The fat-freezing technology from Zeltiq took the world by storm almost a decade ago. Today, it is one of the hottest procedures in the world of cosmetic adjustments. Does it still live up to the hype?

In 2017, 356,378 patients have undergone CoolSculpting procedures in the US alone. In 2018, this number reached 376,962, a 6% increase in popularity. Considering that the technology got FDA approval only in 2012 (2010 for sides treatment, 2012 for stomach), these numbers indicate nothing short of a radical shift in the procedures chosen to deal with fat bulges.

Liposuction—the traditional way of dealing with stubborn fat pockets—on the other hand, is consistently declining in popularity among patients. Last year, only 258,558 patients have requested liposuction procedures in the US—a 27% percent decrease compared to 2000.

The hype is not difficult to explain. The promise of CoolSculpting is to remove fat in a non-surgical way—which means no incisions and no anaesthesia—while delivering similar results to traditional liposuction.

Sound too good to be true? Well, the technology is by no means a silver bullet, and it has its limitations. Not everyone is a good candidate for a CoolSculpting procedure—the device can produce very different results for patients with different body types.

For that reason, liposuction is still necessary to achieve a satisfactory outcome in many cases.

In this article, we will explain when exactly CoolSculpting is an effective option, and when other alternatives should be explored.

How Does CoolSculpting Work?

The simplest way to describe the technology behind CoolSculpting is fat freezing. The technical name for the procedure is called cryolipolysis, and here’s how it works:

  • Your body forms stubborn fat pockets that do not respond to diet or exercise
  • The CoolSculpting device is placed firmly against the treatment area
  • Due to suction, fat cells are pulled towards the skin
  • The device emits focused, targeted cooling
  • The fat cells underneath the skin freeze, crystalize and die
  • Frozen fat cells leave your body organically

A single CoolSculpting procedure takes about 35 minutes. Depending on the patient’s preferences, body type and aesthetic expectations, multiple treatments can be done either in a single session, or throughout a treatment plan.

Right after the procedure, some swelling and bruising in the treatment area are to be expected.

The first results are visible after the swelling and bruising start going away, which is usually about 2-3 weeks after the procedure.

The final results are visible after the swelling and bruising go away completely, which is usually after 2-3 months after the procedure.

Does CoolSculpting Work On All Body Parts?

The technology has the potential to deal with all types of fat bulges.

However, as of writing this article, CoolSculpting is FDA-approved to treat the specified body areas:

  • Under the chin (submental areas)
  • Under the jawline (submandibular areas)
  • Thighs (thigh gap, sides)
  • Abdomen and flank (love handles, belly fat, folds of fat)
  • Bra fat
  • Back fat
  • Under the buttocks (banana rolls)
  • Upper arms (above the elbow)

Are There Any Side Effects to CoolSculpting?

CoolSculpting is an FDA-approved, safe body sculpting technology.

However, some temporary discomfort is to be expected after the treatment:

  • Redness
  • Skin sensitivity and tenderness
  • Swelling
  • Bruising
  • Skin and muscle firmness
  • Tingling and itching sensations
  • Mild aching
  • Sensation of fullness in the back of the throat (only after procedures under the chin and under the jawline)

In extremely rare cases, it is possible to develop a condition called paradoxical adipose hyperplasia. The condition manifests as a hardened bulge of localized fat after the procedure. It appears only months after the CoolSculpting treatment, and surgical intervention may be needed to treat the problem.

That being said, it should be noted that patients with the following medical conditions should not undergo CoolSculpting treatment:

Does CoolSculpting Actually Work? Is It Real?

The company behind the technology, Zeltiq, claim that patients can expect “up to 20-25% fat reduction in the treated areas” after a single 35-minute session.

We will discuss the actual patient results in just a bit. For now, we’d like to emphasize that the success of CoolSculpting treatment depends largely on whether you’re a good candidate for the procedure.

Who Is a Good Candidate for CoolSculpting?

First things first: CoolSculpting is not a weight loss procedure.

Some fat cells are to be frozen and eliminated from your body—which can result in a slight weight loss. However, if the patient does not keep to a healthy food and exercise regimen, they might just as well remove fat from a stubborn bulge and gain weight (due to lifestyle choices) at the same time.

As a general rule, if the primary goal for the patient is to lose weight, we do not rush the decision to assign a treatment plan. We do this because neither CoolSculpting nor many other surgical alternatives can produce the desired outcome. Controlling the body weight is the patient’s responsibility, and depends on lifestyle choices first and foremost.

Both CoolSculpting and liposuction are highly mechanical procedures that focus on very specific body areas. They do nothing to improve your body’s metabolic processes or other factors that influence body weight control.

With that being said, CoolSculpting (and alternatives, such as liposuction) is a great way to deal with stubborn fat pockets that do not respond to diet or exercise. As the name suggests, it is a body sculpting treatment, not a weight loss procedure.

In terms of goals and expectations, we are very optimistic with patients who want to:

  • Increase their thigh gap
  • Get rid of love handles
  • Reduce bra fat on the back
  • Get rid of a double chin
  • Remove fat folds on the back
  • Remove “hanging” underarm fat

These issues are particularly resistant to diets and exercise, making them the perfect target for the procedure.

Research Results

From experience, we know that CoolSculpting produces real, sustainable results.

As mentioned previously, the manufacturer claims to reduce fat by “up to 20-25% in treated areas.” We were interested in independent studies measuring whether that statement lives up to the truth.

In 2015, an academic review of 19 studies found that cryolipolysis indeed produced a significant change in stubborn fat pockets. In total, 1507 cryolipolysis procedures had been studied across the 19 trials, resulting in 14% to 28.5% reduction in fat in treated areas. The results were measured with a caliper (a medical equivalent of a ruler), and gathered 2-6 months after the treatment.

No major health risks had been identified across the trials.

Another 2015 review of 19 trials also concluded that cryolipolysis is an effective measure of dealing with fat bulges. Tissue reduction data had been gathered from 294 patients, with an average of 19.55% fat reduction in treated areas. The rare health complaints received from the patients involved only numbing sensations that lasted for more than 4 weeks.

Patient Stories

Grace Spencer: “A week later, my jeans started zipping up easier”

Like many other patients, Grace Spencer was skeptical when she’d first heard of the cryolipolysis treatment. Freezing off your fat bulges in 30 minutes for good? Surely there must be a catch in there somewhere.

Grace was completely right to be cautious. There are so many so-called “liposuction alternatives” out there that simply don’t work—nowadays, it seems like everyone is pushing a fat-burning (or, in this case, fat-freezing) gadget of their own. Not only the vast majority of these devices do not produce significant results, many of them are not FDA-approved and can cause serious harm to your skin and body.

The woman changed her mind after attending a CoolSculpting seminar, where the technology and its benefits had been properly explained. Grace learned that the device was FDA-cleared to treat many of the areas she was looking to sculpt. Combined with the fact that CoolSculpting is a non-invasive procedure, Grace figured there’s virtually no harm in trying the treatment, especially given the potential benefits. She decided to go for it.

Two areas that Grace Spencer struggled with in particular were bra fat on her back and the love handles. No matter how many High Intensity Interval Training classes she took, the fat folds on her back and sides never seemed to care. Conveniently, those are exactly the types of issues CoolSculpting promised to fix.

Grace knew that during the procedure, no anaesthesia would be required. She would be fully awake and conscious in a seated position. In the end, the woman opened up her laptop and even managed to get some work done while the CoolSculpting device did its work.

First off, the bra fat. Once Grace walked into her aesthetician’s office, the doctor selected the most appropriate head size for the device (out of five possible options.) The doctor warned Grace that she’d need to be sitting very still during the procedure, or the panels might fall off.

The nurse applied a special gel to the target area on her back, and then clamped the CoolAdvantage Petite applicators on the same spot. Grace describes her sensations:

“Suddenly, things got very cold very fast. Luckily it was a level of cold that just naturally numbed the area, which is one of the reasons the treatment is virtually painless.”

The only time grace felt uncomfortable during the procedure was by the very end of the first treatment, when the nurse took the applicators off her back and started massaging the area:

“That feeling was intense and unlike anything I had previously felt—not painful exactly, but definitely a strong and weird feeling.”

Grace opted to have her love handles done during the same session, so the nurse proceeded to prepare her flanks for the second procedure, which was almost identical to the first one—gel, applicators, sitting still for 30 minutes, massage, weird sensations—only that this time, only 2 applicators had been used instead of four.

In the end, the woman was extremely happy with the results. She waited patiently for a month to evaluate the situation, after which she concluded that the targeted fat bulges indeed receded:

“Sure enough, right at the 30-day mark I noticed my back fat was disappearing! A week later, my jeans were zipping up easier. Fast forward four months, and I can officially say that in my experience CoolSculpting works: I’m so happy to see those stubborn areas of fat have disappeared—without surgery and virtually pain-free.”

Carrie Dilluvio: “It’s uh-mazing”

For Carrie Dilluvio, opting for a quick fat reduction solution seemed like cutting corners. As she wrote in her review of the procedure for Enews, the reporter always looked after her body through consistent dieting and exercise.

Even though a CoolSculpting procedure did seem out of character for Carrie, curiosity got the better of her. In Hollywood, CoolSculpting is the hottest procedure at the moment, with the likes of Molly Sims, Kris Jenner and Khloe Kardashian openly accrediting their beauty thanks to the technology.

The first thing her aesthetician did was warn her that CoolSculpting is by no means a weight loss procedure. Carrie knew that.

The next thing the aesthetician did was pinch the reporter… a lot. Carrie wanted to get rid of fat bulges in the belly area, and the doctor pinch-probed the fat in the area. “If your fat is hard, then you are not the right type of candidate,” the doctor said.

This is true. The machine needs to be able to suction as much fat as possible underneath the skin towards the surface and then freeze it off. It increases the effectiveness of the procedure.

Carrie considered herself as pain-tolerant before the procedure. After all, she’d broken her feet… twice. The reported knew what pain feels like.

The CoolSculpting procedure of choice, however, was extremely prolonged and intensive. Overall, three suction treatments had been performed in her belly area—an extremely sensitive body part. In total, she’d gone through three hours of ice-cold suction.

It took time for Carrie to recover after the treatment:

“When I was finished, my stomach was actually swollen and would be like that for a few more days […]. For the first two days after CoolSculpting, I felt good but was severely bruised. My stomach was completely black and blue, with a hint of red from the sharpie I was still trying to scrub off.”

On day 3, the reporter describes her sensations in the belly area as being “repeatedly stabbing me with millions of tiny needles directly into the worst sunburn I’ve ever had.”

In the end, however, she was extremely happy with the results:

“After about 10 days post-procedure, all the pain was finally gone and my skin felt so tight. I noticed not only my tummy but the areas around it have become flatter and looked and felt tighter. There isn’t as much there to pinch anymore! Despite the soreness after the CoolSculpting, I would 100 percent do this again and actually really want to.”

CoolSculpting vs. Liposuction

There are times when a CoolSculpting procedure will simply not achieve the desired result. In those cases, liposuction is considered as the alternative.

In short, here are the advantages of CoolSculpting treatment over liposuction:

  • Quicker treatment. A single CoolSculpting session will normally take about 30 minutes to complete, whereas a liposuction procedure can take up to 2 hours.
  • Quicker, less demanding recovery. As described previously in this article, some discomfort is normal for CoolSculpting patients. Some soreness, skin tenderness, bruising and swelling are to be expected after cryolipolysis treatment. However, the vast majority of patients are perfectly able to return to work the next day. With liposuction, the recovery is different. Since it’s a surgical procedure, patients should expect to take at least 1 week off work (this can extend to 2 weeks based on various factors.)
  • No anaesthesia used. While this may not seem like an obvious advantage to someone without medical training, anaesthesia is never good for your body. Even local anaesthesia can interact with your bodily function. While the risk of complications is extremely low, it is still good to be completely safe.
  • No incision required. A surgery is a surgery, and as such it carries a small risk of complications. The incision site could catch an infection, or there may be a formation of blood clots. Some patients simply cannot undergo a surgical procedure due to preexisting medical conditions.

Inversely, there are cases where liposuction is the superior option:

  • Larger fat deposits. CoolSculpting applicators cover a small skin area on the body per treatment. Covering a large area means several sessions, which can significantly extend the treatment, causing much more discomfort. Most importantly, combining multiple CoolSculpting treatments can inflate the price of the procedures beyond reason. With liposuction, the treatment doesn’t differ much based on whether the target fat pocket is small or large.
  • Certain body parts. While the CoolSculpting technology is FDA-cleared and practically effective on most popular “fat bulge areas”, more unique requests often fail to suffice with cryolipolysis alone. Liposuction can attack fat pockets anywhere on the body.
  • Dramatic effectiveness. CoolSculpting is an amazing breakthrough in non-surgical fat removal. However, it cannot match the ruthless effectiveness of good-old liposuction, during which surprising amounts of fat can be reliably removed.
  • Hardened fat. As mentioned before, only soft, “pinchable” fat can be targeted with CoolSculpting since it needs to be able to suction it towards the skin. For patients with hardened fat pockets, the fat-freezing technology is simply not an option.

CoolSculpting vs. Cryolipolysis

We’ve been receiving a lot of queries in regards which treatment is better: CoolSculpting or cryolipolysis.

We’d like to clarify that cryolipolysis is the fat-freezing methodology that the CoolSculpting device is based on. Essentially, they’re the same thing.

Final Verdict: CoolSculpting Is Very Real, But It’s Not the Magic Bullet

The fat-freezing technology Zeltiq introduced to the world just short of a decade ago has truly been a breakthrough in the world of cosmetic adjustments. No other non-surgical technology can match the effectiveness, safety and reliability of CoolSculpting.

However, not everyone will see the same kind of results with the CoolSculpting device. There are certain prerequisites that make you a good candidate for the treatment, and if you’re not—well, then, you’re much better off exploring alternatives, such as liposuction.

In the end, we always recommend consulting with a doctor you trust, and ask them to offer a treatment plan that best suits your body and goals. CoolSculpting is not the magic bullet.