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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 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"/>.
=How Cold is CoolSculpting? =
CoolSculpting uses an approach of removing heat from the body at a constant rate, something they call Cooling Intensity Factor (CIF) <ref name="Bernstein2016"/><ref name="Zelickson-2009"/>. This makes it tricky to understand the actual temperatures involved, though studies often quote figures of around -5c to -10c. A study looked at the temperature of the skin surface and the fat at a point 1.5cm below the surface during a 60 minute CoolSculpting application<ref name="Sasaki-2014"/>. The skin surface dropped in temperature steadily during the 60 minutes until it was at an average of 12.3c/54f (+/-2.6c). The underlying fat temperature dropped for the first 30 minutes to around 13c/55f then cooled more slowly for the final 30 minutes to around 10c/50f. It's interesting to note that the skin temperature was warmer than the underlying fat. An animal study of two different machines that cooled showed a final skin temperature of 8.6c/47f and 5.8c/42f<ref name="JeongKwon2017"/>. A study evaluated two newer versions of the CoolSculpting device showed skin temperatures of -1.6c and -7.1c<ref name="Kilmer2017"/>.
=How Much Fat Is Lost?=
A 2014 study showed an average of 7mm reduction in fat thickness two months after a single treatment (about 1.4oz/40g)<ref name="GaribyanSipprell2014"/>. A 2012 study of CoolSculpting showed an average reduction of about 4mm after two months<ref name="Shek-2012"/>. A second treatment had a lower reduction of an additional 1-2mm. Another study conducted between 2009 and 2012 of 518 patients showed an average of 23% reduction in fat thickness measured by calipers<ref name="DierickxMazer2013"/>. One patient showed a localized reduction of 2.2cm (nearly 1 inch) in fat thickness in spite of an increase of 0.1 Kg in overall weight.
=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"/>.
=How Long Does It Last?=A case study of two early subjects of CoolSculpting were examined years later<ref name="Bernstein2016"/>. Rather unusually, the subjects opted to have just one flank treated, allowing for an ongoing comparison. The first subject had two cycles on left flank only, CIF of 42 mW/cm<sup>2</sup> (-10c) for 60 minutes. The changes are clearly noticeable after 2 months, 2 years, and 6 years post treatment. The second subject had one treatment cycle with a CIF of 34 mW/cm<sup>2</sup> (-5c) for 60 minutes, and the changes are again clearly visible after three months, five years, and nine years post treatment. I've had similar long-term changes with my DIY approach, as noted below.=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=
<ref name="KleinBachelor2017">Kenneth B. Klein, Eric P. Bachelor, Edward V. Becker, Leyda E. Bowes, Multiple same day cryolipolysis treatments for the reduction of subcutaneous fat are safe and do not affect serum lipid levels or liver function tests, Lasers in Surgery and Medicine, 2017, ISSN [http://www.worldcat.org/issn/01968092 01968092], doi [http://dx.doi.org/10.1002/lsm.22674 10.1002/lsm.22674]</ref>
<ref name="JeongKwon2017">S. Y. Jeong, T. R. Kwon, J. Seok, K. Y. Park, B. J. Kim, Non-invasive tumescent cryolipolysis using a new 4D handpiece: a comparative study with a porcine model, Skin Research and Technology, volume 23, issue 1, 2017, pages 79–87, ISSN [http://www.worldcat.org/issn/0909752X 0909752X], doi [http://dx.doi.org/10.1111/srt.12305 10.1111/srt.12305]</ref>
<ref name="Bernstein2016">Eric F. Bernstein, Long-term efficacy follow-up on two cryolipolysis case studies: 6 and 9 years post-treatment, Journal of Cosmetic Dermatology, volume 15, issue 4, 2016, pages 561–564, ISSN [http://www.worldcat.org/issn/14732130 14732130], doi [http://dx.doi.org/10.1111/jocd.12238 10.1111/jocd.12238]</ref>
<ref name="Kilmer2017">Suzanne L. Kilmer, Prototype CoolCup cryolipolysis applicator with over 40% reduced treatment time demonstrates equivalent safety and efficacy with greater patient preference, Lasers in Surgery and Medicine, volume 49, issue 1, 2017, pages 63–68, ISSN [http://www.worldcat.org/issn/01968092 01968092], doi [http://dx.doi.org/10.1002/lsm.22550 10.1002/lsm.22550]</ref>
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