Why are procedures like coolsculping NOT for the overweight or obese?

Question

Lots of doctors say "This procedure isn't for weight loss" but I have never seen further explanation on different scenarios. For instance, let's say an obese or overweight person meets virtually the same qualifications you ask of your normal weight patients (eg. near their ideal goal weight, has kept steady weight, generally no health issues and not looking to use the procedure for weight loss but instead what its meant for, sculpting. Why or why not would this person be a good candidate?

Robert Heck, MD, FACS · Answer

The reason for this statement in my opinion is that cool sculpting has limitations on what would give a person a visible and positive outcome. Each treatment costs anywhere from $750-$1500 per cycle and if a client is not at or near their healthy height and weight you could literally be treating areas several times over and still not get a visible result. You could be spending thousands of dollars on a treatment which would still not make you happy which just isn't the right thing to do. Hope this helps.

Sheila S. Nazarian, MD · Answer

Coolsculpting is an excellent form of non-invasive  fat reduction for
the right patient. Some applicators take 1 or 2 hours but the new advantage
applicators take only 35 minutes and have significantly less risk for delayed
onset pain (especially in the abdomen). Results are seen at 2 months and
typically 1-3 treatments will be necessary on each area to achieve ideal
results. The number of treatments depends on the amount of fat there and the
patient's goals.  There is not downtime and the results can be impressive
in the right patient.  We also use the Zimmer Z-wave for improved patient
comfort and added results. The best candidates are those who are in pretty
good shape with areas of stubborn fat that won't go away no matter what. There are two types of fat in the body(visceral and subcutaneous fat). Subcutaneous is under the skin and coolsculpting can destroy it. The visceral fat is around the organ and exercise can help get rid of it.

My best,

Sheila Nazarian, MD, MMM

Beverly Hills, Board Certified Plastic Surgeon

Tom S. Liu, MD, MBA · Answer

Great candidates for CoolSculpting are typically within 30 lbs of their ideal weight and wanting to address pinchable areas of fat in order to contour their body. Ideal is variable from person to person, but the results may not be as effective for some patients. Whether CoolSculpting is the right procedure for a patient depends on the his or her unique goals and is determined at a consultation appointment. CoolSculpting is not an alternative for weight loss as many patients may not even lose weight. Specific bulges of fat are able to be reduced by 25% incrementally, and this may not be evident on a scale. Consult a board-certified plastic surgeon on the procedure that would be best for you to achieve your aesthetic goal. Good luck!

Jason Emer, MD · Answer

Non invasive options like coolsculpting and sculpsure only do a 20% improvement at most during a single treatment. They do not work well for those overweight as they are contouring procedures.  Best, Dr. Emer.

Peter J. Capizzi, MD · Answer

I would not rule out CoolSculpting for someone who is overweight but someone who is overweight or obese runs the risk of not seeing the result they may have been looking for. If surgery is not an option, there are some physicians who have wellness plans that you can pair with CoolSculpting to help with with weight loss and body contouring.

Vaishali B. Doolabh, MD, FACS · Answer

I have added a link that might be helpful..Hi.  Thanks for your insightful question.  You are correct that persons at any weight may be a candidate for sculpting with CS.  It is estimated that 20-25% of the upper fat layer is frozen with each cycle, and so, if there is significant thickness to the subcutaneous fat layer, at least two treatments in the same area will be required--this increases cost, and time to achieve the desired look. In this scenario, liposuction will permit more fat removal in a single surgery with quicker results, and may actually be less expensive with the main tradeoffs being the need for anesthesia, small incisions, compression garment wear and a little time off work. Another scenario, some overweight individuals have significant fat intra-abdominally, fat between tissue planes throughout the body, weak abdominal muscles permitting protrusion, etc. that is not accessible with CS and so no change will occur.  Be sure to see a Coolsculpting University certified specialist in a plastic surgeon's for an accurate assessment, and contrast with liposuction pros & cons.  Best wishes,

Daniela Dadurian, MD · Answer

With Coolsculpting and other body contouring procedures the best results are usually seen on patients that are not obese , but  have certain fat deposits that they cannot get rid off despite dieting and exercise.  Each coolsculpting treatment reduces the pinchable fat bulge by 25%. This could be significant in a non obese person, but might not be impressive in a person who has a very large bulge. It would require multiple treatments and therefore may be very time consuming and expensive till the desired effect is achieved.

Dean P. Kane, MD, FACS · Answer

Dear atsukosmiles:Your argument is correct! Many of our overweight and obese patients are very pleased, even ecstatic using CoolSculpting, a non-surgical option to reduce localized fat to fit their clothes better and therefore feel better themselves.Our larger patients have used CoolSculpting (CS) in several ways:Motivation to weight lossfit in their arms into shirts and jackets without customizing their clothesfit into jeans around the waist / muffin top and inner thighs and kneeshighly successful improvement of the double chin, jawline and jowlsThese are some of the areas improved, others come in monthly a slower but steadier correction. All patients are counseled in lifestyle changes including diet and exercise.  Find a capable and friendly Certified CoolSculpting Team to discuss your options. All the best!

Steven F. Weiner, MD · Answer

The problem is that with larger patients, the removal of fat with Coolsculpting can result in a "shark bite" appearance. Meaning, a small portion of fat is gone, surrounded by the initial large amounts of fat. It won't look better and becomes a hard problem to fix. Multiple more applications will be needed to get the surrounding fat to match the "bite". A much better option for larger patients is the Vanquish. This has a larger applicator and tends to "feather" the sides of the treatment, meaning the edges are gradually faded into the remaining fat. The link explains this more.

Reza Momeni, MD, FACS · Answer

It is not that obese people cannot have CoolScupting procedure, but it is a reality  is that in good conscience, the cost of getting enough of a noticeable result would be so prohibitive, that most physicians do not feel  it is appropriate to recommend such a procedure to someone that is obese and to give them hope that with a a reasonable number of procedures they will achieve a reasonable result.  Having said that, if money is no object, use certainly can consider CoolScupting even if you are obese or overweight.  The result will not be overt, so if you think even a mild subtle improvement would make a happy, and the money does not hurt your pocket book, you can certainly try it.    In reality, I would think most patients would be rather unhappy with the results that would obtain if they are obese or overweight.

Why are procedures like coolsculping NOT for the overweight or obese?

Answers (12)

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