Zeltiq CoolSculpting - Pain, Bruising, Risks?

Does Zeltiq hurt? What are the risks? Does it depend on how much suction/temperature doctor uses as to if there is bruising/pain afterwards?

Can Zeltiq cause nerve damage? Cause Other problems? Can the suction pressure be controlled by the dr? Is the Bigger suction more painful than using 2 smaller suctions for the stomach? Pre/post treatment care? How long has it been being used in the states? in Europe? What are the complications?

Doctor Answers 66

Pain from CoolSculpting

It is not uncommon to have bruising, swelling and delayed onset pain after a Coolsculpting procedure. This pain is more commonly experienced with abdominal Coolsculpting. It starts 3-5 days after the procedure and can last 10 days or so. This pain is nerve based and is best treated with Neurontin. Ask your physician to prescribe you some.
Best of luck,
Sheila Nazarian

Beverly Hills Plastic Surgeon
4.8 out of 5 stars 56 reviews

Pain Bruising and Risks associated with CoolSculpting

We have been using CoolSculpting here in the office for about a year and have used about 400 treatment cycles. Given the patient population that we have treated so far we have seen a range of feedback with regard to pain associated with the procedure. Some patients seem to handle the procedures much easier than others. What I have seen is that of the patients who express any concern about pain it is generally more associated with the days after treatment than the day of treatment itself and the sensation that I most often hear patients complain of is a pins and needles kind of sensation or a burning sensation under the skin in the treated area(s). It seems that most complaints come from the treatment of the lower abdomen. I have had the procedure done on myself on my flanks and abdomen and found that the most discomfort that I had personally was in the lower abdomen where my belt rides. The discomfort that I experienced lasted a few weeks post treatment but I have already seen a significant reduction in the fat layer where I was treated and I couldnt be happier with my result.

Paul Vitenas, Jr., MD
Houston Plastic Surgeon
4.8 out of 5 stars 109 reviews

What to Expect

Coolsculpting is very well tolerated by most of my patients. Most patients experience an intense suctioning feel in the treatment area accompanied by moderate discomfort and a burning/stinging sensation as the applicator begins to get colder. After about the first ten minutes, the discomfort subsides and my patients are able to relax for the remainder of the treatment hour. The suction pressure is controlled by the Coolsculpting technician, but there is minimum suction necessary for each of the different applicators. My patients do seem a bit more uncomfortable with the larger applicator opposed to the two smaller, so I typically use the two smaller in succession. Aftercare is comprised of massaging the area, wearing good compression garments, and being patient! Most patients will experience some nerve discomfort in the remaining weeks including tenderness, numbness, tingling, and possibly some sharp/shooting pains. These are all temporary and typically indicate a successful treatment.

Michael E. Ciaravino, MD
Houston Plastic Surgeon
4.9 out of 5 stars 136 reviews

How Long Will Pain/Bruising Last

Bruising is patient specific and normal. It is a consequence of patient selection and is also location specific. We find that some patients bruise more than others and to a varying degree in different locations. Skin Changes--- Most patients experience transient skin changes at the treatment site after the procedure. When the applicator is removed, the tissue appears red and raised, and feels cold and firm. Transient mild bruising may occur around the edges of the site. These changes begin to resolve within a few minutes of the procedure. Mild bruising, and/or minor swelling may arise in the days following the procedure but typically resolve within a week. Occasionally, a patient may have an atypical skin reaction. For example, bruising or swelling may take longer to resolve or the site may become red, warm and tender. These atypical reactions may be due to individual characteristics that make the patient more sensitive to the procedure.

Jay Burns, MD
Dallas Plastic Surgeon
4.6 out of 5 stars 46 reviews

Zeltiq Coolsculpting risks and side effects

Zeltiq is one of the safest procedures available, especially among fat reduction procedures.  It was FDA-approved for fat reduction in September of 2010 and has been safely used in Europe for approximately 5 years.  The reason why it is so safe is that the cold exposure is not to such an extreme that it immediately kills fat cells;  rather, the cold exposure initiates natural programmed fat cell destruction, which is why it takes 2 months to see the results.  The exposed fat cells naturally degrade and the byproducts excreted by your body.  The only contraindications to undergoing Zeltiq is if you have rare conditions of cold-intolerance. 

The procedure may be slightly uncomfortable during the first few minutes of treatment, but it is more of an odd pulling and cold discomfort than pain and gradually turns into a barely noticeable numbness.  This odd feeling is greatest with the largest treatment head/applicator, and less with the small and medium applicators.  Immediately after the procedure, the treated area may have mild to moderate tingling, numbness, and soreness.  Mild bruising is sometimes seen, but is uncommon.  The soreness may last for 2-3 days and feels like the muscle soreness you get after a round of intense exercise.  The tingling and numbness feels just like the sensation your skin has after intense cold exposure.  It lessens over time and is usually limited to 2-3 weeks.  Zeltiq does not cause long-term nerve damage.

With standard settings, there should be little if any bruising or pain.  Sometimes the vacuum settings are increased in thinner individuals to get proper exposure of the treatment area to the cold applicator.  The higher suction could increase the chance of bruising, though it is still usually minimal and limited.  The temperature is currently not altered in the current model of the Zeltiq device.

When a device like this comes along that claims to be so effective with so few risks, it is usually too good to be true, but with the Zeltiq device, it is both good and true.

Narin (Joe) Apisarnthanarax, MD
Houston Dermatologist
4.5 out of 5 stars 13 reviews

What to Expect from a Coolsculpting Treatment

What really impressed me as a physician is the incredible safety profile of the Coolsculpting technology by Zeltiq. There is no risk of damage to the nerves, skin, muscle or any of the surrounding tissues. Think about putting water into a fridge- it cools, but doesn't change state. If you put butter in the fridge- it hardens. Its not a perfect metaphor, but it helps to think of butter when we look at how Coolsculpting specifically targets the lipid cells in cryolipolysis.

As for the temperature, there are sensors on the inside of the applicators that freeze the tissue to specific degrees that start the cell death process. Most people feel a cool tingling sensation at first, and then go numb after about 6-7 minutes. There is some mild discomfort during the two-minute manual massage post-treatment, but this does increase the efficacy by about 70%! As for pain, everyone handles the procedure differently, but most go about their normal daily routine immediately afterwards. You may experiences so bloating, swelling, numbness, or tingling, but all of these subside in a few days to weeks. Ibuprofen is generally recommended to manage any discomfort, or a Benadryl to help you sleep.

In 2011 Coolsculpting was approved in 46 countries, and now that number is 70+. This is an incredibly safe, effective procedure provided worldwide.

Best of luck to you!

Vincent Marino, MD
Scottsdale Physician

CoolSculpting is a very well-tolerated procedure with few side effects

CoolSculpting is a very well-tolerated procedure. There is a tiny bit of discomfort but most individuals do not describe it as painful. With the new CoolAdvantage applicators it's even less uncomfortable than the it was with the original standard handpieces. A bit of numbness and tingling for 4 weeks after the procedure is common. Permanent nerve damage has not been reported. Bruising with the original handpieces was uncommon. With the new CoolAdvantage applicators the risk of bruising is even less than it was before. All in all CoolSculpting is a very well-tolerated procedure which yields excellent results in most individuals.

Jeffrey Dover, MD
Boston Dermatologic Surgeon
4.7 out of 5 stars 10 reviews

Zeltiq Coolsculpting Risks and Side Effects

Thank you for your question. Nowadays with the new applicators we are detecting very little bruising and pain. Most patients complain of some numbness during the first 5 minutes of treatment, then it smooth out. Also, some patients have some pain in the treated area which resolves after 4-5 days. CoolSculpting does not cause nerve damage. However, it varies from patient to patient as it is the individual’s characteristics that make them more sensitive to the procedure. However, having mild bruising and soreness is common. Best of luck!

Hardik Soni, MD
Summit Emergency Medicine Physician
5.0 out of 5 stars 45 reviews

Very Little Pain or Risks


There is very little risk to having CoolSculpting.  That's not to say there aren't adverse effects or side effects.

During the procedure you may experience some pain and discomfort.  Most people tolerate it fine.  Most of the pain comes from the vacuum of the hand piece.  There's a strong tugging and pulling sensation when the hand piece goes on.  When the cold temperature starts, you can get a searing discomfort.  That will go away after a few minutes as the skin goes numb.

After the procedure, you will experience discomfort, as your treatment specialist massages the treated area.  This can sometimes be uncomfortable, but generally is not painful.

After your treatment, you may experience discomfort or pain.  Everyone experiences a different level of discomfort.  Most people tolerate it fine.  A few people will have to take an over the counter medication to manage the discomfort.  A smaller group will require a prescription pain medication.  

Hope this helps,

Dr. Garry Kim

Garry K. Kim, MD
Pasadena Internist

Zeltiq Coolsculpting is a safe effective way to reduce fat with minimal if any discomfort

The temperature used to freeze the fat during the Zeltiq Coolsculpting procedure is standardized.  It is based on the size and shape of the applicator which determines the time and temperature needed to freeze the targeted fat cells into crystals.  Those crystals are then broken up either by manual massage or using a Zimmer Zwave radiowave device.

The applicators used for any given patient are based on the areas of fat to be treated.  The original applicators required significant suction between two cold plates.  The newer cooladvantage handpieces require less suction because the sides and top are cold plates.  The coolsmoothpro designed for the outer thighs has no suction.  

In general more suction means more  post procedure swelling and bruising.  In fact, the cooladvantage handpieces may leave almost no sign of treatment immediately after.   Discomfort is usually minimal -- the area can feel sore in the 5 to 10 minutes afterward as it defrosts.  Later patients may take acetaminophen or ibuprofen.  Rarely a patient experiences more significant discomfort.  After ruling out other causes, it can be treated with a medication like neurontin or lyrica. The pain is thought to be from temporary inflammation of the nerves.  However, there haven't been any cases of nerve damage with coolsculpting.  About two weeks after treatment the area may feel itchy in the area which can be treated if needed with moisturizers and orl antihistamines. Otherwise no special care is needed and patients go right back to normal life activitities after treatment.

Your physician and her staff will choose the applicators that are best for you depending on your anatomy and the locations and sizes of the fat areas to be treated,  Coolsculpting is the most widely used noninvasive fat reduction system in the world with over 3 million cycles of treatment performed worldwide and more peer reviewed journal articles confirming its safety and efficacy than any other.

I hope this answer was helpful.  Best wishes.

Heidi A. Waldorf, MD
New York Dermatologist
5.0 out of 5 stars 11 reviews

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.