What is Fat Freezing, Cryolipolysis or CoolSculpting?
Cryolipolysis or fat freezing are general terms to describe non-surgical cooling fat reduction treatments. These body-contouring procedures involve sucking pinchable body fat into a variety of differently shaped and sized applicators to cool the fat-rich tissue causing fat cell death. Within 4 to 6 months of CoolSculpting, the fat cells crystallise and break down, exiting the body as waste, a result of the natural inflammatory reaction. Cryolipolysis is most commonly used to treat love handles, abdominal fat, the inner thighs, the upper arms, under the chin, below the butt, and even on bra and back fat areas.
Plastic and Reconstructive Surgery published a review in 2015 that analysed 19 previous studies regarding cryolipolysis effectiveness. In each area of the body treated by fat-freezing, patients lost an average of 14.67% to 28.50% of fat (measured by callipers). When measured with ultrasound, fat reduction was between 10.30% and 25.50%.
Published in the Aesthetic Surgery Journal, another independent review of 16 studies, found that participants experienced an average fat loss of 19.55%.
There are many different cryolipolysis machines available, with the most popular being CoolSculpting made by Zeltiq/Allergan. When selecting a provider, ensure the clinic uses a Department of Health, Therapeutic Goods Administration (TGA) approved medical device. See the full list of TGA-Approved cryolipolysis machines here.
In a 2014 study, this non-surgical body contouring approach was demonstrated to reduce skin sagginess, despite not being intended as a skin tightening treatment.
What are the pros and cons of Fat Freezing/CoolSculpting?
- In comparison with surgical procedures like liposuction, which require anesthesia and incisions, this noninvasive fat reduction treatment has fewer risks and less recovery time.
- The procedure should be relatively painless once your skin adjusts to the cold temperature.
- It is possible to treat more than one body area during the same session.
- There is usually no recovery period after treatment and patients can resume normal daily activities immediately.
- Your body permanently removes fat cells destroyed by cryolipolysis
- There is a limit to how much fat can be reduced by fat-freezing, it is considered a “spot treatment” and cannot remove significant amounts of fat.
- It is still possible to gain weight after CoolSculpting in both the treated area and the rest of the body.
- Fat may be put back on quickly by patients with metabolic disorders or diabetes.
- In order to achieve optimal results, most patients require at least 2 or 3 sessions spaced several weeks apart.
- Results from cryolipolysis treatments can take two or more months to appear, as with all nonsurgical body contouring procedures.
- The cost of 3 fat-freezing sessions on a large area can be higher than that of a single treatment for plastic surgery procedures like liposuction.
- Some patients who underwent the procedure did not see much improvement or had side effects like soreness, hyperpigmentation, and lingering nerve pain.
- Others experience saggy skin after losing the underlying fat, normally a problem only for older patients with less skin elasticity. These patients may need a combination of fat removal and skin tightening procedures to achieve their desired outcome.
- Without proper machine placement and monitoring by your technician, frostbite or permanent indentations can occur.
- Two-thirds of patients experience numbness in the treated areas for up to 8 weeks following the procedure.
- In rare cases, paradoxical adipose hyperplasia (PAH) can develop at the treatment site, resulting in an increase in hardened fat. Treatment of PAH usually requires liposuction and skin tightening to correct the condition. A tummy tuck may also be recommended in specific cases.
How much does Fat Freezing and CoolSculpting cost?
Average Cost: $3,690
Range: $600 - $7,000
There are several factors that influence the final cost of cryolipolysis, including the provider, their location, the number of areas targeted, and the number of sessions. Budgeting for at least two sessions is recommended. Even though a single treatment does lower the amount of fat, the majority of individuals require multiple sessions to achieve their desired results.
It is unlikely Medicare or private health insurance will cover the cost of the procedure due to it being purely cosmetic in nature.
What are the risks and side effects of Fat Freezing, CoolSculpting?
Only fat cells are affected by extremely low temperatures and there should not be any damage to the nerves, skin, blood vessels or muscles. Although there isn't really any actual downtime to recuperate, there are still a few other risks involved with this procedure.
From a few days up to three weeks after cryolipolysis, you may experience bruising, redness, swelling, tenderness, firmness, tingling, or cramps. It's not recommended to undergo fat freezing if you're pregnant or breastfeeding, but it won't damage any stomach tissue, organs or affect your fertility.
Patients have also reported nerve pain developing after about five days from treatment. If you experience any pain that lasts longer than a few days or is too severe to manage with over-the-counter pain relievers, talk to your physician.
In the US, the FDA recalled CoolSculpting Elite devices in August 2021 due to an issue with the device’s error messaging system, which the FDA said could increase "the possibility of a cold-induced injury leading to a second and/or third-degree freeze burn." Additionally, there has been at least one report of serious burns from cryolipolysis. Make sure to speak up if you feel any pain throughout the procedure, it may be an indication that the applicator wasn't placed on correctly. Lastly, avoid applying ice to the area after the treatment.
A feeling of fullness lasting 1 to 2 weeks in the back of the throat has been reported by some patients following a cryolipolysis chin treatment.
Besides other well-known risks associated with cryolipolysis, there is also the possibility of paradoxical adipose hyperplasia (PAH), which occurs when fat cells expand from extreme cold exposure. PAH is usually triggered 2 to 3 months after the procedure, often after an initial fat reduction.
PAH has been estimated to occur in 1 out of 3,000 treatment cycles (0.033%), according to the leading manufacturer (CoolSculpting). However, a study published by Plastic and Reconstructive Surgery in 2018 indicates it may be as common as 0.72%, or 1 out of 138 cryolipolysis sessions.
Liposuction can be used to treat PAH, but before the procedure can occur, to lower the risk of recurrence, patients must wait a few months for the fat to soften. Some patients may require 2 liposuction operations and other additional procedures, which can be costly at their own expense.
As fibrosis/scar tissue is unpredictable, most PAH cases require at least VASER ultrasonic liposuction combined with radiofrequency-assisted liposuction (RFAL). Some instances also require surgical skin tightening to remove loose or hard skin and scar tissue.
The most common patient reactions to fat freezing include barely noticeable results, fat dissolving unevenly, lumpiness, and PAH.
Fat freezing can occasionally create a sunken area of uneven fat loss in the shape of the applicator, this issue can usually be remedied with fat grafting or fat-dissolving injections. Some doctors also opt to use dermal fillers to treat indentations and irregularities, though results from this are only temporary.
Who’s a good candidate for CoolSculpting, Fat Freezing?
Fat freezing work best on patients with a body mass index (BMI) of less than 25 and for people who are within 10 kilograms of their ideal weight. Candidates should also have at least 1.5 cm of pinchable fat to fit into the CoolSculpting applicator.
The ideal candidate is someone who is already athletic and fit and has a few minor problem areas that resist diet and exercise. In general, the larger the person, the more treatments required, and the less dramatic the results will be. If your BMI is between 25 and 30, it can take 2 or 3 sessions to produce noticeable results.
Avoid cryolipolysis if you are pregnant or nursing, have poor circulation, neuropathy, have a pacemaker, or use a defibrillator.
You also won't be able to undergo fat freezing if any of the following are present in the treatment area: open or infected cuts, wounds, scar tissue, eczema, dermatitis, or rashes. Make sure these conditions have healed before your appointment.
What happens during a CoolSculpting procedure?
Most sessions last between 35 to 60 minutes, depending on the size and number of the areas being treated. Some clinics offer equipment that can treat multiple areas simultaneously to reduce overall session time.
During the cryolipolysis procedure:
- Your practitioner will use a pen to map out the specific areas you want to target with fat freezing.
- Before applying the applicator/paddle to your skin, a protective gel pad is placed under it
- Your skin and subcutaneous fat get suctioned into the applicator, which then lowers the temperature of your tissue to around -10ºC
- An intense cooling sensation will be felt after the freezing numbs the targeted area
- When the session is over, your provider will remove the paddle and massage the frozen fat to kick-start your body’s natural process of expelling dead fat cells.
Melon Tip: To reduce bruising, refrain from alcohol in the 24 hours before your treatment. Also, try to minimize your general alcohol consumption in the weeks between sessions.
Does Fat Freezing, CoolSculpting work?
According to an independent study published in Plastic and Reconstructive Surgery 2015, cryolipolysis reduces fat cell volume in the targeted area by 14.70 to 28.50%.
Similar results were seen in clinical trials funded by the manufacturer, where fat-layer thickness was reduced by 20 to 25% after one session, and 77% of patients' skin elasticity improved within a period of 1 to 3 months. Overall, patients were most satisfied with inner thigh treatments, whereas stomach-area results left a lot to be desired.
There is no doubt that fat freezing works, and impressively so. However, like many cosmetic procedures, selection and expectations are important factors in patient satisfaction.
CoolSculpting really revolves around the planning and assessment, not just putting the device on. How well fat freezing works for you will greatly depend on the provider you choose and the care they take.
Despite not being a cellulite treatment, fat freezing may reduce stubborn fat that can bulge and ripple, reducing the appearance of cellulite. Cellulite reduction treatments, muscular toning devices (e.g. TruSculpt Flex) or dermal filler injections should be used instead if cellulite dimples and collagen production are a concern.
A 2014 study reported that cryolipolysis could potentially improve skin laxity, although it is not intended to tighten loose skin. Patients have also reported that their skin became saggier after they removed fat cells. CoolSculpting treatments tighten the skin to a degree, though add-on procedures can give a greater degree of tightening if required.
Can you lose weight with Fat Freezing, CoolSculpting?
Cryolipolysis is a nonsurgical fat-reduction procedure that can help you contour your body, unfortunately, not a weight-loss solution.
Fat freezing is most effective on people who are relatively fit and within 10 kilograms of their ideal weight, patients who want to target areas of fat that are not responding to diet or exercise.
Does Fat Freezing, CoolSculpting hurt?
Most people don't find the experience painful after the targeted area goes numb from the cold and pressure. Some patients reported that they even felt comfortable enough to watch TV, read, or nap during the freezing process.
The machine manufacturer provides a disclaimer stating, "you may experience sensations of pulling, tugging, mild pinching, intense cold, tingling, stinging, aching, and cramping at the treatment site.” These symptoms will subside as the area becomes numb.
Compared to the original applicator, which required significant suction to position a lump of fat between two cold panels, recent advancements have made the treatment far more comfortable and effective.
The new replaced applicators now provide full-surface cooling and, therefore, less suction. To ensure full contact with the patient, positioning them correctly is crucial. Additionally, to avoid moisture accumulation and frostbite, the applicators will stop functioning and trigger an alarm if the skin is not in full, direct contact with the device panels.
What happens during recovery after Fat Freezing?
Depending on your body's reaction and the number of areas treated, cryolipolysis recovery will differ. But here is what you can expect:
- Even though you can leave the clinic and go about your day, you might feel sore or see swelling. Most patients take the remainder of the day off to recover.
- Compression gear or clothes can help relieve swelling and discomfort during the first few days after cryolipolysis.
- During the week following your session, nerve twinges are likely to occur, a normal feeling as nerves regenerate. These sensations, sometimes described as tingling, stinging, or cramps usually subside quickly after a few days. If the pain is prolonged or uncomfortable, consult your practitioner on methods to manage
- An itching urge at the targeted area can occur 1 to 2 weeks following the procedure, a reaction to the inflammatory process of clearing fat cells. Oral antihistamines can be taken to alleviate this discomfort.
- A 3-week healing period is standard for numbness in the targeted area.
- 3 to 4 months after your fat-freezing procedure, your body will have mostly eliminated all the damaged fat cells. Make sure to drink plenty of water and exercise regularly to aid this process.
How long does the swelling from Fat Freezing last?
Some patients experience very minimal swelling for just a few days after the procedure, while others may feel swollen for up to four weeks. After the procedure, on average swelling typically lasts for two weeks, before completely subsiding.
Wearing compression gear, drinking plenty of water, and exercising can help reduce swelling.
IV therapy, glutathione & vitamin C supplements, oral diuretics, and hyperbaric oxygen therapy can help significantly decrease swelling. It is also recommended to use a waist trainer daily for 2 to 3 weeks overnight if you want to achieve even faster recovery.
How soon can you schedule a second Fat Freezing treatment?
Doing a second fat-freezing session within 30 to 60 days can help improve the treatment effectiveness.
Researchers found that the first session triggers an inflammatory response from the fat cells lasting 60 to 90 days. Conducting a second treatment within 60 days produces a stronger inflammatory reaction, resulting in greater fat reduction.
How long does it take to see Fat Freezing results?
Within a month of receiving your first fat-freezing treatment, you will begin to see changes, and most of the results should be present after two months.
For up to 6 months following treatment, your body will continue to eliminate the frozen fat cells.
In contrast to liposuction, which removes the fat completely, CoolSculpting releases the fat for your body to digest and metabolise. Depending on your unique biology, the rate at which the fat is normally expelled will vary.
Many patients decide to get 2 to 3 sessions to achieve their desired results. The effects of cryolipolysis are cumulative, the body can really be ‘sculpted’ over time. Each subsequent treatment will result in a further reduction of residual fat. With a wide range of applicator sizes, providers can continue to reduce and contour an area, losing more and more fat.
Exercising right after your fat-freezing session can also enhance your results, as can using muscular toning devices and supplemental hormones or peptides.
How can you speed up CoolSculpting results?
In order to accelerate results, doctors recommend you maintain a healthy weight, eat a healthy, balanced diet, on top of exercising at least an hour a day.
According to a 2015 study, massaging the targeted area for 5 minutes immediately after treatment can produce an increase of up to 68% in fat volume reduction after the first 2 months.
It may be possible to accelerate the process of metabolising the dead fat cells further by using radio-wave devices to break up the crystals.
How long does Fat Freezing, CoolSculpting last?
If you do not put on weight following the procedure, the results of fat freezing can be very long-lasting as the fat cells are permanently destroyed. You will get the most out of your investment if you maintain a healthy diet and exercise frequently.
It's important to remember that you are only eliminating a fraction of the existing fat cells in the area you are targeting. Gaining weight can expand the other remaining fat cells causing shape abnormalities in the uneven neighbouring areas.
Who is qualified to operate a Cryolipolysis machine?
Any licensed medical practitioner can learn how to operate CoolSculpting and other cryolipolysis machines. This includes but is not limited to, registered nurses, machine technicians, doctors and doctors assistants.
Many manufacturers also offer training via their own official programs. For example, Allergan has set up CoolSculpting University for practitioners to get the best training in and knowledge about the procedure.
Cryolipolysis vs. Emsculpt: What's the difference?
Emsculpt is a non-surgical body sculpting procedure that utilises high-intensity focused electromagnetic (HIFEM) technology to stimulate close to 20,000 muscle contractions in one 30-minute session.
Similarly to cryolipolysis, it reduces fat, though its primary benefit is muscle toning.
Sources & Studies
Brightman, L & Geronemus, R 2011, ‘Can Second Treatment Enhance Clinical Results in Cryolipolysis?’, Cosmetic Dermatology, vol. 24, no. 2, pp. 85–88, viewed 21 December 2022, <https://www.mdedge.com/dermatology/article/69933/aesthetic-dermatology/can-second-treatment-enhance-clinical-results>.
Coleman, SR, Sachdeva, K, Egbert, BM, Preciado, J & Allison, J 2009, ‘Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on Peripheral Nerves’, Aesthetic Plastic Surgery, vol. 33, no. 4, pp. 482–488, viewed 21 December 2022, <https://link.springer.com/article/10.1007/s00266-008-9286-8>.
DeGregory, P 2019, Fat ‘freezing’ procedure leaves NYC woman with severe burns: suit, New York Post, viewed 21 December 2022, <https://nypost.com/2019/12/18/fat-freezing-procedure-leaves-nyc-woman-with-third-degree-burns-suit/>.
Ingargiola, MJ, Motakef, S, Chung, MT, Vasconez, HC & Sasaki, GH 2015, ‘Cryolipolysis for Fat Reduction and Body Contouring’, Plastic and Reconstructive Surgery, vol. 135, no. 6, pp. 1581–1590, viewed 21 December 2022, <https://journals.lww.com/plasreconsurg/Fulltext/2015/06000/Cryolipolysis_for_Fat_Reduction_and_Body.13.aspx>.
Kilmer, SL, Burns, AJ & Zelickson, BD 2015, ‘Safety and efficacy of cryolipolysis for non‐invasive reduction of submental fat’, Lasers in Surgery and Medicine, vol. 48, no. 1, pp. 3–13, viewed 21 December 2022, <https://onlinelibrary.wiley.com/doi/10.1002/lsm.22440>.
Stevens, WG 2014, ‘Does Cryolipolysis Lead to Skin Tightening? A First Report of Cryodermadstringo’, Aesthetic Surgery Journal, vol. 34, no. 6, pp. NP32–NP34, viewed 21 December 2022, <https://academic.oup.com/asj/article/34/6/NP32/2801538?login=false>.
Therapeutic Goods Administration (TGA) n.d., Australian Register of Therapeutic Goods (ARTG), Therapeutic Goods Administration (TGA), viewed 21 December 2022, <https://www.tga.gov.au/resources/artg?keywords=cryolipolysis&submit=Search>.
U.S. Food and Drug Administration 2021, Class 2 Device Recall CoolSculpting Elite System, www.accessdata.fda.gov, viewed 21 December 2022, <https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfRES/res.cfm?id=188569>.
Wolters Kluwer Health 2018, Complication of ‘fat freezing’ procedure may be more common than thought, ScienceDaily, viewed 21 December 2022, <https://www.sciencedaily.com/releases/2018/06/180629182037.htm>.