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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&reg ; 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 DIY CoolSculpting]] for details.

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 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="Zelickson-2009"/>. ==Is CoolSculpting Just Thermogenesis? ==Because the time frame of CoolSculpting is months, it seems extremely unlikely that the fat loss is due to the localized metabolism of fat to produce heat. The early research into CoolSculpting used Yucatan Pigs that are incapable of non-shivering thermogenesis<ref name="Kruglikov-2014"/>. While there is a recent study showing that as little as 30 minutes of icing can change the gene expression of fat cells to improve their fat burning capability<ref name="Kern-2014"/>., this is not what is typically meant by "Thermogenesis". Rather this is an increased thermogenic capability, and it could contribute to the fat reduction of CoolSculpting. (The study also showed that in lean subjects, similar changes naturally occurred in winter, but far less change occurred in obese subjects.){| class="wikitable" |- valign="top"|[[File:CoolSculpting-Kern-2014-Icing.jpg|none|thumb|x300px|Changes in fat burning capabilities due to 30 minutes of icing<ref name="Kern-2014"/>. The markers represent each of the seven subjects. ]]|[[File:CoolSculpting-Kern-2014-Winter.jpg|none|thumb|x300px|Changes in seasonal fat burning capabilities of lean and obese subjects<ref name="Kern-2014"/>. (A BMI of 30 was used to divide subjects.)]]|}==How Cold is CoolSculpting? ==

A common concern is frostbite, or other damage to the skin. This is should not be a problemif correctly performed, as you need far colder temperatures (-10c/14f) to cause that type of damage<ref name="Gage-1982"/><ref name="Gage-1979"/>. 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. =Risks and Side Effects of CoolSculpting Compared With Cryosurgery=A 2015 analysis of the available research concluded that CoolSculpting is quite different "presents a compelling alternative to Cryosurgeryliposuction", which uses cold "appears to kill off tissuebe safe in the short term", 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="CryosurgeryTempresults in significant fat reduction"/>. Cell damage is caused by temperatures below -10c/14f<ref name="Gage-1982IngargiolaMotakef2015"/><ref name="Gage-1979"/> and CoolSculpting does not go that cold. =Side Effects However, there are a number of risks to CoolSculpting=.There have been no serious * A common side effects reported so far<ref name="ClNelson"/>. The effect is that the skin being treated goes red, with some bruising and numbness<ref name="ClNelson"/>. I suspect that the bruising may be because the CoolSculpting device sucks<ref name="Coleman-2009"/> the fat against the cooling device. These problems normally resolve within a week. The numbness is not associated with nerve damage<ref name="Coleman-2009"/>.* Studies have shown no changes in blood lipid levels or liver function<ref name="Avram-2009"/>. The numbness is not associated with nerve damage<ref name="Coleman-2009"/>. * A study of 528 patients that underwent a total of 2,729 cycles showed only three cases of mild or moderate pain, which resolved within 4 days<ref name="StevensPietrzak2013"/>. * Another study of 518 patients showed 4% experienced severe pain during the first 5 minutes of treatment, with the remainder reporting mild to tolerable pain<ref name="DierickxMazer2013"/>. * While "CoolSculpting" is a registered trademark of ZELTIQ, there are a variety of relatively cheap machines that claim to perform Cryolipolysis. Many even claim to be "ZELTIQ" even though they look nothing like the machines made by ZELTIQ and cost a tiny fraction of the cost of a genuine machine. * There is one report of frostbite from Cryolipolysis received at a beauty salon<ref name="ChoongWohlgemut2017"/>. It's unclear if this was from an official ZELTIQ CoolSculpting treatment or not. The subject had two painful blisters arise within a few hours of treatment, but was advised against seeking medical help by the salon owner. The blisters deteriorated over the next few days until the subject went to the doctor. At that point there were two nasty 2" by 3" wounds (5x7cm) which were treated as frostbite. * The manufactures report that there have been a small number of patients (about 1 in 20,000 treatments) that report of a paradoxical increase in fat thickness<ref name="JalianAvram2014"/>. A 2015 analysis of the available research concluded However, another report suggests that CoolSculpting "presents a compelling alternative to liposuction", "appears to be safe in the short term", and "results rate is much higher at 1 in significant fat reduction"120 patients<ref name="IngargiolaMotakef2015KellyRodriguez-Feliz2016"/>.{| class="wikitable" style="margin-left: auto; margin-right: auto; border: none;"|- valign="top"|[[File:Paradoxical Adipose Hyperplasia After Cryolipolysis-1.png|none|thumb|300px|An example of a subject that had an increase in fat thickness due to Cryolipolysis. While rare (1:20,000), you can see this is a fairly dramatic increase in fat thickness.]]|[[File:Paradoxical Adipose Hyperplasia After Cryolipolysis-2.png|none|thumb|300px|An MRI shows that the increase in fat thickness is greatest on the edges of the treatment zone.]]|}

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 animal study of CoolSculpting 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"/>. The levels A more recent study of fat on my legs are noticeably lower than other parts of my body, which might be humans using commercial CoolSculpting showed the skin surface temperature dropped steadily during the result 60-minute treatment until it was at an average of regular icing12c/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.

Use I use only ice cubes in a bag, which will result in a mixture of ice and water. This mixture will be around freezing point. '''Never use gel packs''' as these are cold enough to cause skin damage. I'd recommend using the [http://www.amazon.com/dp/B00DP6P6R8 plastic bags designed for making ice cubes], as these form a nice thin layer of ice. You'll need to replace them periodically as they melt completely. '''Do not use large blocks of ice''', as the ice itself can be cold enough to damage the skin. Remember, the goal is a mixture of ice and water. You may need to put a thin layer of material between your skin and the bag of ice cubes until they have melted a little. For more details, ; see [[Cryotherapy]]for details.[[File:IceCubeBags.JPG|nonecenter|thumb|500px|These ice cube bags are cheap and work remarkably well for providing a thin layer of ice that stays in place. They can leak, so you may need to put them inside a Ziploc bag.]]I check my skin temperature periodically, partly for safety and partly to check progress. I like to use a [[Thermal Camera]] as this shows not only the temperature but the area and evenness. [[File:Cryolipolysis Thermal Camera.jpg|center|thumb|300px|An example image from my [[Thermal Camera]] showing the skin temperature.]]

[[File:CoolSculpting asym1.jpg|nonecenter|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|nonecenter |thumb|400px|The asymmetry highlighted by taking the image from an oblique angle.]]