CoolSculpting is a nonsurgical body contouring treatment that uses cryolipolysis (fat freezing) to reduce pockets of stubborn fat in targeted areas.
This fat reduction procedure freezes and destroys fat cells without harming the surrounding tissues. In the weeks following, the body naturally metabolizes and permanently eliminates these damaged cells.
CoolSculpting is cleared by the Food and Drug Administration (FDA) for treating stubborn pockets of fat on several areas of the body, including:
It's also FDA cleared to treat submental fat (a double chin) and submandibular fat under the jawline with a smaller applicator called the CoolMini.Â
Providers commonly use CoolSculpting off-label (beyond its FDA approval) to tone knees, hips, and other stubborn fat bulges, like the mons pubis.Â
Dr. Jason Emer, a board-certified dermatologic surgeon in West Hollywood, California, uses this body sculpting treatment on its own and to enhance the results of surgical fat removal. âIt can be used as a spot treatment after liposuction, to fine-tune or improve upon more dramatic surgical outcomes,â he explains.
âHaving a consultation with an experienced provider whoâs well-versed in fat reduction treatments is the best way to find out if this is the right choice for you,â says Dr. Lorrie Klein, a board-certified dermatologic surgeon in Laguna Niguel, California.
CoolSculpting is not a weight-loss method or a treatment for obesity.
Pros
Cons
Your cost will depend on how many body areas are included in your treatment plan, how many cycles you get, your providerâs credentials, their location, and a few other key factors. Most providers accept financing options like CareCredit.
As you're choosing your provider, look for CoolSculpting pictures with similar lighting, angles, and proportions. Pay special attention to patients with similar body types and areas of concern to your own, and note whether their results show smooth, natural-looking contours and a significant amount of fat reduction.Â
The CoolSculpting before and after pictures in our gallery have been shared by the provider who performed the procedure, with the patient's consent.
Ideal candidates for CoolSculpting are healthy adults within 20 pounds of their ideal body weight, with good skin elasticity (so it can bounce back once the fat is removed) and a body mass index (BMI) of 30 or less. Another requirement is having at least â of an inch of pinchable fat, to fit into the CoolSculpting applicator.Â
âThe best candidate is one that is already fit with small problem areas that are resistant to diet and exercise,â explains Dr. Emer. âThe bigger someone is, the more treatments needed to see an outcome, and the less substantial the results will be.â
Women who are pregnant or breastfeeding, or people with poor circulation, neuropathy, a pacemaker, or a defibrillator should avoid CoolSculpting treatment. You should also skip this treatment if youâve been diagnosed with cryoglobulinemia, paroxysmal cold hemoglobinuria, or cold agglutinin disease.
If you have open or infected cuts or wounds, eczema, dermatitis, or a rash in the treatment area, you wonât be able to have this treatment until those conditions are resolved.
RealSelf Tip: A study published in the Aesthetic Surgery Journal in 2020, which summarized clinical best practices based on the experience of eight plastic surgeons with extensive CoolSculpting experience, notes that âthe authors prefer liposuction over cryolipolysis [CoolSculpting] for patients who require significant debulking or who have a desire for immediate results.â
Lipo is also preferred if the treatment plan involves fat transfer to add volume to another body area, such as the breasts or butt.
Related: Who Is a Good Candidate for CoolSculptingâand Who Isn't
CoolSculpting is not a weight-loss solution: itâs a nonsurgical fat-reduction treatment, intended for subtle body sculpting.
As we mentioned above, it works best for relatively fit people who are already close to their ideal weight but want to target specific areas of unwanted fat.
CoolSculpting takes 35 to 60 minutes, depending on the size and number of areas being treated and the specific applicators being used. Some doctors offer âDualSculptingâ or CoolSculpting Elite, to target multiple treatment areas simultaneously and reduce treatment time.Â
Hereâs what to expect.
RealSelf Tip: Avoid alcohol for 24 hours prior to your treatment, to mitigate bruising.
Clinical evidence shows that CoolSculpting really does work to reduce fat.Â
For some patients, âCoolsculpting works, and impressively so,â says Dr. Cameron Chesnut, a board-certified dermatological surgeon in Spokane, Washington. âLike many things, it is all about patient selection and expectations.âÂ
How well it works for you will depend on your provider, according to Dr. Chesnut. âIt is incredibly important that you pay attention to who you are seeing for this procedure, as it is really about the planning and assessment, not just putting the device on.âÂ
This isnât designed to be a cellulite treatment, but it may improve the look of cellulite in some patients by reducing stubborn fat that can bulge and dimple.
Itâs also not intended to tighten loose skin, but Dr. Emer says that âthere is some degree of skin tightening seen after each CoolSculpting treatment.â This claim is supported by a study published in the Aesthetic Surgery Journal in 2021, which found a significant increase in type I collagen in skin after cryolipolysis treatment. New collagen production can mildly firm skin over time, but anyone looking for dramatic tightening should talk with their provider about add-on treatment options.
The intense cold and pressure during the first few minutes of a CoolSculpting treatment can be painful.
The device's manufacturer says that âyou may experience sensations of pulling, tugging, mild pinching, intense cold, tingling, stinging, aching, and cramping at the treatment site.â As the area becomes numb, these symptoms should subside.
Applicator updates have made the treatment more comfortable and effective over time. âThe original applicators required significant suction to get each bulge of fat positioned between two cold panels,â explains Dr. Heidi Waldorf, a board-certified dermatologist in Nanuet, New York.
âTheyâve been replaced by the CoolAdvantage applicators, which provide full-surface cooling and, therefore, less suction,â she adds. âThe positioning of the applicators on the patient is critical, to provide full contact. In fact, the applicators are set up to trigger an alarm and stop working if there is a âpop offââif the skin is not in full, direct contact with the applicator panelsâto avoid moisture accumulation and frostbite.â
According to Allergan, the device manufacturer, about 1 out of 6,000 treatments (0.017%) results in severe nerve pain, which can develop âseveral days after a treatmentâ and resolve in âseveral weeks.â
CoolSculpting is FDA cleared and generally considered to be a safe cosmetic treatment option for good candidates. (However, itâs not without risks and side effects, which we explore in the next section.)
Knockoff machines sold around the world sometimes find their way into stateside medspas and other practices, so make sure youâre getting the real thing. âThe concern with these devices is the lack of regulation and paucity of studies proving their exact technologyâincluding rate of cooling, max temps, standardizations, and safety precautions and triggers,â says Dr. Waldorf.Â
Dr. Emer underscores this concern. âI have seen numerous patients who were treated with knock-off devices that caused burns and irregularities, so beware.â
Read on to learn about the potential risks and side effects of fat freezing.
CoolSculpting side effects are usually mild and resolve on their own, but you and your provider should still discuss them prior to your treatment.
CoolSculpting also carries a risk of paradoxical adipose hyperplasia (PAH), an increase in fatty tissue at the treatment site. PAH happens when fat cells expand in reaction to extreme cold.
In reported cases, PAH occurred two to five months post-procedure, after an initial fat reduction.Â
The manufacturer says PAH is estimated to occur in 1 out of every 3,000 treatment cycles (an incidence of 0.033%). However, a study reported in the 2018 issue of Plastic and Reconstructive Surgery suggests that it might have an incidence as high as 0.72%, or 1 out of every 138 cryolipolysis treatments.
âIâve never seen it, but I do discuss it as part of informed consent,â says Dr. Waldorf, and your doctor should too. Dr. Klein agrees that itâs rare. âWeâve done thousands of cycles and I have seen only one case of PAH.â Based on what heâs seen, Dr. Emer believes PAH is more of a risk when applicators are used in areas that donât align with their FDA clearance.
In 2023, however, the New York Times published a report, exploring the true incidence of PAH. According to the paper, âIn 2017, Dr. Jared Jagdeo, a dermatologist who was then a consultant for CoolSculptingâs manufacturer, and two co-authors wrote in a journal article that the side effect [PAH] should be reclassified. Its increasing incidences, they wrote, met the World Health Organizationâs criteria for a âcommonâ or âfrequentâ adverse event, instead of a ârareâ one.â
When PAH occurs, the excess fat can sometimes be treated with liposuction, and Allergan claims to cover at least a portion of the cost of liposuction to treat confirmed cases of PAH.Â
Patients have to wait several months for the fat to soften, to reduce the risk of recurrence. Some patients even need two rounds of liposuction, as well as additional procedures, like tummy tucks, potentially at their own expense.
âIn my experience, most PAH needs at least VASER ultrasonic liposuction coupled with Renuvion or BodyTite internal heating, due to the fibrosis/scar tissueâwhich is completely unpredictable,â says Dr. Emer. âSome cases also need skin removal, to remove loose or hard skin and to surgically cut out scar tissue.â
Related: Linda Evangelista Says CoolSculpting âDeformedâ Her. Doctors Explain What Happened.
Most people donât need actual downtime after a fat freezing treatment, but there's still a recovery process that varies in intensity, depending on how your body responds and how many areas youâve had treated.
Hereâs what you can expect.
Related: What to Do During and After CoolSculpting to Get the Best Results
CoolSculpting swelling usually resolves in about two weeks, but it can linger for up to a month, according to Dr. Adam Hamawy, a board-certified plastic surgeon in Princeton, New Jersey. âIâve seen patients who experience very minimal swelling for just a few days and others who feel swollen for up to four weeks. For the majority, swelling almost entirely dissipates within two weeks.â
Again, you can minimize swelling by wearing a compression garment, drinking lots of water, and exercising.
Dr. Emer takes a more active approach with his patients. âWe find that two to three daily sessions of IV therapy with glutathione and vitamin C helps significantly decrease swelling,â he says. âOral diuretics can also be given, and hyperbaric oxygen therapy all help with healing. If you want to be aggressive with the amount of improvement, add a waist trainer daily for two to three weeks, at least overnight.â
You should start to see an improvement 30 days post-procedure, with more significant results visible within two to three months of your final treatment.
Even after that, you may continue to see some improvement. âYour body will continue to eliminate the treated fat cells for up to six months post-treatment,â according to Dr. Frank Lista, a board-certified plastic surgeon in Mississauga, Ontario.
Why does the process take so long? âUnlike liposuction, where the fat is removed, CoolSculpting releases the fat [from cells] to be metabolized and eliminated by your body,â explains Dr. Andrew Lyos, a board-certified plastic surgeon in Houston. Your biology dictates the rate at which fat is eliminated.
As weâve mentioned, you may need two or more treatments to see the results you want.
âResults are cumulativeâwe really can âsculptâ over time,â says Dr. Waldorf. âWith each subsequent treatment, you get a further reduction of the residual fat. We have a range of applicator sizes, so an area that required a larger applicator to start may be further reduced and contoured with a smaller applicator in later appointments.â
âDoing a second treatment within 30 to 60 days can enhance your treatment results,â according to Dr. Lori Brightman, a board-certified dermatologic surgeon in New York City.Â
A study co-authored by Dr. Brightman shows that the first treatment triggers an inflammatory response around the fat cells that dissipates in 60 to 90 days. Having your second treatment within that 60-day window generates a stronger response, leading to greater fat reduction.
âDoing a second treatment within 30 to 60 days can enhance your treatment results,â according to Dr. Lori Brightman, a dermatologic surgeon in New York City.Â
A study co-authored by Dr. Brightman shows that the first treatment triggers an inflammatory response around the fat cells that dissipates in 60 to 90 days. Having your second treatment within that 60-day window generates a stronger inflammatory response, leading to greater fat reduction.
CoolSculpting results can be permanent, as long as you donât gain weight afterward. The fat cells eliminated after the treatment are permanently gone, but any remaining cells can still expand. Weight gain can even lead to contour irregularities, if more numerous fat cells in surrounding areas expand.
A healthy diet and regular exercise will help you make the most of your investment.
CoolSculpting University, Allerganâs official training program, offers training for a variety of medical professionals, including technicians, registered nurses (RNs), physician assistants (PA), and doctors.
When you book your treatment, ask who your provider will be and make sure youâre comfortable with their level of training and experience.
Itâs also important to ensure that a board-certified dermatologist, plastic surgeon, or another type of physician will be the one ensuring that youâre a good candidate and overseeing your treatment plan.
Emsculpt Neo is a body contouring procedure that uses high-intensity focused electromagnetic (HIFEM) technology to induce nearly 24,000 muscle contractions in one 30-minute session. Like CoolSculpting, it reduces fat, but it also offers muscle toning.
We dug into the difference and found out that the two procedures can provide even better results when used together. Find out more.
Updated April 10, 2024