What can I do post-asymmetrical Coolscupting application? (photo)

Question

I recently had CS done on my abs. The clinician did not mark me up, and placed the two applicators on my upper abs in a way that was clearly asymmetrical. When I mentioned this she said not to worry. But when the applicators came off it was clear that they’d been placed asymmetrically. I later voiced my concern about how the results might turn out, but she wouldn’t admit she did anything wrong. What are the steps I can take at this stage to avoid uneven results?

Hung William Song, MD · Answer

The experience and training of the Coolsculpting tech has a very significant effect on the results. Many clinics have a high turnover and do not bother to invest in the proper training. There is definitely an art to applying the applicators to get great results. Acoustic wave therapy after the Coolsculpting treatment can help greatly improve the outcome. Since you already had the treatment, I would recommend just waiting it out to see what the final outcome looks like. The new flat applicators are much more forgiving of technician error so you might be ok.

Kimberly Butterwick, MD · Answer

I do normally draw on the patient while we look in the mirror together to ensure optimal placement to treat the problem area. Not every provider does this, yet still get good results. It’s normal to feel a little anxious about whether your procedure will give you the results you want. You just had your treatment so, at this point, you don’t know what your figure will look like. The asymmetry may be slight enough to not really affect your overall appearance and perhaps there was asymmetry initially, which then made it seem like the applicators were erroneously placed. You should start to see a difference in circumference in a month or two. However, it looks like you’re probably going to need at least one or two more treatments, depending on your goals. If you think you look lopsided after your results start to show, then find a real CoolSculpting expert to administer your next treatments. A board-certified dermatologist who’s been certified by Zeltiq as a CoolSculpting expert and who has a full array of applicators on hand is the best way to ensure good outcome, as is following your CoolSculpting with a session of Zimmer Z-wave radial pulsed therapy to make your end results more uniform and lovely.

Janet Allenby, DO · Answer

Hello,Thank you for your question and picture. We are treating the peak of the fat with CoolSculpting. Often times our body is asymmetrical and we have to treat accordingly. At this point you will have to wait to see how the results turn out. You can have the practice document your concerns and then evaluate in 3-4 months when you see the full results. Good luck and congratulations on your treatment.

Ryan Neinstein, MD, FRCSC · Answer

Thanks for the question, I have found many patients need liposuction post cool sculpting. First because they did not get the results they did were looking for and some of the asymmetry and scarring and even fat growth that can occur from cool sculpting

Michael Kerin, MD · Answer

Thank you for the question.   Unfortunately, what's done is done.  Fortunately though, CS applicators have a feathering result which will likely leave you without a noticeable difference.  After 3 months, if there is a noticeable difference, further treatments can be done to even things out.In our Spa, I do all of the applications myself, to help minimize the chance of an unfavorable cosmetic result.Best of luck.Michael Kerin MDKerin MedSpa & Laser Center

Nicholas Husni, MD, PhD, FACS · Answer

From the photo you sent, I don't see any problem yet.  Remember that one cool sculpting treatment removes only 20-25% of the fat in the treated area. It would be difficult to make someone very noticeably asymmetric with one treatment.  If there is some remaining fat on one side or the other, it can always be retreated.  If you have planned on doing a series of treatments (i.e more than one per area), I would just go ahead and do your next treatment as scheduled.  If you have only one treatment planned, wait until you get your final result (60-90 days) and decide if an area needs to be re-treated. Best of luck to you!

Jason Emer, MD · Answer

Keep in mind, it can take 3-6 months for final results with Coolsculpting. Also, for best results with Coolsculpting, a combination approach is needed. I recommend adding radiofrequency treatments like Vanquish, Venus Legacy, Exilis Ultra for skin tightening and with Z wave/Cellutone for skin smoothing. VASER with ThermiRF is a great alternative. Best, Dr. Emer

Center for Aesthetics and Plastic Surgery - Grand Rapids · Answer

Hello there! At this time, I would recommend waiting the full 6-8 weeks to see your result. There may not be asymmetry left from the procedure.  If you do have residual asymmetry, you should return to your provider to explain the situation. If you do not feel comfortable with this, then another Coolsculpting provider should be able to adjust for any residual asymmetry with further CoolSculpting treatments. Exilis Ultra can also be used to treat leftover fat, and I have also used Kybella on small pockets of fat. Cheers! Sarah RN BSN

Monika Soni, MD · Answer

Thank you for your question! The best thing to do is to wait now for four months to see if you are really asymmetric and the degree of asymmetry.  If you are asymmetric it can be adjusted with either a different Coolsculpting applicator or the Velashape III laser.  We have seen quite a few of these cases recently and have had excellent results.  For now just patience.  For the best Coolsculpting results please consult an expert in the procedure. Best of luck!

Grant Stevens, MD · Answer

Once a treatment is completed, there is nothing that can be done to effect the outcome. (this can be good or not so good news)  I would suggest waiting at least 3 months and then re-evaluating the treatment area and reviewing the photos with your provider.  Applicators are often intentionally placed asymmetrically on the body because the body/fat deposits are asymmetric.  We commonly review these things with patients prior to applying the applicators so there is no confusion as to where and why they were placed in a certain manner.  Having a well trained and experienced Coolsculpting provider definitely contributes to the outcome.  Inappropriately placed applicators can surely lead to less than optimal results.  For now however, try not to worry and see how everything turns out in a few months.