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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"/>.
=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 only drops the temperature to around -1c/31f.
=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"/>.
<ref name="CryroNerves">Aesthetic Plastic Surgery, Volume 33, Number 4 - SpringerLink http://www.springerlink.com/content/3h17qp3gk314ut17/ </ref>
<ref name="CryroChin">Non-invasive CoolSculpting for body contouri... [Lasers Surg Med. 2012] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/22334296 </ref>
<ref name="CryoSkin">Critical temperature for skin necrosis in experi... [Cryobiology. 1982] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/7105779 </ref>
<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>
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