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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 , though this DIY CoolSculpting]] for detailsapproach entails some risks. If you're using a commercial CoolSculpting A safer approach is to use an authorized CoolScultping facility, and I'd recommend ensuring you're going to [http://find.coolsculpting.com/find-a-center/ an authorized provider]. (There are lots of cheap clones of the official CoolScultping machines on ebay.com, so check the machine is by ZELTIQ.)
=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? =
CoolSculpting uses an approach of removing heat from the body at a constant rate, something they call Cooling Intensity Factor (CIF) <ref name="Bernstein2016"/><ref name="Zelickson-2009"/>. This makes it tricky to understand the actual temperatures involved, though studies often quote figures of around -5c to -10cfor the temperature of the paddles that are in contact with the patient's skin. 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 applicationset to -7c/19f<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, and that even though the CoolSculpting device was set to well below freezing point, the skin never got close to that cold. The CoolSculpting setting was a "Cooling Intensity Factor" of 42, and it's unclear to me how that relates to the actual temperature. 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"/>, which is similar to the human study. A Another study in 2017 evaluated two newer versions of the CoolSculpting device designed to go colder for a shorter period showed skin temperatures of -1.6c /29f and -7.1c/19f<ref name="Kilmer2017"/>. Further research by ZELTIQ looked at how isolated pig fat cells responded to chilling for an hour and then rewarming<ref name="PreciadoAllison2008"/>. They found that chilling the fat cells to -2c, 0c or 2c caused the cells to die off (necrosis), while chilling them to 7f/45f caused some necrosis and some apoptosis (programmed cell death). Chilling the cells to 14c/57f, 21c/70f, or 28c/82f resulted in no necrotic injury and approximately the same apoptosis. Mouse fat cells exposed to 8c/46f for 10 minutes showed some crystallization, with more crystallization seen after 25 minutes<ref name="Pinto-"/>. The crystal structures were still visible after 2 hours at 22c/72f. All this research suggests that relatively modest temperatures can result in the loss of fat cells, with lower temperatures having more impact.
=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.
=What About frostbite?=
A common concern is frostbite, or other damage to the skin. This should not be a problem if correctly performed, as you need far colder temperatures (-10c/14f) to cause that type of damage<ref name="Gage-1982"/><ref name="Gage-1979"/>. A study of mice showed the minimum time and temperature for cell damage is -4c/25f for 3 min<ref name="BournePiepkorn1986"/>, but this is actual cell temperature, not exposure to that temperature. CoolSculpting uses temperatures that do not immediately kill off the fat cells, but rather trigger the natural process of cell death ([http://en.wikipedia.org/wiki/Apoptosis apoptosis]). That's why CoolSculpting takes weeks or months for the full effect to be seen. (There is one case report of frostbite from commercial Cryolipolysis received at a beauty salon<ref name="ChoongWohlgemut2017"/>, but it's not clear if this was an official ZELTIQ CoolSculpting treatment or not.)
=Risks and Side Effects of CoolSculpting=
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.
|}
=DIY CoolSculpting=
Having reviewed the evidence for the commercial CoolSculpting, I wondered if it would be possible to replicate the effects by simply applying a bag of ice & water to the skin. An early animal study of 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==
Please use caution, and if you have any doubts you should talk to your doctor. Any issues with circulation or diabetes could make this dangerous, and mistakes can result in serious injury. Here's some things you can do to reduce your risk:* Making a mistake can cause serious injury. Even performed correctly, if you have circulatory issues or a susceptibility to frostbite<ref name="Daanen-2005"/>, DIY CoolSculpting can be dangerous. * Using anything other than ice water can result in temperatures low enough to result in serious frostbite requiring hospitalization<ref name="LeonardKahn2016"/>. * Never use any type of gel pack. These start too cold and can easily cause frostbite<ref name="Stevens-1978"/>, and they warm up too quickly<ref name="ChestertonFoster2002"/>. * A mixture of ice and water will be 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 It's critical that you monitor your skin temperature closely (See below).
* I repeat, don't use gel packs as they can cause skin damage and they'll warm up too quickly to be effective. Ice is cheaper and safer.
* Let you skin rewarm slowly, as rapid rewarming can cause blisters. I cover up the area and let the skin warm up over the course of an hour or more. Don't take a hot shower or actively warm the area.
* Err on the side of caution. Applying ice and water 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, and if it gets too cold you should stop. Generally, I find my skin temperature doesn't drop below 2c/35.6f and is typically warmer than that. I've used several different technologies for skin temperature monitoring, each with their own advantages.
[[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.
==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. 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. 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.
[[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 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 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. I've tested and tried a wide variety of combinations of ice cubes, crushed ice, with/without water added, and lots of different bags. So far, the best option I've found is in this 3 Liter hydration pack letter bladder from a platypus: <jfs id=" B00F5IADN6" noreferb="true"/>. It's a nice size, and it's slimmer than most hydration bladders, so it's easier to cover a larger area. Unlike a cheaper Ziploc bag, it doesn't leak, and is a much better shape. If you want to use it for icing and that the back of your leg, buttocks, or back, you can use the hydration cube tube to release the pressure into a container under your seat.
[[File:DIY CoolSculpting Bag.jpg|center|thumb|300px|The platypus bladder ready for use.]]
* If you want to avoid the expense of the platypus bag, you can use a Ziploc bag, though I do find they tend to leak. You can use bags designed for ice cubes like <jfs id=" B00DP6P6R8" noreferb="true"/> which you'll need to put inside a Ziploc bag, as with a are very thin and will pretty much always leak.
* Fill up the bag most of the way up with ice cubes, then top up with chilled water. Don't fill up the back bag all the way, but then squeeze the bag to remove all the air. You don't want the bag fully filled, that way you in order to have a little bit of movement, and it conforms to your body shape much better.
* You can agitate the ice water in the bag for more effective cooling, but make sure you keep an eye on your skin temperatures when you're doing this.
* 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.
* I generally find that the ice lasts more than an hour, but you may need to replace it depending on how quickly it melts.
* Never, ever use a gel pack. They start off too cold and can cause frostbite, then warm up way too quickly. That makes them both dangerous and ineffective. By comparison, ice is safer, effective, and cheap.
* Be careful, cautious, and if in any doubt, talk to your doctor. Mistakes can lead to serious injury and hospitalization.
==DIY CoolSculpting Questions and Answers==
Here are some of the questions I've been asked about DIY CoolSculpting along with my answers.
=References=
<references>
<ref name="LeonardKahn2016">C.D. Leonard, S.A. Kahn, J.B. Summitt, Full-thickness wounds resulting from 'do-it-yourself' cryolipolysis: a case study, Journal of Wound Care, volume 25, issue Sup4, 2016, pages S30–S33, ISSN [http://www.worldcat.org/issn/0969-0700 0969-0700], doi [http://dx.doi.org/10.12968/jowc.2016.25.Sup4.S30 10.12968/jowc.2016.25.Sup4.S30]</ref>
<ref name="BournePiepkorn1986">Michael H. Bourne, Michael W. Piepkorn, Frederic Clayton, Larry G. Leonard, Analysis of microvascular changes in frostbite injury, Journal of Surgical Research, volume 40, issue 1, 1986, pages 26–35, ISSN [http://www.worldcat.org/issn/00224804 00224804], doi [http://dx.doi.org/10.1016/0022-4804(86)90141-1 10.1016/0022-4804(86)90141-1]</ref>
<ref name="CSFaq">CoolSculpting Fat Freezing Procedure for Body Sculpting, http://www.coolsculpting.com/the-coolsculpting-procedure/what-is-the-coolsculpting-procedure, Accessed on 11 June 2015</ref>
<ref name="ClNelson">AA. Nelson, D. Wasserman, MM. Avram, Cryolipolysis for reduction of excess adipose tissue., Semin Cutan Med Surg, volume 28, issue 4, pages 244-9, Dec 2009, doi [http://dx.doi.org/10.1016/j.sder.2009.11.004 10.1016/j.sder.2009.11.004], PMID [http://www.ncbi.nlm.nih.gov/pubmed/20123423 20123423]</ref>
<ref name="Bernstein2016">Eric F. Bernstein, Long-term efficacy follow-up on two cryolipolysis case studies: 6 and 9 years post-treatment, Journal of Cosmetic Dermatology, volume 15, issue 4, 2016, pages 561–564, ISSN [http://www.worldcat.org/issn/14732130 14732130], doi [http://dx.doi.org/10.1111/jocd.12238 10.1111/jocd.12238]</ref>
<ref name="Kilmer2017">Suzanne L. Kilmer, Prototype CoolCup cryolipolysis applicator with over 40% reduced treatment time demonstrates equivalent safety and efficacy with greater patient preference, Lasers in Surgery and Medicine, volume 49, issue 1, 2017, pages 63–68, ISSN [http://www.worldcat.org/issn/01968092 01968092], doi [http://dx.doi.org/10.1002/lsm.22550 10.1002/lsm.22550]</ref>
<ref name="Stevens-1978">DM. Stevens, JV. D'Angelo, Frostbite due due to improper use of frozen gel pack., N Engl J Med, volume 299, issue 25, pages 1415, Dec 1978, PMID [http://www.ncbi.nlm.nih.gov/pubmed/714122 714122]</ref>
<ref name="ChestertonFoster2002">Linda S. Chesterton, Nadine E. Foster, Lesley Ross, Skin temperature response to cryotherapy, Archives of Physical Medicine and Rehabilitation, volume 83, issue 4, 2002, pages 543–549, ISSN [http://www.worldcat.org/issn/00039993 00039993], doi [http://dx.doi.org/10.1053/apmr.2002.30926 10.1053/apmr.2002.30926]</ref>
<ref name="Daanen-2005">HA. Daanen, NR. van der Struijs, Resistance Index of Frostbite as a predictor of cold injury in arctic operations., Aviat Space Environ Med, volume 76, issue 12, pages 1119-22, Dec 2005, PMID [http://www.ncbi.nlm.nih.gov/pubmed/16370261 16370261]</ref>
<ref name="PreciadoAllison2008">Jessica A. Preciado, John W. Allison, 59. The effect of cold exposure on adipocytes: Examining a novel method for the non-invasive removal of fat, Cryobiology, volume 57, issue 3, 2008, pages 327, ISSN [http://www.worldcat.org/issn/00112240 00112240], doi [http://dx.doi.org/10.1016/j.cryobiol.2008.10.060 10.1016/j.cryobiol.2008.10.060]</ref>
<ref name="Pinto-">H. Pinto, E. Arredondo, D. Ricart-Jane, Evaluation of adipocytic changes after a simil-lipocryolysis stimulus., Cryo Letters, volume 34, issue 1, pages 100-5, PMID [http://www.ncbi.nlm.nih.gov/pubmed/23435706 23435706]</ref>
</references>