CoolSculpting

It seems like everyone wants to be leaner.

Losing body fat is big business and one of the latest approaches is CoolSculpting®, also called Cryolipolysis®. The word 'Cryolipolysis' literally means "cold fat loss", and CoolSculpting works by chilling the skin so that the underlying fat cells are reduced. I've found that a similar effect can be produced at home for almost no cost.

1 CoolSculpting

CoolSculpting uses an FDA approved device to chill the skin for up to an hour, with a session lasting one to three hours, producing a reduction in the fat thickness in the treated area. Animal and human studies have shown a reduction in fat thickness between 20% and 80% over 3 months following treatment. The device sucks the skin and underlying fat into a cup. More than one treatment can be used, but the results of the second treatment are not as dramatic as the first. CoolSculpting is considered an alternative to liposuction, which is the most common type of plastic surgery.

2 How does CoolSculpting work?

The CoolSculpting device.

The device removes heat from the skin at a constant rate, rather than chilling to a particular temperature. While the underlying mechanism is unclear, the current theory is that chilling fat tissues to just below freezing triggers inflammation of the fat cells (Panniculitis) and then triggers natural cell death in the fat cells (apoptosis). The inflammation starts 3 days after treatment, peaking at 30 days, with some residual inflammation seen after 90 days and the number of fat cells declining over the 90 day period.

3 How much fat is lost?

A study of CoolSculpting showed an average reduction of about 4mm after two months. A second treatment had a lower reduction of an additional 1-2mm. There is an individual variation in response to CoolSculpting, with some practices reporting 30% of patients being 'unimpressed with the results.

4 What about frostbite?

A common concern is frostbite, or other damage to the skin. This is not a problem, as you need far colder temperatures (-10c/14f) to cause that type of damage. CoolSculpting uses temperatures that do not immediately kill off the fat cells, but rather trigger the natural process of cell death(apoptosis). That's why CoolSculpting takes weeks or months for the full effect to be seen.

5 CoolSculpting compared with Cryosurgery

CoolSculpting is quite different to Cryosurgery, which uses cold to kill off tissue, such as tumors. Typically cryosurgery uses far lower temperatures (-20c/-4f to -40c/-40f) and immediately kills off the living cells (necrosis) . Cell damage is caused by temperatures below -10c/14f and CoolSculpting does not go that cold.

6 Side effects of CoolSculpting

There have been no serious side effects reported so far. The skin being treated goes red, with some bruising and numbness. I suspect that the bruising may be because the CoolSculpting device sucks the fat against the cooling device. These problems normally resolve within a week. Studies have shown no changes in blood lipid levels or liver function. The numbness is not associated with nerve damage. There are reports of a small number of patients having a prolonged (weeks), painful response to CoolScuplting.

7 Weight Loss or Spot Reduction?

CoolSculpting reduces the fat thickness in the limited area that is treated rather than producing overall Weight Loss. CoolSculpting does not seem to be effective in obese people, though it may simply be harder to observe the effects. It's worth noting that CoolSculpting reduces the fat thickness in people who have a stable weight; in other words, you don't need to be on a diet for it to work.

8 How long does it take to work?

The effects of CoolSculpting should start within a few weeks, but the full effect may take 3-4 months. Tests indicate that the changes are noticeable after 2-7 weeks (average 4 weeks).

9 'DIY CoolSculpting'

Having reviewed the evidence for the commercial CoolSculpting, I wondered if it would be possible to replicate the effects by simply applying ice to the skin. An early study of CoolSculpting showed a reduction in the fat levels from -1c/31f, though not as great a loss as colder temperatures. The levels of fat on my legs are noticeably lower than other parts of my body, which might be the result of regular icing. There is evidence that applying ice to the skin produces an inflammation response in just a few minutes, so this approach seems viable. Use only ice cubes in a bag. Do not use gel packs as these are cold enough to cause skin damage. For more details, see Cryotherapy.

9.1 Testing 'DIY CoolSculpting'

So I undertook a simple experiment and applied a bag of ice to the right side of my abdomen for 1-3 hours a day for two weeks. I generally did this in the evenings, applying the ice while watching TV or reading. While the ice is initially uncomfortable and cold, this sensation disappears in a couple of minutes. It also seems that after the first few times the ice is applied, the discomfort is far less.

9.2 Results of DIY CoolSculpting

At the end of the two weeks the fat thickness on the left side was noticeably thinner than the right side. The difference seemed to increase in the week following termination of the icing. At this point I started icing the right side to regain symmetry. It’s hard to evaluate exactly how much change occurred in a few weeks, and I’m already quite thin (<10% body fat), so small differences are more noticeable than would be the case on someone larger. It’s also not clear to me how the fat reduction will increase over the next few months, as the indications are from CoolSculpting that it should take 3-4 months for the full effect. I used Skinfold Calipers to check my abdominal skinfold thickness and found a 2mm difference (measured 2 inches to the side of my navel). This is enough to be obvious to me, but not to show up well on photographs. Below are a couple of pictures that attempt to capture the resulting asymmetry.

The asymmetry resulting from icing the left side of abdomen using an oblique light to highlight the differences. The larger shadow on the right of the picture highlights the reduction in fat thickness in this area. You can also see larger bulges on the left side of the photo.

The asymmetry highlighted by taking the image from an oblique angle.

9.3 How to perform 'DIY CoolSculpting'

I iced for 1-3 hours most days, which is far more than CoolSculpting which uses a single 1 hour session. I have no idea if 'more is better' or if a single hour every couple of months is optimal. None of the research I found had any indication of the dose/response relationship. At this point I'm continuing with the 1-3 hours most days, as this is easy for me to do.

9.4 DIY CoolSculpting Questions and Answers

Here are some of the questions I've been asked about DIY CoolSculpting along with my answers.

• Is this a replacement for diet and exercise? Absolutely not. This approach will reduce the level of fat in a given area rather than producing an overall reduction in body fat.
• Do you apply the ice directly or use a barrier such as a cloth? I normally apply the bag of ice directly to the skin. Sometimes I'll use a thin layer such as a tee shirt for a few minutes until the skin adjusts and then remove the layer. This prevents the sudden drop in temperature from making me squeal.
• Is DIY CoolSculpting the same as drinking ice water? No, it's quite different. This approach triggers local removal of fat rather than changing the overall metabolism. (Drinking a gallon of ice water will only use about 70 Calories, so that is not a great solution to Weight Loss.)
• Is DIY CoolSculpting like applying an ice pack as described in The Four Hour Body? No, the four hour body uses ice to chill the body overall rather than reduce the fat in a local area.
• What happens to the fat that is lost? The absolute level of fat lost in this technique is not huge, so the calories made available from the fat is probably inconsequential.
  • A rough estimate is that each treatment covers around 10cm x 3cm and produces a 4mm fat loss, which is 12,000 mm³ or 12ml. 12ml is about 11 grams of fat, or about 100 Calories. Over three months that's about one Calorie per day. Treating multiple areas will increase this, but it appears most clinics would only treat 2-3 areas at a time.
• Will the fat come back? It's too soon to know the long term effects, but it probably depends. If you're putting on weight, then you'll probably continue to put on weight. If your weight is stable or going down, then it seems unlikely that you'll get a rebound effect.
• How did you see results in two weeks when the studies say it takes several months? The animal studies of CoolSculpting showed that the process started after about 3 days, with the removal of the fat apparent between 14 and 30 days and from day 30 to 90 the process declined. Therefore it is not unreasonable to see some results after two weeks. Also, CoolSculpting uses one hour long chilling, whereas I was chilling for 1-3 hours a day for two weeks, which is a lot more treatment.
• Is there any corresponding skin tightening? In my experiment, there was not enough fat loss to make a difference to skin tension. Overall, CoolSculpting and DIY CoolSculpting are unlikely to produce the dramatic overall fat loss that would lead to sagging skin.
• Is 'DIY CoolSculpting' the same as the real thing? No, the DIY approach of applying ice is different to CoolSculpting, which uses a single session applied for a shorter period.
• Does 'DIY CoolSculpting' work the same way as Commercial CoolSculpting? It's hard to know for sure, but I believe the underlying mechanism is the same. DIY CoolSculpting could be burning more calories to keep the body warm, but that would produce an overall Weight Loss, not a spot reduction. Another mechanism, such as increased blood flow, could be behind the spot reduction, but that does not seem likely. Commercial CoolSculpting uses colder temperatures than DIY CoolSculpting, so the DIY version may not be as effective . However, the DIY can be applied far more frequently than the commercial approach.