CoolSculpting 101: Everything You Need to Know About the Fat Freezing Treatment

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WHERE DID COOLSCULPTING COME FROM?
The idea for CoolSculpting arose, in part, from observations of fat loss caused by cold temperatures. The most famous example is “popsicle panniculitis” (otherwise known as inflammation). Scientists noted that exposure to cold from a popsicle placed between the cheek and the gums caused swelling, firmness, and inflammation in the cheek. After the swelling would go down, the cheek would be thinner — often forming a dimple in response to the death of the fat cells. The studies showed that fat was more susceptible to cold than the surrounding tissues. The ZELTIQ Company, founded in 2005, used this research to eventually produce the CoolSculpting device.

AM I A GOOD CANDIDATE FOR COOLSCULPTING?
CoolSculpting is not a weight loss device, but a body contouring device. It will help flatten stubborn areas of fat excess. It’s designed to be used on specific sites, not broad areas. Love handles, postpartum lower belly fat excess, and outer thigh fat bulges are good choices for CoolSculpting. Fat that hangs over your belt, inner thigh excess, or upper arm fat are not good areas for CoolSculpting. Consultation prior to proceeding with the procedure will determine if you’re a candidate.

HOW DOES COOLSCULPTING WORK?
CoolSculpting a non-invasive procedure with minimal or no downtime. CoolSculpting involves cryolpolysis, a process in which exposure to near freezing temperatures results in death of the fat cells. The cells are fatally injured, die within two to three months, and are removed by the immune system.

WHAT HAPPENS DURING A COOLSCULPTING TREATMENT?
When you arrive for the procedure, a medical professional will review the area(s) to be treated. After marking the area, a protective gel pad will be applied and the excess fat will be pinched into the CoolSculpting applicator. Once the treatment begins, the target area will quickly become numb due to the cold, which will persist throughout 60 minutes of treatment. When the hour is over, the treated area will be red and, for many, look as if there’s a "stick of butter" underneath the skin. The provider will massage the site, and the lump will dissipate quickly. You’ll be free to continue with your regular daily activities immediately after.

ARE THERE ANY SIDE EFFECTS?
Some patients experience soreness or a “pins and needles” sensation for a few days, but most are symptom-free.

HOW MUCH FAT CAN I EXPECT TO LOSE?
In general, you can expect to see a 20-25% reduction of fat in the treated area. Most patients see noticeable results within three months, but some may see results in as early as a few weeks. There is one major exception: those who gain weight during treatment. If you are serious about body contouring, you must avoid weight gain during treatment or your results will be poor.

WHAT HAPPENS TO FAT AFTER COOLSCULPTING?
When the CoolSculpting device is employed, the temperature of the tissue in the treated area is lowered to well below body temperature (about 0 degrees celsius). This temperature produces a cold injury, damaging the saturated fats that make up the fat cell membranes. This leads to fat cell death, a process known as apoptosis. This is a “cellular suicide” in which damaged cells shrink, undergo fragmentation, and form particles known as apoptotic cell bodies. The apoptotic bodies are removed by the immune system through phagocytosis, which is to say that immune cells called macrophages “eat” the remnants, thus disposing of them. The initial phagocytosis process may lead to a red-pink appearance in the CoolSculpting area. The complete removal of apoptotic bodies by macrophages takes weeks to months and correlates with the time it takes to see CoolSculpting results.

BUT COULDN’T I JUST PLACE ICE ON MY STOMACH AND SEE THE SAME RESULTS?
Placing a bag of ice on your stomach is uncontrolled and will not provide sufficient cooling to kill the fat cells. Also, without the protective gel pad, applying such cold temperatures to the skin would cause damage to the overlying surface.

WHAT CAN I DO IN ADDITION TO COOLSCULPTING?
CoolSculpting is designed to contour areas of excess fat, especially on the trunk. A newly designed applicator head also allows for the outer thighs to be treated. If an area needs more contouring than what can be obtained from a single session, multiple sessions can be performed at least two months apart. Patients who undergo more than one session will see increased benefit. In some cases, when the tissue is too thick to be sucked in the CoolSculpting vacuum head, liposuction first is recommended. Multiple types of liposuction are available, but the traditional liposuction techniques remain the best method. Liposuction serves to remove much of the fat in the treatment area, deflating the volume and improving the contour. Care must be taken not to remove too much fat, as surface and contour irregularities may occur. After recovery from liposuction, treated areas are now partially deflated from the fat removal. Sometimes these areas require further contouring, which can be achieved with CoolSculpting. Typically the time between liposuction and CoolSculpting is four to six months. CoolSculpting may also be used following a tummy tuck (after appropriate healing, of course). A tummy tuck is usually recommended when the belly has loose skin, hanging tissue, and/or a weak muscle wall. A tummy tuck allows for removal of this tissue and tightening of the muscle, but will produce a scar across the lower abdomen. By reducing the “love handles” through CoolSculpting, this scar may be shortened.

About Dr. John Zavell
Dr. John F. Zavell is a board-certified plastic surgeon based in Ohio, where he specializes in surgical and non-surgical treatments at his practice Reconstructive and Aesthetic Surgeons. He's a member of the American Society of Plastic Surgeons, the American Society of Aesthetic Surgeons, and a Fellow of the American College of Surgeons. He's a clinical associate professor at the University of Toledo Medical Center and has been Chairman of Plastic Surgery at Flower Hospital for over 10 years.
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Toledo Plastic Surgeon