If we could reduce fat without dieting, without surgery, and without a big expense, most of us would consider trying this type of procedure. With this in mind, the scientific community took notice when a dermatologist observed that frostbite victims suffered fat loss of their arms and legs after being exposed to prolong freezing temperatures. Investigators later found ice crystals formed in the fat that was exposed to cold temperatures. The fat cell was damaged, broken down by inflammation, and eliminated from the body through the lymphatic system, very similar to dietary fat.
Eliminating fat by freezing it, instead of diet or surgery, could prove to be successful and very marketable. Almost everyone feels that they have excess fat somewhere. Further investigation revealed that fat cells are more sensitive to cold injury than the skin, blood vessels, nerves, or muscle. Theoretically you could deliver cold to human tissue, target the fat, disrupt the fat cell, and allow the inflammatory process to remove the cold damaged fat cell from the body.
A device was needed to freeze the fat without damaging the skin, blood vessels nerves, etc. The Zeltiq Corporation developed the CoolSculpting machine, using heated paddles to protect the skin, which allowed cold to damage the fat between the two paddles. It works best on areas that could easily be brought between the paddles (e.g., male love handles). The procedure is accomplished in 2-3 hours and some patients describe pain that almost made them pass out. There is redness and bruising for up to one week after the procedure. The results are seen in 2-3 months. Costs range from $700 to $1500 per area per session and the result, more often than not, requires multiple sessions.
As with most unproven “newest and greatest” technology, I have been hesitant to promote CoolSculpting in our office. I have only proven technology that consistently delivers expected results. Although not in the “too good to be true” category, the results with CoolSculpting are not always all that is promised and it usually ends up costing more than advertised to get an acceptable improvement. It also does not work well in large areas but works best on the limited area which is placed between the heated paddles. I see a number of patients disappointed with the results after spending more than they expected since it required additional treatments. They end up coming to see me for further improvements using liposuction. With mechanical liposuction, I can extend the areas addressed and “feather” the fat removal into the adjacent areas to get the best results. It is important to realize that, contrary to the name CoolSculpting, externally applied devices reduce the fat but they cannot “sculpt” the area as can be done with internal liposuction.
Many of these patients also had CoolSculpting to correct their post-partum abdominal wall but were left with loose, sagging skin and a distended abdominal wall. They need a tummy tuck to remove loose skin and tighten their lax and separated muscles which develop during pregnancy. However, they have spent upwards of $8,000 on multiple sessions of CoolSculpting which removed some the fat but did not correct the underlying problems. They still need a tummy tuck.
Unfortunately the equipment is becoming ubiquitous. In the St. Louis area, CoolSculpting is heavily advertised in hair removal centers and medical spas. Here the evaluators and the providers are looking for a ROI (Return on Investment) on the expensive equipment and are less concerned about selecting good candidates. The success rate has been diminished by offering it to candidates who need more extensive fat reduction procedures. They have also reduced prices with discounts and coupons to attract more people into their facility. Both these practices serve to devalue the procedure as well as the equipment.
The bottom line is CoolSculpting, in the hands of a reputable provider, can be of benefit to a small segment of people. It does not work on large areas and cannot make an overweight person thin again. However it will diminish fat in an appropriately small area by about one third. But, patients need to be aware that it is not painless, may also require multiple treatments, and therefore a greater expense than anticipated.
Thomas J. Francel, M.D.
