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=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="Zelickson-2009"/>. Tests indicate that the changes are noticeable after 2-7 weeks (average 4 weeks)<ref name="Shek-2012"/>.
=CoolSculpting and Long Term Weight Loss=
There is evidence that long-term weight loss is it difficult to maintain, with many people regaining their lost weight over time<ref name="Anderson-2001"/><ref name="Weiss-2007"/>. There is growing evidence that weight loss changes the bodies weight regulation, creating a drive to regain the lost body fat<ref name="MacLeanBergouignan2011"/>. One study found that the greatest body weight previously recorded is a linked to weight regain<ref name="ByrneCooper2004"/>, and it's known that obesity can result in an increased number of fat cells (adipose hyperplasia))<ref name="ArnerWestermark2009"/><ref name="SunKusminski2011"/>. It's possible that the increase in fat cells may be a driver for weight regain<ref name="MacLeanHiggins2015"/>, and there is some evidence that a number of fat cells will determine the weight loss or gain from exercise<ref name="KrotkiewskiMandroukas1979"/>. I wonder if the reduction in the number of fat cells from CoolSculpting might help with long-term weight maintenance. I should emphasize that I've seen absolutely no supporting evidence for this idea, but I hope we will see research to either support or refute the concept.
=CoolSculpting and Massage=
A 2014 study looked at CoolSculpting followed immediately by 2 minutes of massage, and compared the results with CoolSculpting alone<ref name="Boey-2014"/>. Subjects received the CoolSculpting on both sides of their body, but massage only on one side, the other acting as a control. The study found that the addition of massage improved fat reduction by 68% after two months and 44% after four months. Samples of the fat tissue showed increasing inflammation, peaking at 30 days post treatment, with no signs of necrosis or fibrosis at any time (0-120 days). The massage and non-massage groups were similar, but quite small. The massage was described as "1 minute using a vigorous kneading motion followed by 1 minute of circular massage using the pads of the fingers."
<ref name="KellyRodriguez-Feliz2016">Emma Kelly, Jose Rodriguez-Feliz, Michael E. Kelly, Paradoxical Adipose Hyperplasia after Cryolipolysis, Plastic and Reconstructive Surgery, volume 137, issue 3, 2016, pages 639e–640e, ISSN [http://www.worldcat.org/issn/0032-1052 0032-1052], doi [http://dx.doi.org/10.1097/01.prs.0000480023.35573.b7 10.1097/01.prs.0000480023.35573.b7]</ref>
<ref name="ChoongWohlgemut2017">W.L. Choong, H.S. Wohlgemut, M.J. Hallam, Frostbite following cryolipolysis treatment in a beauty salon: a case study, Journal of Wound Care, volume 26, issue 4, 2017, pages 188–190, ISSN [http://www.worldcat.org/issn/0969-0700 0969-0700], doi [http://dx.doi.org/10.12968/jowc.2017.26.4.188 10.12968/jowc.2017.26.4.188]</ref>
<ref name="MacLeanHiggins2015">P. S. MacLean, J. A. Higgins, E. D. Giles, V. D. Sherk, M. R. Jackman, The role for adipose tissue in weight regain after weight loss, Obesity Reviews, volume 16, 2015, pages 45–54, ISSN [http://www.worldcat.org/issn/14677881 14677881], doi [http://dx.doi.org/10.1111/obr.12255 10.1111/obr.12255]</ref>
<ref name="Anderson-2001">JW. Anderson, EC. Konz, RC. Frederich, CL. Wood, Long-term weight-loss maintenance: a meta-analysis of US studies., Am J Clin Nutr, volume 74, issue 5, pages 579-84, Nov 2001, PMID [http://www.ncbi.nlm.nih.gov/pubmed/11684524 11684524]</ref>
<ref name="Weiss-2007">EC. Weiss, DA. Galuska, L. Kettel Khan, C. Gillespie, MK. Serdula, Weight regain in U.S. adults who experienced substantial weight loss, 1999-2002., Am J Prev Med, volume 33, issue 1, pages 34-40, Jul 2007, doi [http://dx.doi.org/10.1016/j.amepre.2007.02.040 10.1016/j.amepre.2007.02.040], PMID [http://www.ncbi.nlm.nih.gov/pubmed/17572309 17572309]</ref>
<ref name="MacLeanBergouignan2011">P. S. MacLean, A. Bergouignan, M.-A. Cornier, M. R. Jackman, Biology's response to dieting: the impetus for weight regain, AJP: Regulatory, Integrative and Comparative Physiology, volume 301, issue 3, 2011, pages R581–R600, ISSN [http://www.worldcat.org/issn/0363-6119 0363-6119], doi [http://dx.doi.org/10.1152/ajpregu.00755.2010 10.1152/ajpregu.00755.2010]</ref>
<ref name="ByrneCooper2004">Susan M. Byrne, Zafra Cooper, Christopher G. Fairburn, Psychological predictors of weight regain in obesity, Behaviour Research and Therapy, volume 42, issue 11, 2004, pages 1341–1356, ISSN [http://www.worldcat.org/issn/00057967 00057967], doi [http://dx.doi.org/10.1016/j.brat.2003.09.004 10.1016/j.brat.2003.09.004]</ref>
<ref name="ArnerWestermark2009">E. Arner, P. O. Westermark, K. L. Spalding, T. Britton, M. Ryden, J. Frisen, S. Bernard, P. Arner, Adipocyte Turnover: Relevance to Human Adipose Tissue Morphology, Diabetes, volume 59, issue 1, 2009, pages 105–109, ISSN [http://www.worldcat.org/issn/0012-1797 0012-1797], doi [http://dx.doi.org/10.2337/db09-0942 10.2337/db09-0942]</ref>
<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>
</references>