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[[File:WeightlossCoolSculpting device.jpg|right|thumb|300px250px|It seems like everyone wants to be leanerThe commercial CoolSculpting® device.]]Losing body fat is big business {{DISPLAYTITLE:CoolSculpting and one DIY CoolSculpting (Cryolipolysis)}}The idea of using cold to remove fat seems too good to be true, but if you understand the latest approaches limitations it can be quite effective. It could also be performed cheaply at home. This approach is marketed as CoolSculpting®, also called or Cryolipolysis®. The word 'Cryolipolysis' literally means "cold fat loss", and CoolSculpting It works by chilling the skin so that the underlying fat cells are reduced. While commercial CoolScuplting requires expensive equipment, I've found that a similar effect can be produced at home for almost no cost.
=CoolSculpting=
CoolSculpting uses an FDA approved device to chill the skin for up to an hour<ref name="CyroMeta"/>, 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="CryroNerves"/>. More than one treatment can be used, but the results of the second treatment are not as dramatic as the first<ref name="CryroChin"/>. CoolSculpting is considered an alternative to liposuction, which is the most common type of plastic surgery.
=How does CoolSculpting work?=
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 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 ([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"/>, though a study of 528 patients that underwent 2,729 cycles showed only three cases of mild or moderate pain, which resolved within 4 days<ref name="StevensPietrzak2013"/>.
=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.
=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<ref name="CsPig"/>. Tests indicate that the changes are noticeable after 2-7 weeks (average 4 weeks)<ref name="CryroChin"/>.
='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<ref name="CryoNovel"/>. 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<ref name="CyroMeta"/>, so this approach seems viable. '''Use only ice cubes in a bag. Do not Never use gel packs as these are cold enough to cause skin damage.''' For more details, see [[Cryotherapy]].
==Testing 'DIY CoolSculpting'==
So I undertook a simple experiment and applied a bag of ice to the right 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. At this point I started icing the right side to regain symmetry. It’s It's hard to evaluate exactly how much change occurred in a few weeks, and I’m 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.
[[File:CoolSculpting asym1.jpg|none|thumb|400px|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.]]
[[File:CoolSculpting asym2.jpg|none|thumb|400px|The asymmetry highlighted by taking the image from an oblique angle.]]
==The Duration of DIY CoolSculpting Changes==
==DIY CoolSculpting Questions and Answers==
Here are some of the questions I've been asked about DIY CoolSculpting along with my answers.
* '''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 removes heat at a constant rate<ref name="CryoNovel"/>, where this DIY CoolSculpting uses the constant temperature of the ice, so the DIY version may not be as effective. However, the DIY can be applied far more frequently than the commercial approach.
=References=
<references>
<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>
<ref name="StevensPietrzak2013">W. G. Stevens, L. K. Pietrzak, M. A. Spring, Broad Overview of a Clinical and Commercial Experience With CoolSculpting, Aesthetic Surgery Journal, volume 33, issue 6, 2013, pages 835–846, ISSN [http://www.worldcat.org/issn/1090-820X 1090-820X], doi [http://dx.doi.org/10.1177/1090820X13494757 10.1177/1090820X13494757]</ref>
</references>