Kenneth Litwin, MD

From your photos and your history, if you came to see me I would probably recommend having SculpSure for your abdominal "pooch" (4 applicators) and your flanks (3 applicators on each side) for a total of 3 areas treated (25 min each).  I would then put you on a ProLon Fasting Mimicking Diet for 3 monthly cycles in order to improve your metabolism to get rid of excess visceral (inside the abdomen) fat and subcutaneous (under the skin) fat.  We would then have you back in 4-6 weeks for your 2nd SculpSure treatment for those 3 areas.     I don't think you need liposuction and I researched CoolSculpting prior to purchasing my SculpSure machine and determined that SculpSure works better with a lower risk of side effects like numbness of the skin or permanent fat nodules.  SculpSure is also a lot more flexible in terms of where you can position the applicators and gives a more even reduction of fat due to the laser energy and heat spreading out more in the treatment area rather than creating a sharp line of where the fat was treated and where it wasn't. 

I have found that combining SculpSure with ProLon and a healthy lifestyle (sleep, exercise, nutrition) is all synergistic.  Doing SculpSure as part of a program which addresses all of these issues will lead to faster and more complete reduction of fat will lead to you achieving the results that you are looking for.  So you will look better, drop a couple sizes, and actually be healthier inside because you have improved your metabolism and optimized important factors such as insulin sensitivity and glucose, cholesterol, and IGF-1 (insulin-like growth factor 1).  

Usually there is not much redness of the skin after SculpSure treatment other than that caused by the applicator frames being pressed tightly against the skin or from the belt(s) being on nice and tight. This tightness is necessary to ensure good contact with the skin at all times during the procedure, which makes sure that the laser energy is being delivered evenly and to the subcutaneous fat layer 1.5-3 cm under the skin.  The redness caused by this pressure on the skin by the applicator should resolve within a few days.   

If there is severe redness or blistering that is a different story. If the applicators are placed in areas of skin like the belly button or if the skin somehow gets pinched or overlapped this could lead to increased absorption of energy in that area of skin, which could result in a mild or moderate skin burn.  This can be avoided by proper placement of the applicator frames and applicators and proper positioning of the patient. Also if during treatment one particular area seems to be more uncomfortable, the patient should tell the clinician about this, and the applicator can be repositioned or the energy level for that applicator can be reduced.  

As for soreness after treatment with SculpSure, it is normal or even expected to have tenderness to the touch of the treated area, more so beneath the skin layer where the fat was treated. Certain areas like the inner thighs can be a bit more uncomfortable after the procedure.  There can also be nodules of damaged fat present for up to 4 weeks which are tender to touch.  For most people the discomfort following treatment is mild and completely manageable.  Massaging the area in the shower at least once a day can be helpful.  Remember, SculpSure is something you do instead of surgery to permanently remove fat.  There is going to be some discomfort with any treatment done to remove fat, whether it's CoolSculpting, WarmSculpting with SculpSure, or liposuction surgery.  I would say that the discomfort is no worse than if you were to do a lot of abdominal crunches several days in a row.  In my opinion the discomfort during and following SculpSure is completely manageable and it's worth it when you see the full results a few months later.    

Usually it's best to do your 2nd SculpSure treatment in 4-6 weeks so that you get results as quickly as possible.  This is because the maximum results from a treatment session may not be seen for up to 12 weeks.   If you wait longer, it's not like starting from scratch though. Those fat cells that you treated the first time are still going to be gone permanently. 

That being said, I would not do a treatment if you are still having discomfort from the 1st treatment.  Usually any discomfort would be related to tenderness of temporary nodules of damaged fat and this should resolve after 4 weeks or so.  


If you are mainly concerned about having pain during the treatment, I think you should have a discussion with your treating physician about what could be done to reduce that the next time.  

I have found that it's important for people that the treatment environment be a quiet, peaceful room with nice music playing (or bring your own headphones), calming aromatherapy, nice lighting and potentially something pleasant to look at out the window.  Also I have heard from patients that they feel more comfortable if they do something specific just before arriving for their visit. I'll leave it to you to figure out what I am talking about.  And no, it's not taking pain medication or having a shot of hard liquor.   I've had people ask for topical anesthetic, but I don't think that helps at all, although it helps with other laser treatments which are directed at the skin surface. I think Nitronox, which is available at some offices, might be a good option. But the effectiveness of that does vary and it could increase the cost of your treatment. 

I just treated someone last night who during his 1st treatment told me that he needed the energy setting on the machine turned down due to discomfort (which I did and he was fine after that).  

During the 2nd treatment we made some adjustments to the applicator frame and belt pattern, and made the environment more spa-like (music, turned off overhead lights, aromatherapy etc).  This time he said the initial setting was completely comfortable and eventually we were able to use the maximum energy setting without any problem. 


So just because you had a high level of discomfort during your 1st session does not mean that the 2nd session won't be more tolerable. 

If you can lose weight/body fat prior to having WarmSculpting done, you may not need as many areas treated or "applicators" used per treatment. Therefore your cost will be less.  This is because cost generally correlates with the number of applicators used for each treatment, because the doctor using the machine has to pay the laser company each time a laser applicator is used. So it would be best if you could reduce the amount of fat in a particular area that needs treatment enough to reduce the number of applicators needed.  Also, since each treatment reduces the fat by up to 24%, if you can reduce the thickness of fat in the treatment area, you will need fewer treatment sessions for that area to produce the results that you want.  If you are too overweight (BMI >30) the amount of fat reduction compared to the total amount present may not be enough to produce a significant result.  So if you have a layer of fat 4 inches deep, and you reduce that by 25% each time, it will take you much longer than if you had a layer of fat only 3 inches deep. 

I can certainly understand why you would want to get started now with treatment, but I really think you will be happier with your results and how much you have to spend if you delay treatment for at least 3 months.  I would recommend researching ProLon (5 day fasting mimicking diet) and consulting with a physician who is experienced with using this program. Probably in only 3 months you will be able to lose significant fat from all over your body (including the face and arms) and lose several inches from the waist through the loss of visceral fat, which is the fat associated with diabetes and heart disease and cancer.  SculpSure just treats subcutaneous fat but ProLon would reduce both types of fat.  So please do yourself and your wallet a huge favor and research ProLon.  

As far as the number of applicators per area, this will vary. Some people only need 4 applicators to take care of their entire abdominal area.  Some people need 4 applicators for the upper and 4 applicators for the lower abdomen.  For flanks rarely you can get by with 2 but usually you will need 3 and sometimes 4 applicators per side.    As far as cost that is highly variable, it depends on your area and the cost of living and supply and demand.   Where I live, it's currently around 1500$ per treatment area (for 2 treatment sessions 6 weeks apart, each treatment area usually being 4 applicators) 

I researched both options prior to deciding to go with the SculpSure device for my patients. Based on my research, I found that both could lead to effective permanent reduction of about the same amount/% of fat in stubborn areas.   Since I don't have a CoolSculpting machine, you may consider me biased towards SculpSure, but the reason I don't have both is because it didn't make sense to buy both since one of them is superior. 

The advantages of SculpSure are 

1) less time for treatment area (25 min vs. 50 min)   

2) wider area of treatment due to WarmSculpting having a "spreading out" quality vs narrow/sharp line of treatment with CoolSculpting.  So you can use the applicators to treat a wider area while still getting a natural look 

3) greater possibility for treatment areas with WarmSculpting (upper lower abdomen, flanks, back, inner/outer thighs, double chin area + even other areas possible)    Can use SculpSure for treatment of double chin area for patients with a BMI up to 40.  Multiple possibilities for applicator layout with WarmSculpting. 

4) WarmSculpting: No significant pain following treatment, no numbness, zero need for pain medications and zero downtime, unlike CoolSculpting where it's common to get some numbness due to the freezing process affecting nerves in the skin.  

5) Better, more natural look with WarmSculpting  vs sharp line of fat treated vs untreated areas with CoolSculpting.  

6) most importantly, no risk for paradoxical adipose hyperplasia with WarmSculpting vs evidence showing that with CoolSculpting that freezing treatment stimulates fat cells to grow more, requiring liposuction surgery to remove those cells later.   

7) The company that manufactures SculpSure is the leader in the field of laser aesthetic medicine and an excellent reputation 

8) I have heard that the actual treatment experience with CoolSculpting is quite tolerable with a feeling of numbness during it.  With WarmSculpting, my personal and clinical experience is that any discomfort during a WarmSculpting treatment is completely tolerable.   

Both of these treatments are really game-changers when it comes to permanent fat reduction compared with surgery.  Both are relatively expensive, but not unaffordable. Neither will work that well if you are very overweight and both will more effective if combined with a safe and effective weight loss program, particularly a fasting mimicking diet like ProLon that we use for our patients. 

Thank you for your question, I wish you the best.