Optimizing Treatment of Paradoxical Adipose Hyperplasia With the High-Definition Liposuction Body Scale

Background: Cryolipolysis is a noninvasive outpatient procedure that uses localized, topical cooling to reduce subcutaneous fat. Paradoxical adipose hyperplasia (PAH) is an infrequent adverse event that occurs a few months following cryolipolysis. The pathological intricacies of PAH are currently poorly understood. However, increased adiposity, skin laxity, and diastasis of abdominal muscles have been observed. Current treatments remain underreported and lack direction in treating patients with varying PAH severity. Objective: In this article, we aim to discuss the authors’ approach to treating patients with PAH utilizing the high-definition liposuction (HDL) body scale. Methods: We present five cases with varying degrees of PAH severity. The HDL body scale was used as an algorithm to grade PAH deformities and subsequently guide surgical design. Results: The HDL body scale provides an effective protocol for the treatment of PAH deformities by grading the degree of fat excess, amount of skin redundancy, and extent of skin texture changes. Depending on PAH severity, surgical interventions that include ultrasound-assisted liposuction, helium-activated plasma radiofrequency, a localized tucking procedure, and/or a staged full tucking procedure can be implemented. Five cases representing the range of PAH deformities and subsequent surgical design using the HDL body scale and surgical algorithm are presented. Conclusion: The HDL body scale can be utilized to guide the effective treatment of PAH deformities. *Level of Evidence: Level V, clinical experience