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Vanquish, CoolSculpting, Zerona. What's the Best?

What are the options when it comes to non-surgical fat reduction (besides not eating and working out) those are obvious and are already under way. What are the risks?

Doctor Answers 9

Freezing and heating fat works - Zerona doesn't

Vanquish is the latest in non-invasive fat reduction. It is FDA-approved for deep tissue heating, but clinical studies demonstrate fat reduction after treatment. Vanquish heats fat using RF (radio frequency) - specially tuned electricity that in this application targets fat without injuring other tissues. Treatment consists of 4-6 weekly sessions. It does not contact the skin, and the treatment feels like sitting under a warm blanket for 30 minutes. Average loss of waist circumference after treatment of the waist and flanks was 2 1/4 inches. Vanquish has a large "spot" area that can treat the abdomen and sides of the waist simultaneously.

CoolSculpting or Zeltiq is "cryolipolysis" or freezing of the fat. A suction cup like applicator is used to freeze the fat over a 1 hour treatment time. The skin after treatment feels like a stick of butter and is massaged. Occasionally, patients have discomfort in the treatment area that requires pain management. Results take around 1 month and result in around 20-30% fat loss in the area of treatment. New treatment regimens recommend that patients have multiple applications to sculpt the area of treatment smoothly and avoid irregularities.

Zerona is a fairly obsolete technology. Although I do not have the technology myself, feedback from colleagues is that it is not very efficacious. It also requires diet and exercise recommendations in order for Zerona to work.

San Diego Dermatologic Surgeon
5.0 out of 5 stars 18 reviews

We have experience with Vanquish, CoolSculpting and Zerona for fat reduction.

I have experience with Vanquish, CoolSculpting and Zerona.  We have had our CoolSculpting device now for over 5 years and were the first office in Orange County to have Vanquish.  We obtained our Vanquish in January, 2014.  We have had very nice results from both of these devices.  CoolSculpting works by freezing the fat cells and causing the cells to die.  This device is ideal for localized areas of fat such as the 'love handles' and 'bra rolls'.  The downside of CoolSculpting is that it takes one hour per localized area.  Vanquish utilizes a large panel which lies very close to the skin and can cover a broad area.  Vanquish then heats up the fat cells to over 110 degrees fahrenheit to cause the fat cells to die as well.  As you can see, you can reduce fat cells by taking them to either extreme in temperature for enough time.  Both devices take some time to see the final results.  Results can be impressive in certain patients.  I don't compare the results to liposuction as I feel I can obtain better results surgically, but not everyone is interested in surgery.  It is best to obtain a consultation to see which device is best for you.  With regards to Zerona, it utilizes low level energy to supposedly cause fat cells to 'leak'.  I had the device for several results and patients seemed happy; however, I returned the device as I felt they achieved their results from the exercise, diet and supplements that were recommended with it.

Sanjay Grover, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 145 reviews

Vanquish, CoolSculpting and Zerona

Here is a breakdown of the difference between the three devices:


  • Zerona uses a cool laser to address fat on the waist, thighs and hips
  • Results of Zerona have been unimpressive

  • CoolSculpting good for very targeted fat reduction
  • Some people have temporary discomfort or soreness afterwards
  • "Dimpling" is very rare with CoolSculpting 

  • Vanquish good for larger abdomens
  • New applicators are coming out to address fat reduction on the thighs

Margaret Weiss, MD
Baltimore Dermatologic Surgeon
3.5 out of 5 stars 7 reviews

Vanquish for Fat Reduction

Vanquish is the latest adancement in non-invasive fat reduction. Unlike some other products, it treats a very large surface area: abdomen, flanks simultaneously, and it is virtually 100% pain free and relaxing. Our patients and staff have been very pleased with the results in San Diego.

Roy A. David, MD
San Diego Facial Plastic Surgeon
4.5 out of 5 stars 21 reviews

Vanquish, CoolSculpting It's all about choices

Great questions, but let’s compare apples to apples and add some science as well. It’s all about “fat busting” getting rid of those fat cells, and doing so without surgery, and that’s what Vanquish, CoolSculpting and Liposonix do. They injure fat cells, so the body then eliminates them. Zerona is in a different ball park. It temporary shrinks the fat cells, but doesn’t knock them out. So how to choose? It’s all about choice. Vanquish is new and it offers (for the first time) a chance to treat it all - the full tummy and love handles in four treatment sessions. CoolSculpting has been a great choice for our patients as well. It is better for that more focused bothersome area of excess fat. For us and maybe for you, the answer is a combination of treatments, with many options.

Douglas J. Key, MD
Portland Dermatologic Surgeon
4.5 out of 5 stars 11 reviews

Vanquish, Coolsculpting and Zerona. Which is the Best?

I get this question all the time since we have both Vanquish and Coolsculpting in our office.  We have done the most Coolsculpting in Orange County for the past three years.  Zerona  is based on low level LED lights to cause the fat cells to leak fat temporarily.  However, with Zerona you need to adhere to their diet supplements also.  Zerona long term has not proven to be effective.  Coolsculpting is designed to be for local areas of fat.  It is limited by the ability of the machine to suck the fat into the applicator.  Coolsculpting is great for localized areas of fat that can fit into the applicators.

Vanquish is completely different in that the technology utilizes a large three panel, no contact device that delivers radiofrequency waves into the fat to melt the fat without pain.  The science of Vanquish specifically targets fat so we have seen inches of fat loss within several weeks.  One of the main advantages of Vanquish is that you can cover a large area such as the abdomen and the love handles with the panels in one treatment.

Dr. Liu

Grace Liu, MD
Newport Beach Dermatologic Surgeon
5.0 out of 5 stars 38 reviews

Non-invasive Fat Reduction

We have done a trial with Zerona and we offer Coolsculpting and Vanquish as well as Smart Lipo in our office. Zerona took too much patient participation (!) for us to offer it. Its success is dependent on diet and lifestyle changes that are great but I felt our staff would really have to work with the patients to assure that they got the results possible and we just are not geared for that type of interaction.

We have had Coolsculpting since its inception. I love the science behind it and it does kill fat non-invasively. We have definitely gotten great results for SOME patients and my advice is to make sure you have the right problem for Coolsculpting to be the solution. Patients who need 1-3 applications to grab the majority of their abdominal fat do very well!

We added Vanquish because it seemed likely to help patients for whom Coolsculpting would be too expensive and time consuming to give visible results. That has proved to be the case. For big tummies, our patients that follow the protocol and hydrate well the day before, day of, and day after treatment are seeing more than the average 2 inch loss that the company promotes after 4 weekly treatments. Those patients are thrilled because it is quick, neat and painless.

I think both systems have a place in our fat fighting arsenal.

Rutledge Forney, MD
Atlanta Dermatologic Surgeon
3.5 out of 5 stars 6 reviews

Vanquish vs CoolSculpt (Zeltiq) vs UltraShape

I recommend Ultrashape for mild fat reduction and waist enhancement for a number of reasons:

CoolSculpt (Zeltiq) is older technology. It works, but there is often discomfort reported with the treatment, it takes more sessions, the applicator paddles do not fit all body parts or shapes, there can be bruising, numbness and paresthesias (unpleasant sensations) afterwards that usually go away with time. I have seen some ridges above the applicators of untreated fat that now must be addressed.

Vanquish is a  non-invasive body contouring treatment, is the first that incorporates “focused-field radio frequency” to destroy fat without touching the patient’s body. That is it heats up the fat which despite the company's claims can cause discomfort as reported by some of the patients that have done this.

In contrast UltraShape has none of these limitiations. UltraShape is a non invasive, non thermal, non painful, quick procedure with no downtime for mild to moderate fat reduction whereas liposuction is invasive and reserved for more aggressive fat removal. UltraShape® is a non-surgical treatment option that instantly and selectively  through focused ultrasound waves,  breakdown fat cells in the targeted area/s, as well as tightens the skin. The targeted fat cells are released through the body’s natural metabolic processes. The treatment is performed in-office and requires no needles, incisions or anesthesia. There is minimal discomfort during the treatment and no bruising, swelling or downtime afterwards. Essentially a “walk-in, walk-out” 45 minute procedure. UltraShape® can be used to contour: Flanks, Abdomen and Thighs

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 72 reviews

I think the Vanquish combined with the Z wave gives the best non-painful, non-invasive fat reduction results available.

Vanquish is an efficient, non-painful, non-invasive fat reduction procedure.Bottom line is both Vanquish which uses RF to heat the fat and CoolSculpting, freezing the fat both work.We spent a full year talking to people that had Vanquish and/or CoolSculpting in their office (not the reps) and bought Vanquish.In my opinion, the Vanquish technology is better for my practice for a few reasons.First Vanquish is not painful.In talking to technicians who have used both, the CoolSculpting can be painful to very painful so compliance is an issue.Vanquish is relaxing and does not hurt.It may feel warn, but not painful.Also with CoolSculpting you have to treat one flank, then the other, then the abdomen or in some cases the upper abdomen and the lower abdomen.Vanquish can target all of these areas in 1 treatment.Vanquish can be more cost effective for the provider and therefore the patient as there are no disposables with the procedure.With CoolSculpting you pay for disposable equipment with each use, Vanquish there are no disposables because the machine does not touch the skin.We use the Z Wave with every Vanquish treatment.The Z Wave uses sound waves to “break up” the fat Vanquish destroyed and in my opinion it reduces any lumps and helps the body absorb the fat faster.I think the Vanquish combined with the Z wave gives the best non-painful, non-invasive fat reduction results available.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.