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[[File:CoolSculpting device.jpg|right|thumb|250px|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<ref name="ClNelson"/>, the current theory is that chilling fat tissues to just below freezing 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="CsPig"/>.
=How much fat is lost?=
A study of CoolSculpting showed an average reduction of about 4mm after two months<ref name="CryroChin"/>. 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<ref name="CSIndividuality"/>.
=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<ref name="CryoSkin"/><ref name="CellDeath"/>. 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.
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 ([http://en.wikipedia.org/wiki/Necrosis necrosis]) <ref name="CryosurgeryTemp"/>. Cell damage is caused by temperatures below -10c/14f<ref name="CryoSkin"/><ref name="CellDeath"/> and CoolSculpting does not go that cold.
=Side effects of CoolSculpting=
There have been no serious side effects reported so far<ref name="ClNelson"/>. The skin being treated goes red, with some bruising and numbness. I suspect that the bruising may be because the CoolSculpting device sucks<ref name="CsSuction"/><ref name="CryroNerves"/> 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<ref name="CyroMeta"/>. The numbness is not associated with nerve damage<ref name="CryroNerves"/>. There are reports of a small number of patients having a prolonged (weeks), painful response to CoolScuplting<ref name="CSIndividuality"/>.
=Weight Loss or Spot Reduction?=
CoolSculpting reduces the fat thickness in the limited area that is treated rather than producing overall weight loss<ref name="ClNelson"/>. CoolSculpting does not seem to be effective in obese people, though it may simply be harder to observe the effects<ref name="ClNelson"/>. 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.
<ref name="CellDeath">What temperature is lethal for cells? [J Dermatol Surg Oncol. 1979] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/110858 </ref>
<ref name="CryoNovel">Selective cryolysis: a novel method of non-i... [Lasers Surg Med. 2008] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/18951424 </ref>
<ref name="CSIndividuality">Zeltiq sometimes painful, variable results | Christopher B. Zachary FRCP http://www.drzachary.net/2010/06/20/variability-in-responses-to-cryolipolysis/ </ref>
</references>