Fat Reduction without Surgery

Dear readers,

I researched and looked at the current state of nonsurgical (I consider liposuction surgical) fat reduction treatments and technologies for several years before deciding on the information in this article. In my opinion, at this writing (2012), CoolSculpting is the most effective, safest, non-surgical way to lose annoying bumps and bulges of stubborn fat. As usual, I have no financial interest in this company!

How does CoolSculpting work?

CoolSculpting is based on the science of cryolipolysis, a term that combines “cryo” (icy cold) with “lipolysis” (the destruction of fat).

This cold based technology uses a non-invasive applicator that is applied to a specific area and cools the fat cells to just above freezing causing crystallization. The crystallized cells then break apart and are naturally metabolized by the body very slowly.

CoolSculpting is designed to target and reduce (20-30% with each treatment) the resistant fat bulges on the flanks (love handles), abdomen, and back. The company is very active in research and is developing applicators for the inner thighs, upper arms, and possibly under the chin for the future. I don’t recommend doing these other non-approved areas with the current applicators.

Which nonsurgical fat reduction technologies don’t work?

Methods involving lasers, radiofrequency, or ultrasound do not give results with the same quality and consistency. They generally work by rupturing the fat cell membrane with temporary loss of its contents but since they don’t kill the cell, the fat just reaccumulates several months later. Or, they work on the little fibrous tentacles around the fat and may make the area smoother but they don’t destroy the fat cells themselves. And you might remember Lipodissolve (an injectible) was removed from the market by the FDA due to numerous reported complications.

How is the CoolSculpting treatment done?

This is a general scenario, with some variation among different clinics. After arriving in loose-fitting clothing such as sweats, patients sign a consent form, have their “Before” photographs taken, and have the body area to be treated measured. The area to be treated is marked and covered with a gel pad to protect the skin. A specially designed cooling applicator cup is applied to the desired area of fat. The applicator cup uses a gentle (but somewhat startling) vacuum pressure to draw the excess skin and underlying fat between two cooling panels.

During the procedure, the applicator delivers precisely controlled cooling conditions that have been proven to target and eliminate fat cells in specific areas of the body. You will feel a firm pulling in the treated area and then the area will become numb (much as it would if an ice pack were applied). You may experience tingling, aching or cramping while the area is becoming numb. Most patients are able to read, work, listen to music, watch a movie or relax while the treatment is in progress.

Who will benefit from CoolSculpting?

Patients who do well with this procedure typically range from normal weight to about 50 pounds over their target body weight. This is difficult to quantify exactly because fat is distributed differently on everyone. If the fat is inside the abdomen (intraabdominal) it cannot be Coolsculpted. Some of the patients who do best are people with a little more because there is more to improve. Some who are quite thin already, may not notice as much visible improvement. This is because 25% of a small amount is less. Makes sense! It is best forresistant (small to moderately full) fat bulges on the flanks (love handles) and abdomen in patients that are in relatively good shape. The fat must be “pinchable,” which means the fat deposited is under the skin and not around internal organs. CoolSculpting is not intended for patients with more significant fatty deposits. For these patients, surgical techniques such as liposuction are more effective. A reputable clinic will insist on an in-person consultation to determine if you really could benefit.

Who should not do this treatment?

Patients who are pregnant or breastfeeding. It is not recommended because this was not studied and why take any chance at all with a pregnancy? Also, the hormones that are active during pregnancy could make the treatment less effective. Also, patients who have rare cold related diseases like cryoglobulinemia or Raynaud’s (unless it’s very mild) should not do Coolsculpting. Regarding diseases involving nerves, there is no data I’ve seen on this but since the treatment can temporarily change the tiny nerves in the skin, best to check with your neurologist if you have multiple sclerosis. Since the procedure has been used in the public domain less than 5 years, it is possible that other restrictions/side effects could be discovered.

Is it safe?

The bottom line is yes……. but see the restrictions above. The company (Zeltiq) spent $100 million or more in research and development over many years on this device. One of the lead scientists on this device was Rox Anderson, MD who is affliliated with Harvard and has been involved in lasers and skin based technology for many years (kind of a laser “rock star”). The company has records of 300,000 treatments worldwide at this writing.

How long does the procedure take?

It takes one hour per site being treated. Up to three or four sites may be treated on the same day but it’s a long treatment! There is also an approximately 15 minutes needed at the beginning and 15 minutes at the end. So for example, if you need both love handles done (2 applicators), you would need approximately two and half hours for the whole experience.

Are the results permanent?

The results are considered permanent because the treated fat cells are eliminated. As long as you maintain your weight with your normal diet and exercise, your long-term results should remain stable. Weight gain will prevent you from appreciating your full results.

Is it painful?

Unlike most other methods of fat reduction, CoolSculpting involves no needles, surgery, or downtime. Patients often spend procedure time reading, working on their laptops, or simply relaxing. You can return to normal activities immediately after the treatment.

What can I expect immediately after CoolSculpting?

After the massage, an ace wrap will be placed around the treated area to provide support and comfort. This varies office to office but most use some compression. We recommend for you to leave the wrap in place for the remainder of the day and remove before bedtime. Your treated area may look or feel stiff. Normal healing includes:

  • Temporary blanching (whitening of the skin) or redness. The redness may remain for a few hours after treatment. This is an expected but temporary effect.
  • Bruising, swelling and tenderness can occur in the treated area for 1-4 weeks. The area often feels sore when touched for 2-7 days. You may feel a temporary dulling (a numb feeling) of sensation in the treated area. This is normal and may last for 2-6 weeks after your procedure.

How active can I be after the treatment?

I tested this personally by going to yoga, running, hiking and swimming in the two days after my treatment. I experienced no discomfort during any of these activities. I have heard people say though that if the area jiggles it’s a little uncomfortable (jogging) so use the compression garment suggested by your doctor. Generally, you can return to your normal daily activities including exercise immediately after, if you feel comfortable but follow your doctor’s instructions!

Side effects and what can I expect the first weeks and months after CoolSculpting?

It is common for the treated area to feel bloated and look swollen for up to 1 month. It typically resolves within 2-4 weeks.

You may also experience one or more of the following sensations:

  • Itching, tingling or numbness for 2-8 weeks
  • Tenderness to the touch, or soreness for 1-3 weeks
  • Temporary mild to moderate cramping or aching that feels like muscle spasms. A very rare person (about 1/2500 patients) will develop more painful cramping or abdominal discomfort. Call your doctor if this happens but it resolves generally. However, symptoms could be similar to other more serious problems like appendicitis, so you must call your doctor!

When will I see results and what is realistic to expect?

You will experience a gradual reduction of the fat layer, typically over two to four months’ time. Your body will continue to process the injured fat cells from your body for approximately four months after your procedure. The procedure can reduce the treated fat layer by up to 20-30%.


In conclusion, non-surgical fat reduction is a relatively new and evolving field. In my opinion, CoolSculpting is the best technology to date. I would expect there to be significant innovation over the next 10 years in this area.

Dr. Irwin