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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® 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 , though this DIY CoolSculpting]] for detailsapproach entails some risks. If you're using a commercial CoolSculpting A safer approach is to use an authorized CoolScultping facility, and I'd recommend ensuring you're going to [http://find.coolsculpting.com/find-a-center/ an authorized provider]. (There are lots of cheap clones of the official CoolScultping machines on ebay.com, so check the machine is by ZELTIQ.)

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 -10cfor the temperature of the paddles that are in contact with the patient's skin. 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 applicationset to -7c/19f<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, and that even though the CoolSculpting device was set to well below freezing point, the skin never got close to that cold. The CoolSculpting setting was a "Cooling Intensity Factor" of 42, and it's unclear to me how that relates to the actual temperature. 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"/>, which is similar to the human study. A Another study in 2017 evaluated two newer versions of the CoolSculpting device designed to go colder for a shorter period showed skin temperatures of -1.6c /29f and -7.1c/19f<ref name="Kilmer2017"/>. Further research by ZELTIQ looked at how isolated pig fat cells responded to chilling for an hour and then rewarming<ref name="PreciadoAllison2008"/>. They found that chilling the fat cells to -2c, 0c or 2c caused the cells to die off (necrosis), while chilling them to 7f/45f caused some necrosis and some apoptosis (programmed cell death). Chilling the cells to 14c/57f, 21c/70f, or 28c/82f resulted in no necrotic injury and approximately the same apoptosis. Mouse fat cells exposed to 8c/46f for 10 minutes showed some crystallization, with more crystallization seen after 25 minutes<ref name="Pinto-"/>. The crystal structures were still visible after 2 hours at 22c/72f. All this research suggests that relatively modest temperatures can result in the loss of fat cells, with lower temperatures having more impact.

A common concern is frostbite, or other damage to the skin. This should not be a problem if correctly performed, as you need far colder temperatures (-10c/14f) to cause that type of damage<ref name="Gage-1982"/><ref name="Gage-1979"/>. A study of mice showed the minimum time and temperature for cell damage is -4c/25f for 3 min<ref name="BournePiepkorn1986"/>, but this is actual cell temperature, not exposure to that temperature. 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. (There is one case report of frostbite from commercial Cryolipolysis received at a beauty salon<ref name="ChoongWohlgemut2017"/>, but it's not clear if this was an official ZELTIQ CoolSculpting treatment or not.)

Having reviewed the evidence for the commercial CoolSculpting, I wondered if it would be possible to replicate the effects by simply applying a bag of ice & water to the skin. An early animal study of 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"/>. A more recent study of humans using commercial CoolSculpting showed the skin surface temperature dropped steadily during the 60-minute treatment until it was at an average of 12c/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.

Please use caution, and if you have any doubts you should talk to your doctor. Any issues with circulation or diabetes could make this dangerous, and mistakes can result in serious injury. Here's some things you can do to reduce your risk:* Making a mistake can cause serious injury. Even performed correctly, if you have circulatory issues or a susceptibility to frostbite<ref name="Daanen-2005"/>, DIY CoolSculpting can be dangerous. * Using anything other than ice water can result in temperatures low enough to result in serious frostbite requiring hospitalization<ref name="LeonardKahn2016"/>. * Never use any type of gel pack. These start too cold and can easily cause frostbite<ref name="Stevens-1978"/>, and they warm up too quickly<ref name="ChestertonFoster2002"/>. * A mixture of ice and water will be about freezing point, but solid ice can be much colder, so don't use a solid block of ice.* Make sure the ice is starting to melt slightly so that you have a mixture of ice and water. * I've found that crushed ice in a Ziploc bag works well as it conforms to the shape of your body and starts melting quickly. * Monitor It's critical that you monitor your skin temperature closely (See below).

* Err on the side of caution. Applying ice and water for shorter periods and building up over a few days is safer than more aggressive approaches.

So , I undertook a simple experiment and applied a bag of ice to the 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.

The research into CoolSculpting suggests that it takes 3-4 months for the full effect. Because I applied the CoolSculpting more to the left side of my abs, it is possible to see how long the effects last. I used DIY CoolSculpting in May 2012 for a period of a few weeks. In the following five years, my weight fluctuated by around 15 pounds and I performed no more DIY CoolSculpting or icing of my abs during that time. Regardless of these fluctuations the slight difference in the two sides remained constant. This difference is slight, amounting to around 1-2mm, but is noticeable on inspection. This suggests that the effects of DIY CoolSculpting last for at least five years and probably much longer. Obviously , DIY CoolSculpting does not prevent overall weight gain, but it's unclear if it will limit this gain in any way.

I iced for 1-3 hours most days, which is far more than CoolSculpting which uses a single 1 hour session. I have no idea if 'more is better' or if a single hour every couple of months is optimal. None of the research I found had any indication of the dose/response relationship. The latest research suggests that 30 minutes might be enough to induce changes, but I find 1-3 hours is convenient. I've tested and tried a wide variety of combinations of ice cubes, crushed ice, with/without water added, and lots of different bags. So far, the best option I've found is in this 3 Liter hydration pack letter bladder from a platypus: <jfs id=" B00F5IADN6" noreferb="true"/>. It's a nice size, and it's slimmer than most hydration bladders, so it's easier to cover a larger area. Unlike a cheaper Ziploc bag, it doesn't leak, and is a much better shape. If you want to use it for icing and that the back of your leg, buttocks, or back, you can use the hydration cube tube to release the pressure into a container under your seat.

* Fill up the bag most of the way up with ice cubes, then top up with chilled water. Don't fill up the back bag all the way, but then squeeze the bag to remove all the air. You don't want the bag fully filled, that way you in order to have a little bit of movement, and it conforms to your body shape much better.