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[[File:CoolSculpting device.jpg|right|thumb|250px|The commercial CoolSculpting® device.]] {{DISPLAYTITLE: CoolSculpting and DIY CoolSculpting (Cryolipolysis)}}
CoolSculpting uses cold to reduce fat and it can be effective as long as you know the limitations; a similar effect can be achieved cheaply at home. This approach is marketed as CoolSculpting® or Cryolipolysis®. It works by chilling the skin, causing the underlying fat cells to naturally die off. This reduces the thickness of fat in the area treated, though the actual reduction is quite small. Typically, a single treatment will result in the loss of about 1.4oz/40g of fat and 7mm of thickness two months after treatment. While commercial CoolSculpting requires expensive equipment, I've found that a similar effect can be produced at home for almost no cost. See [[#DIY CoolSculpting| the section on DIY CoolSculpting]] for details. If you're using a commercial CoolSculpting facility, I'd recommend ensuring you're going to [http://find.coolsculpting.com/find-a-center/ an authorized provider].
=What is CoolSculpting?=
CoolSculpting uses an FDA approved device to chill the skin for up to an hour<ref name="Avram-2009"/>, with a session lasting one to three hours<ref name="CSFaq"/>, 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<ref name="ClNelson"/>. The device sucks the skin and underlying fat into a cup<ref name="Coleman-2009"/>. More than one treatment can be used, but the results of the second treatment are not as dramatic as the first<ref name="Shek-2012"/>. CoolSculpting is considered an alternative to liposuction<ref name="StevensPietrzak2013"/>, which is the one of the most common types of plastic surgery<ref name="PlasticSurgry2013"/>. There are some initial indications that CoolSculpting may improve skin texture and laxity, with a tightening of the lose skin<ref name="CarruthersStevens2014"/>. While promising, more studies are needed.
The device removes heat from the skin at a constant rate, rather than chilling to a particular temperature. (I suspect that simple icing is not used to ensure the technique is patentable.) While the underlying mechanism is unclear<ref name="ClNelson"/>, the current theory is that chilling fat triggers inflammation of the fat cells ([http://en.wikipedia.org/wiki/Panniculitis Panniculitis]) and then triggers natural cell death in the fat cells ([http://en.wikipedia.org/wiki/Apoptosis 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<ref name="Zelickson-2009"/>.
=How Cold is CoolSculpting? =
A study looked at the temperature of the skin surface and the fat at a point 1.5cm below the surface during a 60 minute CoolSculpting application<ref name="Sasaki-2014"/>. The skin surface dropped in temperature steadily during the 60 minutes until it was at an average of 12.3c/54f (+/-2.6c). The underlying fat temperature dropped for the first 30 minutes to around 13c/55f then cooled more slowly for the final 30 minutes to around 10c/50f. It's interesting to note that the skin temperature was warmer than the underlying fat. An animal study of two different machines that cooled showed a final skin temperature of 8.6c/47f and 5.8c/42f<ref name="JeongKwon2017"/>.
=How Much Fat Is Lost?=
A 2014 study showed an average of 7mm reduction in fat thickness two months after a single treatment (about 1.4oz/40g)<ref name="GaribyanSipprell2014"/>. A 2012 study of CoolSculpting showed an average reduction of about 4mm after two months<ref name="Shek-2012"/>. A second treatment had a lower reduction of an additional 1-2mm. Another study conducted between 2009 and 2012 of 518 patients showed an average of 23% reduction in fat thickness measured by calipers<ref name="DierickxMazer2013"/>. One patient showed a localized reduction of 2.2cm (nearly 1 inch) in fat thickness in spite of an increase of 0.1 Kg in overall weight.
A 2015 analysis of the available research concluded that CoolSculpting "presents a compelling alternative to liposuction", "appears to be safe in the short term", and "results in significant fat reduction"<ref name="IngargiolaMotakef2015"/>. However, there are a number of risks to CoolSculpting.
* A common side effect is that the skin being treated goes red, with some bruising and numbness<ref name="ClNelson"/>. I suspect that the bruising may be because the CoolSculpting device sucks<ref name="Coleman-2009"/> the fat against the cooling device. These problems normally resolve within a week. The numbness is not associated with nerve damage<ref name="Coleman-2009"/>.
* Studies have shown no changes in blood lipid levels or liver function<ref name="Avram-2009"/><ref name="KleinBachelor2017"/>.
* A study of 528 patients that underwent a total of 2,729 cycles showed only three cases of mild or moderate pain, which resolved within 4 days<ref name="StevensPietrzak2013"/>.
* Another study of 518 patients showed 4% experienced severe pain during the first 5 minutes of treatment, with the remainder reporting mild to tolerable pain<ref name="DierickxMazer2013"/>.
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=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 animal study of Cryolipolysis showed Cryolipolysis showed a reduction in the fat levels from 10 minutes' exposure to temperatures of -1c/31f, though not as great a loss as colder temperatures<ref name="Manstein-2008"/>. A more recent study of humans using commercial CoolSculpting showed the skin surface temperature dropped steadily during the 60-minute treatment until it was at an average of 12c/54f<ref name="Sasaki-2014"/>. There is evidence that applying ice to the skin produces an inflammation response in just a few minutes<ref name="Avram-2009"/>, so this approach seems viable. There are clearly risks to Cryolipolysis, but for me I decided they were acceptable. ==Frostbite and Other Risks==I Please use only ice cubes in a bagcaution, which will result in a and if you have any doubts you should talk to your doctor. Any issues with circulation or diabetes could make this dangerous. Here's some things you can do to reduce your risk:* Never use any type of gel pack. These start too cold and can easily cause frostbite. * A mixture of ice and water. This mixture will be around about freezing point, but solid ice can be much colder, so don't use a solid block of ice.* Make sure the ice is starting to melt slightly so that you have a mixture of ice and water. * I've found that crushed ice in a Ziploc bag works well as it conforms to the shape of your body and starts melting quickly. * Monitor your skin temperature closely (See below).* I repeat, don''Never t use gel packs''' as these are cold enough to they can cause skin damage. Iand they'd recommend using the [http://wwwll warm up too quickly to be effective.amazonIce is cheaper and safer.com/dp/B00DP6P6R8 plastic bags designed for making ice cubes]* Let you skin rewarm slowly, as these form a nice thin layer rapid rewarming can cause blisters. I cover up the area and let the skin warm up over the course of icean hour or more. YouDon'll need to replace them periodically as they melt completelyt take a hot shower or actively warm the area. '''Do not use large blocks * Err on the side of caution. Applying ice'''for shorter periods and building up over a few days is safer than more aggressive approaches. ==Monitoring Skin Temperature==You should monitor your skin temperature closely, as the ice itself can be and if it gets too cold enough to damage the you should stop. Generally, I find my skintemperature doesn't drop below 2c/35.6f and is typically warmer than that. RememberI've used several different technologies for skin temperature monitoring, the goal each with their own advantages. * A thermocouple is a mixture temperature sensor on the end of ice and water. You may need a wire, which allows you to put a thin layer of material between continuously monitor your skin temperature, and I have one that supports four sensors at the same time and is only <jfs id="B01CNLX9M4" noreferb="true"/>. This is probably the bag of ice cubes until they have melted a little; see most cost effective approach.<br/>[[CryotherapyFile:Temperature Monitor.jpg|center|thumb|300px|This is the temperature monitor I use for checking skin temperatures.]] for details.<br/>[[File:IceCubeBagsSkin Temperature Probes.JPGjpg|center|thumb|500px300px|These ice cube bags are cheap and work remarkably well for providing a thin layer of ice that stays in placeI tape the probes over the area I'm icing to check the temperature. They can leakDepending on the location, so you I may need to put spread them inside a Ziploc bagout rather more than this.]]I check my skin temperature periodically, partly for safety and partly to check progress. I like to use a * A [[Thermal Camera]] is great as this shows it allows you to see not only the temperature at one spot, but the area pattern of temperature changes. The downsides are that you have to take the ice off to check the temperature, and the cameras are expensive. I'd use this with the above temperature sensor rather than instead of it. Of the two consumer-grade thermal cameras on the market, I prefer the FLIR, but it's discontinued and evennessthe new model hasn't been released yet. If you don't want to wait for the update, I'd recommend looking at the Seek <jfs id="B00NYWABAA" noreferb="true"/>, but check out [[Thermal Camera]] for more details. <br/>[[File:Cryolipolysis Thermal Camera.jpg|center|thumb|300px|An example image from my [[Thermal Camera]] showing the skin temperature.]]==Typical Skin Temperatures==I've made a number of tests, monitoring my skin temperature for up to three hours. The graph below shows three tests where I took temperature readings every 15 minutes, and it's fairly typical of what I see. The skin temperature initially drops fairly quickly, dropping to around 5-15c/40-60f within five minutes, and stabilizing around 5-10c/40-50f within 15-20 minutes. After that, the temperature tends to be reasonably stable, and most of the variation is down to how much the ice water is moved. If the bag of ice water is kept very still, the skin temperature will rise somewhat, but if it's actively agitated, then the skin temperature can drop. It takes some effort for me to get the skin temperature below 2c/36f, and obviously, the skin temperature never drops below freezing, as the ice water isn't that cold.[[File:Skin Temp Graph.jpg|center|thumb|400px|Skin temperature against time while icing.]]Here are some other tests I performed, showing the variation you might experience, with temperatures rising and falling. Some of this variation is due to the body's natural responses, but quite a bit is due to how much I move the ice water around. [[File:Skin Temp Graph2.jpg|center|thumb|400px|Various other tests of icing.]]
==Testing 'DIY CoolSculpting'==
So I undertook a simple experiment and applied a bag of ice to the left 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.
[[File:CoolSculpting asym2.jpg| center |thumb|400px|The asymmetry highlighted by taking the image from an oblique angle.]]
==The Duration of DIY CoolSculpting Changes==
The research into CoolSculpting suggests that it takes 3-4 months for the full effect. Because I applied the CoolSculpting more to the left side of my abs, it is possible to see how long the effects last. I used DIY CoolSculpting in May 2012 for a period of a few weeks. In the following two five years , my weight fluctuated by around 15 pounds. and I performed no more DIY CoolSculpting or icing of my abs during that time. Regardless of these fluctuations the slight difference in the two sides remained constant. This difference is slight, amounting to around 1-2mm, but is noticeable on inspection. This suggests that the effects of DIY CoolSculpting last for at least two five years and probably much longer. Obviously DIY CoolSculpting does not prevent overall weight gain, but it's unclear if it will limit this gain in any way.
==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. The latest research suggests that 30 minutes might be enough to induce changes, but I find 1-3 hours is convenient. * You can use bags designed for ice cubes like <jfs id=" B00DP6P6R8" noreferb="true"/> which are cheap and easy. * I find that simply using crushed ice in a Ziploc bag works nicely as the ice conforms to the shape of the part that's being iced. * Give the ice a few minutes to start melting, as it's initially well below freezing temperature.* You can put a thin piece of material between the bag of ice and your skin initially. This reduces the shock and allows the ice to start melting. I tend to have the bag in direct skin contact within a few minutes. * If the ice is mostly melted, change it out for fresh ice, but remember to ensure there's at least some water in the bag. * Never, ever use a gel pack. Only use frozen water. *
==DIY CoolSculpting Questions and Answers==
Here are some of the questions I've been asked about DIY CoolSculpting along with my answers.
<ref name="SunKusminski2011">Kai Sun, Christine M. Kusminski, Philipp E. Scherer, Adipose tissue remodeling and obesity, Journal of Clinical Investigation, volume 121, issue 6, 2011, pages 2094–2101, ISSN [http://www.worldcat.org/issn/0021-9738 0021-9738], doi [http://dx.doi.org/10.1172/JCI45887 10.1172/JCI45887]</ref>
<ref name="KrotkiewskiMandroukas1979">Marcin Krotkiewski, Konstantinos Mandroukas, Lars Sjöström, Lars Sullivan, Hakon Wetterqvist, Per Björntorp, Effects of long-term physical training on body fat, metabolism, and blood pressure in obesity, Metabolism, volume 28, issue 6, 1979, pages 650–658, ISSN [http://www.worldcat.org/issn/00260495 00260495], doi [http://dx.doi.org/10.1016/0026-0495(79)90018-0 10.1016/0026-0495(79)90018-0]</ref>
<ref name="KleinBachelor2017">Kenneth B. Klein, Eric P. Bachelor, Edward V. Becker, Leyda E. Bowes, Multiple same day cryolipolysis treatments for the reduction of subcutaneous fat are safe and do not affect serum lipid levels or liver function tests, Lasers in Surgery and Medicine, 2017, ISSN [http://www.worldcat.org/issn/01968092 01968092], doi [http://dx.doi.org/10.1002/lsm.22674 10.1002/lsm.22674]</ref>
<ref name="JeongKwon2017">S. Y. Jeong, T. R. Kwon, J. Seok, K. Y. Park, B. J. Kim, Non-invasive tumescent cryolipolysis using a new 4D handpiece: a comparative study with a porcine model, Skin Research and Technology, volume 23, issue 1, 2017, pages 79–87, ISSN [http://www.worldcat.org/issn/0909752X 0909752X], doi [http://dx.doi.org/10.1111/srt.12305 10.1111/srt.12305]</ref>
</references>