What is this device? A fat-killing machine–literally!!

Cool sculpting (or, cryolipolysis) is a non-invasive/ non-surgical procedure for body contouring and fat reduction.

Cool sculpting can serve as an alternative to more invasive procedures such as liposuction.  Because there is no surgical incision, the risk for complications for cool sculpting versus liposuction are significantly lower (Ingargiola et al, 2015).

The concept for cool sculpting was first discovered in 1970 when researchers noted a nodule with subsequent death of fat cells in the cheek tissue of an infant who had been sucking on an ice popsicle (Ingargiola et al., 2015).  This phenomenon was later observed in adults as well.

Researchers learned that fat tissue was more susceptible to injury from cold versus the more water rich surrounding tissues. From this observation, the procedure of cool sculpting was born.   

What is cool sculpting and how does it work?  

Cool sculpting applicator and anti-freeze membrane. The applicator pulls the skin and fat into it with gentle suction, while the antifreeze membrane protects the skin from direct contact.

Cool sculpting procedures involve the application of cold temperatures to targeted areas of fat for specified periods of time using different sized and shaped applicators (Ingargiola et al., 2015). 

Treatment sites typically include (Hetzel et al., 2023; Ingargiola et al., 2015): 

• Abdomen
• Bra line
• Male breast tissue
• Inner thighs
• Hip rolls and flanks
• Inner part near the knee
• Arms 
• Ankles

Typically, this involves a gel-covered membrane placed between the skin and the cool sculpting applicator to prevent direct contact between the skin and the cooling surface.  Next a suction is applied to pull the skin with its fat tissue into the cooling applicator device.  

From here the fat is exposed to cold temperatures ongoing for a determined amount of time, typically 30 minutes to 60 minutes.  The procedure may be a little uncomfortable due to the suction pressure and cold, but is generally not painful.

The goal is to maximize the destruction of fat cells while avoiding damage to the skin, nerves, connective tissue, and muscle tissue surrounding the targeted fat region. 

Researchers observed inflammatory responses which led to death of the fat cells peaking at around 30 days post procedure.  

Post-procedure massage enhances fatty tissue reduction

A small study in individuals where cool sculpting was followed by 1 minute of vigorous kneading followed by 1 minute of circular massage with the finger tips on one side of the abdomen but not the other revealed that the treatment + massage led to 44-68% greater reduction in fatty tissue versus the treatment only side.  

No harmful effects were noted in the tissues that had received the massage intervention with a view of the tissues on biopsy.

How effective is cool sculpting? 

Cool sculpting is most appropriate when you have a small amount of fat you want to reduce (Image credit freepik.com)

Cool sculpting is a very effective procedure, with potentially long lasting effects.  

A case study of 2 patients that were treated on one side of the flank and not the other demonstrated persistence of fat reduction in the treated area at both 2 and 5 year follow ups despite clients reporting weight fluctuations (Berstein, 2013).  

Research notes high patient satisfaction ratings typically after treatment procedures, and also notes that multiple sessions produce superior results to single treatments (Ingargiola et al. , 2015).  

Patient satisfaction in a review of 18 studies ranged from 82% to 100% patient satisfaction with results.  Also, identification of treated areas by blinded reviewers revealed 79% to 100% success in identifying the treated area (Hetzel et al., 2023).  

Fat layer reduction in one study over the hip region showed an average effect of 28.5% fat reduction after two treatments, compared to 19.7% after one treatment (Ingargiola et al., 2015). 

In a review of 18 studies, average fat tissue reduction as measured by ultrasound ranged from 2mm to 5mm depth reduction, or approximately 20% to 32% reduction in depth (Hetzel et al., 2023).  

How safe is cool sculpting? 

A review of 19 studies found that cool sculpting side effects post procedure tended to be mild (Ingargiola et al., 2015).

These side effects were temporary and resolved on their own and  included:

• Tenderness at treatment site
• Bruising
• Redness 
• Swelling

Interestingly, there was a single case of fat cell hyperplasia in the treatment site (increased production of new fat cells leading to a bulge in the treated area) (Ingargiola et al., 2015).  

In a separate review of 18 studies, fat cell hyperplasia was found to occur more commonly in men, and to be relatively rare, with 4 cases reported in 976 patients (Hetzel et al., 2023).  

Potential risks do exist for freeze burns of first or second degree in nature.  This is why sessions are limited in time, and why a barrier between the cold application apparatus and the skin are essential.  However, in a review of 18 studies, no cases of cold induced skin injuries were reported (Hetzel et al., 2023).  

Cool sculpting is considered a very safe alternative to liposuction or other invasive procedures.

Who is not a candidate for cool sculpting?

Cool sculpting is effective and safe, however, it is important to have realistic expectations.  Cool sculpting will thin out fat layers for those that want to spot and treat problematic areas.  

As the average fat reduction ranged from 0.2 cm to 0.5 cm in thickness, this treatment is not ideal for clients who are significantly overweight or obese.  The average client’s BMI in 18 studies was just slightly overweight at 26.6 (Hetzel et al., 2023).  

Patients with the following disease conditions listed below are not appropriate for cool sculpting:

• Cold agglutinin disease
• Cryoglobulinemia
• Skin or blood vessel lesions in desired treatment area
• Hernia at or near the treatment area (the suction 

How Lancaster Wellness can help!

Lancaster Wellness can evaluate you for appropriateness for cool sculpting therapy and meet your cool sculpting needs!

Lancaster Wellness can help meet your specific needs around treating undesirable fatty areas with cool sculpting.

Our MD-led team can help identify who will benefit and who is less likely to benefit from cool sculpting treatment sessions.  

Schedule a consultation at your convenience by clicking the link here!  

References

Bernstein E. F. (2013). Longitudinal evaluation of cryolipolysis efficacy: two case studies. Journal of cosmetic dermatology, 12(2), 149–152. https://doi.org/10.1111/jocd.12036

Hetzel, J., Awad, N., Bhupalam, V., & Nestor, M. (2023). Cryolipolysis in the United States-Review of the clinical data. Journal of cosmetic dermatology, 22 Suppl 3, 8–14. https://doi.org/10.1111/jocd.16029 

Ingargiola, M. J., Motakef, S., Chung, M. T., Vasconez, H. C., & Sasaki, G. H. (2015). Cryolipolysis for fat reduction and body contouring: safety and efficacy of current treatment paradigms. Plastic and reconstructive surgery, 135(6), 1581–1590. https://doi.org/10.1097/PRS.0000000000001236