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 74

Pain Bruising and Risks associated with CoolSculpting

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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.

Houston Plastic Surgeon
4.8 out of 5 stars 116 reviews

What to Expect

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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 151 reviews

How Long Will Pain/Bruising Last

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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 47 reviews

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Zeltiq Coolsculpting risks and side effects

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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.

Zeltiq CoolSculpting

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It is not uncommon to experience bruising, swelling, or a slight discomfort from CoolSculpting. All of these symptoms typically subside within a few hours to days. There should be no risk of nerve damage unless you are seeing an untrained medical professional. At SculptMD, there is no risk of nerve damage and we reduce the chances of swelling or bruising through our Zimmer Z-wave device.

Daljeet Samra, MD
Pleasanton Physician
5.0 out of 5 stars 5 reviews

Risks associated with Coolsculpting.

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Although Coolsculpting is a non surgical procedure, it can cause the following side effects.

1. The suction accompanied by older applicators are much higher than the new applicators . Therefore the old applicators can cause bruising, can be more painful, and the post procedure neuropathic pain symptoms such as tingling, numbness is much higher compared to Cool-advantage applicators. The degree of discomfort depends upon the area, total number of treatments and the individual pain tolerance.

2. The discomfort with large applicators are much more than smaller applicators.

3. The risk of long term nerve damage is unknown.

4. The incidence of Paradoxical Adipose Hyperplasia is extremely rare and can be treated by liposuction.

Coolsculpting pain, risks

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The most common side effect after a Coolsculpting procedure is mild swelling and numbness over the treated area.  This usually subsides after a few days and does not cause significant discomfort in the majority of patients.  Occasionally, a more sever type of pain can occur, which is neurogenic in nature, and can be treated with Neurontin if the pain persists.  With the introduction of the new Cool Advantage applicators we have seen much less of these type of post Coolsculpting reactions, because the new applicator works without putting as much suction on the tissue.  It does seem to occur more commonly with the larger applicator vs the smaller, but again it is very infrequent now with the new applicators.  There can also be some minimal bruising post Coolsculpting as there is suction being applied to the treatment area, but if you do not bruise easily you most probably will not bruise from a Coolscupting procedure.  Patients on Aspirin or other blood thinners would be at higher risk for bruising post Coolsculpting, so if possible it is best to stop those for a few days before getting Coolsculpting.

Thank you for the question.


Dr. Flashner 

Paul Flashner, MD
Boston Physician
4.9 out of 5 stars 25 reviews

Pain, Bruising and Swelling

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As a Diamond Level Practice, MD Laser Spa has had tremendous experience with Coolsculpting with great success!

The "good news" is Coolsculpting came out with new applicators pretty recently that are much more comfortable and actually are more effective with better coverage on area and shorter application time, the pain/swelling and bruising that many experienced was from the "older applicator" which was from the strong vacuum which has been greatly improved and much gentler.

There still can be a little discomfort during the first few minutes of the initial "freezing" application but that goes away quickly, there will be a slight numbness to the area that was treated but will also go away within a couple of weeks and swelling is nominal and also goes away in a few days.

All in all, Coolsculpting is very effective, comfortable and safe.

Please come see us at MD Laser Spa for a complimentary consultation to see how we can get you your best results!!

Robert F. Gray, MD, FACS
Bay Area Facial Plastic Surgeon


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It is important to have clear expectations with any procedure you have done and that includes side effects and particularly pain.  For most patients with the initial application of coolsculpting applicator you will feel the sensation of your drawing up into the applicator.  Pain is very subjective but this sensation by most is not considered painful.  Most patients do experience a discomfort after the procedure and swelling.  The swelling  and pain is short lived.  Any procedure done on your body causes an inflammatory response.  It's your body's natural process to begin the healing process.  Swelling that persist or has oozing should be evaluated by your healthcare provider.

Rosalind Jackson, MD
Miamisburg OB-GYN
5.0 out of 5 stars 1 review

After Affects of CoolSculpting

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Depending on which provider you visit for your CoolSculpting needs, can change your after affects. With the new CoolAdvantage the treatment time has been cut in half along with the discomfort of the treatment.  The reduction in suction with the new CoolAdvantage has presented less after affects of bruising, swelling and pain. The suction level with be the same with every CoolAdvantage. CoolSculpting has been FDA approved for many years. Best of luck! 

Gideon Kwok, DO
Rancho Cucamonga Physician
4.9 out of 5 stars 28 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.