Why Does Zeltiq Coolsculpting Only Reduce Fat by 25%?

Zeltiq supposedly yields a 25% reduction of fat in the areas treated. But if Zeltiq chills all the fat to the same temperature, then why does only 25% of it die? Does the fat immediately under the skin die the most, since it's closest to the cold source? If so, how can there not be problems with sagging skin?

Doctor Answers 7

CoolSculpting kills fat cells and fat loss develops

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Your question was very thought-provoking, thank you! I had accepted at face value that not all fat cells die and didn't question it further. I presented your questions to the science division of Zeltiq and they answer as follows:


Question ~ But if Zeltiq chills all the fat to the same temperature, then why does only 25% of it die?

Answer ~ ZLETIQ did a lot of research to understand the mechanism of action in CoolSculpting. In a nutshell, cells die as a function of temperature, as well as the time the cells were at that temperature.  Cooling rate also plays a role. Optimal parameter combinations to cause cell death differ for every cell type. 

 Question ~ Does the fat immediately under the skin die the most, since it's closest to the cold source?

Answer ~ we do not cool from the top down, we target the subcutaneous fat

 Question ~ how can there not be problems with sagging skin?

Answer ~ Similar to liposuction, most patients recover with no sagging skin. Those patients who started with or who are more prone to develop flaccid skin, their skin laxity can be accentuated.

I hope you find this helpful.

Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Coolsculpting and the mechanism of action

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Coolscultping is a process whereby the fat is frozen through a specially designed applicator.  The fat is frozen deep into the subcutaneous tissue and the skin is protected. Through careful research by a team of Harvard dermatologists they designed coolsculpting through the theory of "popsicle panniculitis" whereby the fat is killed off and slowly excreted from the body.  The skin does not sag with this procedure since the fat is slowly resolved over months to reduce the bulge of fat by 25%.

Cool sculpting works on bulging fat

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It works to reduce 22 to 40 percent of the fat permanently.

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Removal of 25% fat per treatment

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Thank you for your question.

You need to be a good candidate for the CoolSculpting procedure.  If there is pre-existing "loose skin", you may not be a good candidate for the procedure.  Because there is a reduction of 20-25% of fat cells, this procedure has not been found to cause "saggy skin" afterwards.  Best to see a certified physician and have an examination.

Best Wishes!

Reducing Fat with CoolSculpting

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The cooling mechanism does affect the superficial fat more than the deep fat so as a result, the majority of fat removal occurs closer to the skin.    As the reduction of overall fat is approximately 25% and evenly distributed, the technique has not been found to  create sagging skin.   If a patient has preexisting saggy skin, Zeltiq will not improve the condition as it is not a skin tightening technique.

Carlin Vickery, MD (retired)
New York Plastic Surgeon

Coolsculpting by Zeltiq gives and uniform fat reduction.

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Scientists and clinicians went through studies to determine the temperature and time of exposure of cold to develop a consistant moderate cell involution. It seems that the cell drop out occurs throughout the fat layer being treated.  Because it is a slow chill the temperature is consistant through out.   There is uniform distribution of affected cells.  25% is a good amount (not too much, not too little) for most. Of course if you repeat treatment you can get more than 25%.  

As this technology is used more widely there will no doubt be improvements with perhaps the ability to select the amount of fat reduced.  We do not have that option yet.

As for loose skin, Coolsculpting does not tighten skin, young healthy skin will retract naturally, older skin may need a little help from Thermage.

Susan Van Dyke, MD
Paradise Valley Dermatologic Surgeon
4.6 out of 5 stars 36 reviews

Coolsculpting reduces fat on average by 25%

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This is average fat layer reduction and has to do with the susceptibiltiy of the fat cells to the temperature utilized by Coolsculpting. It has been reported to be more than 25% in some cases reaching as high as 45% with one treatment. The studies done reveal the loss of fat cells due to inflammatory cells  (macrophages) digesting those necrotic adipocytes. The collagen septae are not damaged and in fact may increase.  This may be why patients retain their elasticity of the skin.

Steven Hacker, MD
West Palm Beach Dermatologic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.