CoolSculpting: The Ultimate Guide

Pros

• Reducing excess fat can be a strong motivator to kick-start an active, healthy lifestyle.
• This fat reduction procedure is less invasive than surgical procedures like liposuction, which requires anesthesia and incisions.
• Most patients don’t need any downtime or recovery time, making it much more convenient for busy people than surgical fat removal.
• CoolSculpting results are “Worth It,” according to 68% of patients who reviewed the treatment on RealSelf. Happy patients cite a significant improvement and natural results.
• Because the injured fat cells are fully eliminated, the body sculpting results from this treatment can be permanent (as long as you maintain a stable weight).

Cons

• It's not a one-time treatment: Most people need at least two and often three or more treatments (several weeks apart) for optimal results. 
• While the average cost is less than half of what most people pay for liposuction, CoolSculpting can still get expensive when you tally up the cost of multiple sessions.
• As with other nonsurgical body contouring treatments, you’ll need to wait two to three months for the body to process and eliminate the fat cells, so you can see your final results.
• Fat reduction results from this and other non-invasive procedures aren’t as dramatic as what you’d get from plastic surgery.
• RealSelf members who rated the procedure “Not Worth It” didn’t see much of a difference or had common side effects like soreness, hyperpigmentation, and lingering numbness and nerve pain. 
• Others were surprised by sagging skin after losing underlying fat deposits. Older patients with less skin elasticity may need to combine fat reduction with a dedicated skin tightening treatment.
• There’s a real risk of developing paradoxical adipose hyperplasia (PAH), an increase in hardened fat at the treatment site, after treating fat to extremely cold temperatures.

• Average Cost:
• $2,275

• Range:
• $650 - $6,835

Your cost will depend on how many body areas are included in your treatment plan, how many cycles you get, your provider’s credentials, their location, and a few other key factors. Most providers accept financing options like CareCredit.

See our complete guide to CoolSculpting costs

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. 

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 ⅔ of an inch of pinchable fat, to fit into the CoolSculpting applicator. 

“The best candidate is one that is already fit with small problem areas that are resistant to diet and exercise,” explains Dr. Emer. “The bigger someone is, the more treatments needed to see an outcome, and the less substantial the results will be.”

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 you’ve 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 won’t 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 “the authors prefer liposuction over cryolipolysis [CoolSculpting] for patients who require significant debulking or who have a desire for immediate results.”

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 CoolSculpting—and Who Isn't

CoolSculpting is not a weight-loss solution: it’s 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 “DualSculpting” or CoolSculpting Elite, to target multiple treatment areas simultaneously and reduce treatment time. 

Here’s what to expect.

• First, you’ll lie down, and your provider will map out the specific areas you want to target with a pen. 
• They’ll lay a protective gel pad over your skin before applying an applicator to the treatment area. Some applicators have a vacuum that sucks in skin and fat, while others simply apply pulses of pressure.
• You’ll feel the applicator lower your tissue temperature to -10ºC. This extreme cold can feel uncomfortable until your tissue goes numb.
• When your treatment time is complete, your provider will remove the applicator and massage the frozen fat (which some doctors call a “butterstick” because it looks so much like a frozen lump of butter) to smooth out the area and kick-start the elimination of injured fat cells. Some doctors use the Zimmer Z-Wave Pro for this, finding its shockwaves useful for softening treatment areas post-CoolSculpting. “Using the Z-Wave also reduces discomfort immediately post-procedure,” says Dr. Klein, who says it’s much more comfortable than manual massaging the treated area.

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. 

• An independent study published in Plastic and Reconstructive Surgery showed that CoolSculpting reduces fat cell volume in the treated area by between 14.7% and 28.5%. 
• Clinical trials funded by the device manufacturer showed similar results, with a 20–25% reduction in fat-layer thickness after a single treatment. Treatments on the inner thighs have the highest patient satisfaction levels, while abdominal-area results get lower marks.

For some patients, “Coolsculpting works, and impressively so,” says Dr. Cameron Chesnut, a board-certified dermatological surgeon in Spokane, Washington. “Like many things, it is all about patient selection and expectations.” 

How well it works for you will depend on your provider, according to Dr. Chesnut. “It 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.” 

This isn’t 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.

It’s also not intended to tighten loose skin, but Dr. Emer says that “there is some degree of skin tightening seen after each CoolSculpting treatment.” 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 “you may experience sensations of pulling, tugging, mild pinching, intense cold, tingling, stinging, aching, and cramping at the treatment site.” As the area becomes numb, these symptoms should subside.

Applicator updates have made the treatment more comfortable and effective over time. “The original applicators required significant suction to get each bulge of fat positioned between two cold panels,” explains Dr. Heidi Waldorf, a board-certified dermatologist in Nanuet, New York.

“They’ve been replaced by the CoolAdvantage applicators, which provide full-surface cooling and, therefore, less suction,” she adds. “The 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 ‘pop off’—if the skin is not in full, direct contact with the applicator panels—to avoid moisture accumulation and frostbite.”

According to Allergan, the device manufacturer, about 1 out of 6,000 treatments (0.017%) results in severe nerve pain, which can develop “several days after a treatment” and resolve in “several weeks.”

CoolSculpting is FDA cleared and generally considered to be a safe cosmetic treatment option for good candidates. (However, it’s 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 you’re getting the real thing. “The concern with these devices is the lack of regulation and paucity of studies proving their exact technology—including rate of cooling, max temps, standardizations, and safety precautions and triggers,” says Dr. Waldorf. 

Dr. Emer underscores this concern. “I have seen numerous patients who were treated with knock-off devices that caused burns and irregularities, so beware.”

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.

• Patients can experience redness, swelling, tenderness, blanching, bruising, firmness, tingling, or cramping in the treatment area for a few days to several weeks afterwards.
• Some reviewers on RealSelf say they developed nerve pain in the treated area about five days post-procedure. If you have any pain that lasts more than a few days and feels too intense for over-the-counter pain medication, talk to your provider. 
• After CoolMini treatment for a double chin, some patients have reported a feeling of fullness in the back of the throat for one to two weeks. 
• It’s also possible to experience “tongue deviation,” lower lip weakness, or dry mouth for a few days or weeks after treatment under the chin or jawline.
• There has been at least one report of serious burns (frostbite) as a direct result of CoolSculpting. The FDA recalled CoolSculpting Elite devices in August 2021 due to a problem with the system’s error messaging system, which they said could increase "the possibility of a cold-induced injury leading to a 2nd and/or 3rd degree freeze burn." Allergan says this happens in about 1 out of 15,000 treatments (0.006%), so it is rare, but it’s still important to be vocal if you experience discomfort beyond the first few minutes of your procedure. This could be a sign that the applicator isn’t properly applied.  
• It’s not advised to have this cosmetic procedure while you’re pregnant or nursing, but it won’t affect your future fertility or damage any abdominal tissue or organs. 
• Contour irregularities or asymmetry can be a problem. “CoolSculpting can sometimes create a depression or area of uneven fat loss in the shape of the paddle,” says New York City–based plastic surgeon Dr. Lara Devgan. This undesirable result can be treated with Kybella injections (to dissolve fat) or fat transfer from other areas, to fill in the indentation. Dr. Emer treats indentations and irregularities with Renuva, “a synthetic matrix that helps to regenerate your own fat in the indented area.”

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. 

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.

“I’ve never seen it, but I do discuss it as part of informed consent,” says Dr. Waldorf, and your doctor should too. Dr. Klein agrees that it’s rare. “We’ve done thousands of cycles and I have seen only one case of PAH.” Based on what he’s seen, Dr. Emer believes PAH is more of a risk when applicators are used in areas that don’t 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, “In 2017, Dr. Jared Jagdeo, a dermatologist who was then a consultant for CoolSculpting’s 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 Organization’s criteria for a ‘common’ or ‘frequent’ adverse event, instead of a ‘rare’ one.”

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. 

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.

“In my experience, most PAH needs at least VASER ultrasonic liposuction coupled with Renuvion or BodyTite internal heating, due to the fibrosis/scar tissue—which is completely unpredictable,” says Dr. Emer. “Some cases also need skin removal, to remove loose or hard skin and to surgically cut out scar tissue.”

Related: Linda Evangelista Says CoolSculpting “Deformed” Her. Doctors Explain What Happened.

Most people don’t 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 you’ve had treated.

Here’s what you can expect.

• You should be able to carry on with normal activities, but may feel sore or notice swelling in the treatment area.
• Take it easy for the first 24 hours, avoiding vigorous exercise and heavy lifting (which could make swelling worse).
• Some providers recommend wearing Spanx or a compression garment for the first few days, to ease swelling and discomfort; others suggest wearing loose clothing. Ask yours what they recommend.
• After about five days, you’ll probably feel nerve twinges in the treatment area. Sometimes described as stinging, cramping, or tingling, this is a normal sensation as damaged nerves regenerate. If it lasts longer than a few days or feels intensely painful, reach out to your provider for their recommendations on pain medication.
• One to two weeks post-procedure, it’s common for the treated area to feel itchy. This is a histamine reaction to the inflammatory process of clearing fat cells, and it can be treated with oral antihistamines. 
• Numbness in the treated area typically resolves within three weeks, as the nerves come back online.
• Your body will flush out the damaged fat cells for three to four months post-procedure. Drink plenty of water and take care of yourself by opting for healthy food and exercise. 

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. “I’ve 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.”

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. “We find that two to three daily sessions of IV therapy with glutathione and vitamin C helps significantly decrease swelling,” he says. “Oral 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.”

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. “Your body will continue to eliminate the treated fat cells for up to six months post-treatment,” according to Dr. Frank Lista, a board-certified plastic surgeon in Mississauga, Ontario.

Why does the process take so long? “Unlike liposuction, where the fat is removed, CoolSculpting releases the fat [from cells] to be metabolized and eliminated by your body,” explains Dr. Andrew Lyos, a board-certified plastic surgeon in Houston. Your biology dictates the rate at which fat is eliminated.

As we’ve mentioned, you may need two or more treatments to see the results you want.

“Results are cumulative—we really can ‘sculpt’ over time,” says Dr. Waldorf. “With 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.”

“Doing a second treatment within 30 to 60 days can enhance your treatment results,” according to Dr. Lori Brightman, a board-certified dermatologic surgeon in New York City. 

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.

“Doing a second treatment within 30 to 60 days can enhance your treatment results,” according to Dr. Lori Brightman, a dermatologic surgeon in New York City. 

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 don’t 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, Allergan’s 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 you’re comfortable with their level of training and experience.

It’s also important to ensure that a board-certified dermatologist, plastic surgeon, or another type of physician will be the one ensuring that you’re a good candidate and overseeing your treatment plan.