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 59

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.

Houston Plastic Surgeon
4.8 out of 5 stars 120 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.

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

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 54 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 106 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
4.7 out of 5 stars 44 reviews

Coolsculpting experience

Coolsculpting is tolerated fine by many, yes it can cause minimal bruising and minimal soreness. in rare cases tingling and burning sensation that may stay few days to weeks however there is medication to calm that feeling. it does work and every time it is applied you can expect 20-25% response. see bellow video about experience of a patient we published. Best. Dr. Parham Gharagozlou

What kind of pain, bruising and risks are experienced with Coolsculpting?

With any new procedure, one should fully understand all the risks associated to determine whether the selected treatment is the right one for them. As for Coolsculpting by Zeltiq, this procedure boasts one of the highest safety ratings vs other devices, mainly because there is no surgery, no cutting, no anesthesia, which is why it's a great option for so many people struggling with that last bit of fat that will not respond to diet and exercise. Here are a few things you should know, and consider, before treating with Coolsculpting. 

Does Coolsculpting hurt?

If you are very sensitive, we would highly recommend treating ONLY with the new CoolAdvantage Coolsculpting family of Applicators.  These applicators provide comfort during and after treatment, almost to the point where patients say they feel no sensation whatsoever! The original applicators, when applied to areas like the abdomen, did provide an uncomfortable sensation due to the suction of tissue into the applicator. 

What are the risks from Coolsculpting?

Two main (most common) risks to consider are: pain post treatment, typically experienced when treating the abdomen areas, and sometimes the outer thighs, and much more rare is freezer burn, where the treated area will have a very slight discoloration (this does fully resolve and treatment can be accelerated).

Is there bruising with Coolsculpting?

Typically yes when using the original applicators, and typically no with the newest CoolAdvantage family of applicators.  The bruising is mainly a function of the suction, and with the original applicators that had a small opening and longer base, the tissue would have to be pulled harder to fit in the applicator, thus causing the bruising. 

Can suction be controlled with Coolsculpting?

Again, if you are very sensitive, we would highly recommend treating only with CoolAdvantage family of applicators as these provide comfort during and after treatment. 

Is the Bigger suction more painful than using 2 smaller suctions for the stomach? 

Here you are referring to the Coolmax vs Cool Core, applicators designed for the abdomen areas.  The large applicator is a massive applicator that treats a bigger section of fat compared to the two smaller ones, this one covers 2.5x the amount of coverage of one small applicator and is the choice applicator is the positioning of the fat tissue requires it.  This applicator upon treatment onset does draw in a lot of tissue and thus the pain that is experiences is from the suction. Now, we would absolutely recommend the CoolAdvantage Plus applicator as many client remark NO PAIN whatsoever with this maximum applicator. 

Coolsculpting Pre/post treatment care? 

Luckily, Coolsculpting is a very low maintenance treatment option that does not really require much after care. A few things to note, however, many of our patients remark that ice packs and light massage while driving, in the shower, etc, help to with bringing circulation to the area. 

How long has Coolsculpting been being used in the states?

About 10 years. 

Edward Stokes, MD
West Hollywood Physician
5.0 out of 5 stars 1 review

Pain, Bruising and Risks with CoolSculpting

This is a very common and good question to ask! CoolSculpting is one of the easiest and safest procedures to have for non invasive permanent fat reduction, and is FDA approved. We have provided over 2000 treatments and I have been treated myself as well as almost all staff members. The most discomfort (and I use the word discomfort, not pain) is in the first few minutes of "freezing" and then when the applicator is removed and the massage is done. The discomfort is rather tolerable and most people don't even have this. The feeling for up to a few weeks after treatment could be a numb, itchy feeling to the area treated. We suggest Arnica pellets and gel or cream to the area before and after treatment. The CoolMax larger handpiece could have more discomfort because twice the area is being treated and therefore felt more.

On rare occasions there could be nerve pain in which a medication in prescribed (Neurontin), which alleviates this and which sub ides in a short amount of time.


Every patient is different in terms of pain response and side effects during and after.  It is not uncommon to have some bruising, swelling, and pain due to temporary nerve injury.  The pain can start several days after the treatment and continue for a number of days after that.  Medication can be used to help with the pain.  Good luck with your treatment.  

Michelle Ellern, DO
Livingston Physician
5.0 out of 5 stars 1 review

Pain, Bruising, Risks

Zeltiq does not cause permanent nerve damage usually. While some temporary nerve pain from inflammation can occur, normal sensation occurs within 2 weeks. Bruising is rare, but can occur with improper placement. Suction pressure can be controlled by the doctor but there is a standard protocol. There is no pre-treatment care, and post treatment protocols vary by area.

Maiysha Clairborne, MD
Atlanta Family Physician
5.0 out of 5 stars 2 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.