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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 so that , causing the underlying fat cells to naturally die off, reducing . This reduces the thickness of fat in the area treated. While commercial CoolSculpting requires expensive equipment, I've found that a similar effect can be produced at home for almost no cost.

CoolSculpting uses an FDA approved device to chill the skin for up to an hour<ref name="CyroMetaAvram-2009"/>, with a session lasting one to three hours<ref name="CSFaq"/>, producing a reduction in the fat thickness in the treated area. Animal and human studies have shown a reduction in fat thickness between 20% and 80% over 3 months following treatment<ref name="ClNelson"/>. The device sucks the skin and underlying fat into a cup<ref name="CryroNervesColeman-2009"/>. More than one treatment can be used, but the results of the second treatment are not as dramatic as the first<ref name="CryroChinShek-2012"/>. CoolSculpting is considered an alternative to liposuction<ref name="StevensPietrzak2013"/>, which is the one of the most common type types of plastic surgery<ref name="PlasticSurgry2013"/>. There are some initial indications that CoolSculpting may improve skin texture and laxity, with a tightening of the lose skin<ref name="CarruthersStevens2014"/>. While promising, more studies are needed. =How Much Does CoolSculpting Cost?=The cost seems to vary quite a bit, and I couldn't find any recommended prices. However, self-reported costs seem to be generally between $1,500 and $4,000.

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="CsPigZelickson-2009"/>. However==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.)

==How much Cold is CoolSculpting? ==A study looked at the temperature of the skin surface and the fat is lostat 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. =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="CryroChinShek-2012"/>. A second treatment had a lower reduction of an additional 1-2mm. There is Another study conducted between 2009 and 2012 of 518 patients showed an individual variation average of 23% reduction in response to CoolSculpting, with some practices reporting 30% of patients being 'unimpressed with the resultsfat thickness measured by calipers<ref name="CSIndividualityDierickxMazer2013"/>. 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. =What about 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="CryoSkinGage-1982"/><ref name="CellDeathGage-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.=CoolSculpting compared with 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="CryoSkinGage-1982"/><ref name="CellDeathGage-1979"/> and CoolSculpting does not go that cold. =Side effects 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="CryroNervesColeman-2009"/> 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="CyroMetaAvram-2009"/>. The numbness is not associated with nerve damage<ref name="CryroNervesColeman-2009"/>. There are reports of a small number of patients having a prolonged (weeks), painful response to CoolSculpting<ref name="CSIndividuality"/>, though a 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"/>. There have been a small number of patients (about 1 in 20,000 treatments) that report a paradoxical increase in fat thickness<ref name="JalianAvram2014"/>. A 2015 analysis of the available research concluded that CoolSculpting "presents a compelling alternative to liposuction", "appears to be safe in the short term", and "results in significant fat reduction"<ref name="IngargiolaMotakef2015"/>.

The effects of CoolSculpting should start within a few weeks, but the full effect may take 3-4 months<ref name="CsPigZelickson-2009"/>. Tests indicate that the changes are noticeable after 2-7 weeks (average 4 weeks)<ref name="CryroChinShek-2012"/>. =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 samples were similar.

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 study of CoolSculpting showed a reduction in the fat levels from temperatures of -1c/31f, though not as great a loss as colder temperatures<ref name="CryoNovelManstein-2008"/>. The levels of fat on my legs are noticeably lower than other parts of my body, which might be the result of regular icing. There is evidence that applying ice to the skin produces an inflammation response in just a few minutes<ref name="CyroMetaAvram-2009"/>, so this approach seems viable. '''Use only ice cubes in a bag. '''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. For more details, see [[Cryotherapy]].[[File:IceCubeBags.JPG|none|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.]]

* ** A rough estimate is that each treatment covers around 10cm x 3cm and produces a 4mm fat loss, which is 12,000 mm³ or 12ml. 12ml is about 11 grams of fat, or about 100 Calories. Over three months that's about one Calorie per day. Treating multiple areas will increase this, but it appears most clinics would only treat 2-3 areas at a time.

* '''Does 'DIY CoolSculpting' work the same way as Commercial CoolSculpting?''' It's hard to know for sure, but I believe the underlying mechanism is the same. DIY CoolSculpting could be burning more calories to keep the body warm, but that would produce an overall [[Weight Loss]], not a spot reduction. Another mechanism, such as increased blood flow, could be behind the spot reduction, but that does not seem likely. Commercial CoolSculpting removes heat at a constant rate<ref name="CryoNovelManstein-2008"/>, where this DIY CoolSculpting uses the constant temperature of the ice, so the DIY version may not be as effective. However, the DIY can be applied far more frequently than the commercial approach.

<ref name="CSFaq">CoolSculpting - Patient FAQs Fat Freezing Procedure for Body Sculpting, http://www.coolsculpting.com/heresthe-coolsculpting-procedure/what-is-the-skinny/patientcoolsculpting-faq/ procedure, Accessed on 11 June 2015</ref><ref name="ClNelson">CoolSculpting AA. Nelson, D. Wasserman, MM. Avram, Cryolipolysis for reduction of excess aadipose tissue... [, Semin Cutan Med Surg, volume 28, issue 4, pages 244-9, Dec 2009, doi [http://dx.doi.org/10.1016/j.sder.2009.11.004 10.1016/j.sder. 2009.11.004] - PubMed - NCBI , PMID [http://www.ncbi.nlm.nih.gov/pubmed/20123423 20123423]</ref><ref name="CryosurgeryTemp">All About Cryosurgery , http://hassam.hubpages.com/hub/All-About , Accessed on 11 June 2015</ref><ref name="CsPigZelickson-2009">CoolSculpting B. Zelickson, BM. Egbert, J. Preciado, J. Allison, K. Springer, RW. Rhoades, D. Manstein, Cryolipolysis for noninvasive fat cell destrucdestruction: initial results from a pig model., Dermatol Surg, volume 35, issue 10, pages 1462-70, Oct 2009, doi [http://dx.doi.org/10.1111/j.1524-4725. [Dermatol Surg2009.01259.x 10.1111/j.1524-4725. 2009.01259.x] - PubMed - NCBI , PMID [http://www.ncbi.nlm.nih.gov/pubmed/19614940 19614940]</ref><ref name="CsSuctionAvram-2009">CoolSculpting MM. Avram, RS. Harry, Cryolipolysis for subcutaneous fat layer reduction., Lasers Surg Med, volume 41, issue 10, pages 703-8, Dec 2009, doi [http://wwwdx.newmanmdplasticsurgerydoi.comorg/CoolSculpting10.html <1002/ref><ref name="CyroMeta">CoolSculpting for subcutaneous fat layer redlsm.20864 10.1002/lsm. 20864], PMID [Lasers Surg Med. 2009] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/20014262 20014262]</ref><ref name="CryroNervesColeman-2009">SR. Coleman, K. Sachdeva, BM. Egbert, J. Preciado, J. Allison, Clinical efficacy of noninvasive cryolipolysis and its effects on peripheral nerves., Aesthetic Plastic SurgeryPlast Surg, Volume volume 33, Number issue 4 , pages 482- SpringerLink 8, Jul 2009, doi [http://dx.doi.org/10.1007/s00266-008-9286-8 10.1007/s00266-008-9286-8], PMID [http://www.springerlinkncbi.nlm.nih.comgov/content/3h17qp3gk314ut17pubmed/ 19296153 19296153]</ref><ref name="CryroChinShek-2012">SY. Shek, NP. Chan, HH. Chan, Non-invasive CoolSculpting cryolipolysis for body contouricontouring in Chinese--a first commercial experience... [, Lasers Surg Med, volume 44, issue 2, pages 125-30, Feb 2012, doi [http://dx.doi. 2012org/10.1002/lsm.21145 10.1002/lsm.21145] - PubMed - NCBI , PMID [http://www.ncbi.nlm.nih.gov/pubmed/22334296 22334296]</ref><ref name="CryoSkinGage-1982">AA. Gage, JA. Caruana, M. Montes, Critical temperature for skin necrosis in experiexperimental cryosurgery... [, Cryobiology. , volume 19, issue 3, pages 273-82, Jun 1982] - PubMed - NCBI , PMID [http://www.ncbi.nlm.nih.gov/pubmed/7105779 7105779]</ref><ref name="CellDeathGage-1979">AA. Gage, What temperature is lethal for cells? [, J Dermatol Surg Oncol. , volume 5, issue 6, pages 459-60, 464, Jun 1979] - PubMed - NCBI , PMID [http://www.ncbi.nlm.nih.gov/pubmed/110858 110858]</ref><ref name="CryoNovelManstein-2008">D. Manstein, H. Laubach, K. Watanabe, W. Farinelli, D. Zurakowski, RR. Anderson, Selective cryolysis: a novel method of non-iinvasive fat removal... [, Lasers Surg Med. , volume 40, issue 9, pages 595-604, Nov 2008] - PubMed - NCBI , doi [http://wwwdx.doi.ncbiorg/10.nlm1002/lsm.nih20719 10.gov1002/pubmed/18951424 </ref><ref name="CSIndividuality">Zeltiq sometimes painfullsm.20719], variable results | Christopher B. Zachary FRCP PMID [http://www.drzacharyncbi.nlm.nih.netgov/2010/06/20/variability-in-responses-to-cryolipolysispubmed/ 18951424 18951424]</ref>