treatment

How do I know if I have PAH?
PAH usually develops three to six months after cryolipolysis and presents as a firm, enlarged area of fatty tissue, often in the same shape as the applicator used during treatment. A consultation with Dr. Dayan can confirm whether what you’re seeing is PAH.

Will PAH go away on its own?
PAH does not resolve on its own and does not respond well to additional non-invasive treatments. Correcting it requires a surgical approach tailored to the degree of fat regrowth.

How is PAH treated?
Depending on severity, treatment may involve liposuction, a combination of radiofrequency, ultrasound, and liposuction, or a full surgical revision with skin tightening in the most advanced cases. Dr. Dayan selects the least-invasive option that will fully restore the area.

Can PAH be completely corrected?
In many cases the appearance can be significantly reduced or eliminated, though the right expectation depends on the degree of regrowth. Dr. Dayan will explain the realistic outcome for your specific situation during your consultation.

Did I do something to cause PAH?
No. PAH has no known identifiable risk factors and is not the result of anything the patient did. It is a rare, unexpected reaction to cryolipolysis that can affect any treated area.

When can PAH be treated?
Because PAH develops over three to six months, treatment is typically planned once it has fully presented and been evaluated. A consultation allows Dr. Dayan to assess the area and recommend the best timing and approach.

Why Choose Avance Plastic Surgery Institute for PAH Treatment

Corrective and Revisional Expertise: a surgeon skilled at restoring areas affected by complications from prior procedures
Least-Invasive Philosophy: a commitment to choosing the gentlest approach that will achieve the desired result
Harvard Surgical Training: board-certified with Chief Resident experience at Massachusetts General Hospital
Full Technology Toolkit: command of liposuction, radiofrequency, and ultrasound to tailor correction to each case
Attentive, Transparent Care: a clear explanation of the plan, goals, and expected outcomes at every step

Schedule Your PAH Treatment Consultation in Reno/Tahoe

If you developed paradoxical adipose hyperplasia after CoolSculpting, the appearance can be improved — and Dr. Erez Dayan is here to help. Contact Avance Plastic Surgery Institute in Reno/Tahoe, NV at (775) 800-4444 to schedule your PAH treatment consultation. Virtual consultations are also available for patients traveling from out of town.

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Reviews

5.0 / 5.0

5.0 stars from 587 reviews

Hands down the most qualified, honest and knowledgeable plastic surgeon in Northern Nevada. Dr. Dayan and his staff are truly committed to offering leading edge technology, quality and professionalism to each and every treatment ranging from to simple non invasive injections to complicated procedures. What he and his team have to offer always seems too good to be true, but they always over exceed expectations and are incredibly budget conscientious. The Reno-Tahoe area is incredibly fortunate to welcome such a skilled and qualified aesthetic professional into the area!

Shelby M.

Dr. Dayan is the surgeon clients should interview with and choose for their procedures. I am always very cautious when deciding important life decisions and I can say without a doubt that I would go through my surgeries again with Dr. Dayan. Every appointment has been professional, courteous, informative, and truthful. I never felt rushed. I also appreciate knowing my privacy is maintained. My fear of pain is very respected, and his demeanor eases it quite a bit. I made my decision to trust Dr. Dayan because of his extensive education, vast experience, and my first-hand witness of his character. These factors have allowed me to look forward to all of my appointments.

Aubrey S.

I had three consultations and didn't make any decisions lightly, but Dr. Dayan blew the competition out of the water. From the moment I met him during my consultation, he was honest and open while also personable. He also insisted on putting me in touch with previous patients before I made my decision so that I could have a better understanding of the process and recovery as a whole. I ultimately picked him because I knew he would do a good job but also because I felt at ease with him. The day of surgery, I was very nervous and he was comforting while efficient with his time. He was also completely honest with me during my recovery and called either myself or my husband often to make sure I was doing well, but also to make sure my husband understood the process completely. He also makes himself so available for any little questions or concerns I've had, making me feel secure in knowing he's only a phone call or a text away. Although I am not yet completely healed (only 3 weeks post-op) I already feel so confident in the work that has been done. He has helped me to transform something that had me so insecure for such a long time into a body I feel comfortable in. I cannot wait for the final results! I won't hesitate to return to Dr. Dayan for anything else I need done. Between him and his office staff (Alli) I feel like more of a member of the Avance family rather than a patient!

Jacelyn O.

I highly encourage anyone who is considering plastic/reconstruction surgery to schedule a consultation with Dr. Dayan. I couldn't have asked for a better experience and outcome from my breast augmentation. At my consultations, not only did I get my questions thoroughly answered, but I was treated with such genuine kindness and patience. Dr. Dayan is professional, highly knowledgeable, honest and has a certain way of connecting with others. For these reasons, I trusted him and felt supported throughout my whole breast augmentation experience from pre- to post-surgery care. All around, I felt safe and informed about this big decision/investment which is all I could ever ask for. I recovered so much easier than I expected, and my breasts are looking perfect and natural! Dr. Dayan definitely listened to what I wanted and followed through. Lastly, I want to mention how sweet and supportive his team is over at Avance! I am very appreciative of their service.

Sidney C.

My results after a "noninvasive" procedure are amazing. The cutting-edge techniques and noninvasive technology that Dr. Dayan incorporates into his procedures, as well as being a gifted and talented surgeon and individual, all contribute to his many accomplishments. However, I personally am impressed with his abilities to listen, communicate, and create beautiful results. I highly recommend a consultation with Dr. Dayan before making a final decision on any kind of procedure. Just another satisfied patient!

Mary J.

I had a perfect experience at Avance. Dr. Dayan was quick, professional, and checked in with me regularly to make sure I was comfortable during the short procedure I needed done. His demeanor was calming and I was able to put full trust in his abilities from start to finish. Erez really knows his stuff, and it's amazing he's here in Reno when he could clearly be somewhere much bigger if he wanted. I definitely won't hesitate to book again if needed.

Chris S.

Absolutely an amazing experience! Where to start? When I first thought of getting a mommy makeover my expectations were not that high because I didn’t ever think I could look the way I wanted to. I always just hoped it would be an improvement and I would be happy with that. Then I met Dr. Dayan. From the first consultation he made me realize that he could give me beautiful results that I didn’t know were possible. He was so kind and confident and I knew from that moment that he was going to be my surgeon. I booked my surgery (a breast augmentation with implants and a tummy tuck with lipo) that day and it was the best choice I have ever made. Before my procedure he was very thorough and explained step by step what he was going to do which made me feel so comfortable. I actually wasn’t nervous at all. I was so excited! I am now 1 month post op and my results are above and beyond what I could have ever dreamed my body could look like after a mommy makeover. Dr. Dayan did an exceptional job. I am not completely healed and I already am so pleased. There are no words that can do justice to how amazing it is to put trust in someone with my body and wake up with results that are better than I could have ever imagined. He truly is skilled in his profession and has the eye for what is best for your body to give you the best results. He followed up with me several times post op to see how I was feeling. If I had any concerns or questions he responded to them quickly and personally which made me feel confident that everything was going well! His care is exceptional from beginning to end. He has an amazing staff as well. His Patient coordinator Ali is so sweet and helpful. She is amazing with communication as well as helping you with financial options and scheduling. You won’t be disappointed working with Dr. Dayan and Ali!

Valerie F.

Dr. Dayan and his team are the best of the best! The level of care, professionalism is top of the class. I strongly recommend Dr. Dayan and his entire team. I cannot say enough about his work - he is incredibly talented and I am confident under his care. Of course the results are amazing! I love my LIPS!

Nasya M.