title: Paradoxical Adipose Hyperplasia and Cellular Effects After Cryolipolysis: A Case Report.
abstract: Cryolipolysis is a noninvasive technique for the reduction of subcutaneous adipose tissue by controlled, localized cooling, causing adipocyte apoptosis, reportedly without affecting surrounding tissue. Although cryolipolysis has a low incidence of adverse side effects 33 cases of paradoxical adipose hyperplasia (PAH) have been reported and the precise pathogenesis of PAH is poorly understood. This present case study of PAH aims to characterize the pathological changes in the adipose tissue of PAH on a cellular level by using multiple different assays [hematoxy lin and eosin staining, LIVE/DEAD staining, BODIPY(®) 558/568 C12 (4,4-Difluoro-5-(2-Thienyl)-4-Bora-3a,4a-Diaza-s-Indacene-3-dodecanoic acid) staining]. to identify the underlying mechanism of PAH and reduce the prevalence of PAH in the future. Tissue with PAH had fewer viable cells, significantly decreased quantities of interstitial cells (p = 0.04), and fewer vessels per adipose tissue area when compared to the control tissue. Adipocytes from the PAH tissue were on average slightly smaller than the control adipocytes. Adipocytes of PAH tissue had irregularly contoured edges when compared to the smooth, round edges of the control tissue. These findings from a neutral third party are contrary to prior reports from the inventors of this technique regarding effects of cryolipolysis on both the microvasculature and interstitial cells in adipose tissue. Our use of different assays to compare cryolipolysis-treated PAH tissue with untreated adipose tissue in the same patient showed adipose tissue that developed PAH was hypocellular and hypovascular. Contrary to prior reports from the inventors, cryolipolysis may cause vessel loss, which could lead to ischemia and/or hypoxia that further contributes to adipocyte death. LEVEL OF EVIDENCE 5: Risk.
authors.affiliation: Mr Seaman is a Graduate Student (Ph.D. Candidate), Ms Cao recently graduated and now has her BS, and Dr Peirce is an Associate Professor, Department of Biomedical Engineering and Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia; and Dr Tannan is completing her Hand Surgery Fellowship at The Hand Center of San Antonio and Dr Gampper is Vice Chair and Program Director, Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Seaman
authors.affiliation: Mr Seaman is a Graduate Student (Ph.D. Candidate), Ms Cao recently graduated and now has her BS, and Dr Peirce is an Associate Professor, Department of Biomedical Engineering and Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia; and Dr Tannan is completing her Hand Surgery Fellowship at The Hand Center of San Antonio and Dr Gampper is Vice Chair and Program Director, Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Shruti C
authors.initials: SC
authors.lastname: Tannan
authors.affiliation: Mr Seaman is a Graduate Student (Ph.D. Candidate), Ms Cao recently graduated and now has her BS, and Dr Peirce is an Associate Professor, Department of Biomedical Engineering and Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia; and Dr Tannan is completing her Hand Surgery Fellowship at The Hand Center of San Antonio and Dr Gampper is Vice Chair and Program Director, Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Yiqi
authors.initials: Y
authors.lastname: Cao
authors.affiliation: Mr Seaman is a Graduate Student (Ph.D. Candidate), Ms Cao recently graduated and now has her BS, and Dr Peirce is an Associate Professor, Department of Biomedical Engineering and Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia; and Dr Tannan is completing her Hand Surgery Fellowship at The Hand Center of San Antonio and Dr Gampper is Vice Chair and Program Director, Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Shayn M
authors.initials: SM
authors.lastname: Peirce
authors.affiliation: Mr Seaman is a Graduate Student (Ph.D. Candidate), Ms Cao recently graduated and now has her BS, and Dr Peirce is an Associate Professor, Department of Biomedical Engineering and Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia; and Dr Tannan is completing her Hand Surgery Fellowship at The Hand Center of San Antonio and Dr Gampper is Vice Chair and Program Director, Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Gampper
mesh_terms: D017667:Adipocytes / Q000473:pathology / Q000648:ultrastructure; D002470:Cell Survival; D017679:Cryotherapy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000209:etiology / Q000473:pathology; D018613:Microscopy, Confocal; D008875:Middle Aged; D013194:Staining and Labeling; D050151:Subcutaneous Fat / Q000473:pathology* / Q000648:ultrastructure