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Unless you're one of the select few humans genetically predisposed with the physique of a Victoria's Secret model, you probably have to accept a certain amount of body fat. But there are some areas, especially for women, that can be particularly stubborn. Women are more inclined to store fat than men, for example—especially as we age—and we also tend to carry more fat in our hips and thighs (you know, because of that whole childbirth thing).
So while a certain percentage of body fat is totally healthy and normal, it can be particularly frustrating for women who are trying to displace any excess. Diet and exercise can only do so much, and for a long time, the only real solution for getting rid of excess fat was surgical—that is, until a very buzzy noninvasive procedure called CoolSculpting emerged on the scene. By literally freezing away the tissue, it promises to effectively stimulate fat loss—with absolutely no downtime.
Intrigued by the idea of "lunchtime lipo," we pressed plastic surgeon David Rapaport, of New York City’s Coolspa, for all of the details.
Meet the Expert
Dr. David Rapaport is a board-certified plastic surgeon based in New York City. He practices at Park Avenue Dermatology, as well as Coolspa, a treatment center specializing in non-surgical fat reduction procedures.
What is CoolSculpting?
CoolSculpting is not your standard body contouring procedure. Most cosmetic procedures to remove fat require lasers or surgery, which can leave the surrounding healthy tissue damaged, causing bruising or bleeding. The results are great, but traditional procedures have considerable drawbacks. So naturally, a team of Harvard scientists came up with a new solution for fat elimination. "CoolSculpting is a technique that permanently reduces unwanted fatty bulges through a biologic process called cryolipolysis, which basically kills fat cells through cold," says Rapaport.
As Rapaport explains, the technology was discovered by a Harvard researcher examining old scientific literature detailing pediatric patients who had recently eaten popsicles. "Essentially, the extreme cold was killing fat cells but not killing skin cells," explains Rapaport.
Following a CoolSculpting treatment, tiny crystals form within the fat cells, eventually dying off after being eaten by other cells. This process continues over the next several weeks, while the dead fat cells are broken down, dissolved by your body, and eliminated through the lymph system, all of which occurs unbeknownst to the recipient, without any diet or exercise changes. How exactly does all that happen without you feeling a thing? Science. It works because fat cells freeze at a higher temperature than other types of cells.
How the Procedure Works
During a CoolSculpting procedure, a variety of shapes and sizes of applicators are placed over a gel pad (which protects the skin from being frozen and damaged) for specific amounts of time, at specific temperatures. "What we see is, on average, according to FDA clearance, approximately a 20-25% reduction in fat cells," says Rapaport.
Got an hour? That's all you need. Rapaport says there's no downtime involved, so after your lunch-hour fat-freezing session, you can go right back to work. If you're doing multiple areas, it could take more than an hour, but Rapaport often utilizes multiple machines simultaneously on his patients, so you could treat both thighs—plus your abdomen and arms—in the same one-hour session. "Most treatments last around 35 minutes," he says. "The applicator that goes under your chin is a shallower cup and requires 45 minutes. Outer thighs require an hour and fifteen minutes but both can be done at the same time."
The device feels cool on your skin for the first few moments when it's activated, but after a few minutes, you won't feel anything. Once the machine has done its job, the practitioner will massage the treated areas to break up the crystallized fat cells. At first you'll be able to see where the device was working because that area will be raised, but after the massage, you won't see a thing.
Who's the Best Candidate for CoolSculpting?
"The ideal candidate is somebody who’s not far away from a good body weight," notes Rapaport, "and someone with reasonably good quality skin—in terms of elasticity. Most importantly, the fat needs to be pinchable. If you can pinch it, we can probably freeze it."
CoolSculpting vs. Comparable Procedures
For decades, the only way to quickly get rid of excess fat on the body (aside from diet and exercise) was liposuction. According to 2018 statistics from the American Society of Plastic Surgeons, the surgical procedure averages $3518, making it more costly than CoolSculpting, which averages between $2000 and $4000 per session. Liposuction is much more invasive, though, requiring weeks of recovery time and often an overnight stay in a hospital. But it does remain the gold standard in fat reduction. "Lipo allows for direct sculpting and the surgeon to have total control," says Rapaport. "But the non-invasive gold standard is CoolSculpting."
Another FDA-approved treatment to destroy fat cells, the injectable Kybella, costs roughly the same price as CoolSculpting, but isn't as successful, according to Rapaport. "Unlike CoolSculpting, which specifically kills fat cells, Kybella kills whatever it touches," he says. "If injected along the jaw line, you could temporarily or permanently injure the nerve that moves your mouth with Kybella. It doesn't allow for surgeons to really sculpt an area the way other procedures do."
How to Prepare for a CoolSculpting Treatment
Some physicians will advise patients to avoid taking anti-inflammatories such as aspirin before a CoolSculpting procedure (this could help reduce bruising). Many will also suggest that beverages and caffeine be limited before, but a light meal can be eaten.
You'll start to see changes in your figure within four to eight weeks, with full results by week 12. If it's determined that you need a second treatment, you can come back in as early as eight weeks. "It's extremely frequent for people to do more than one session," says Rapaport, adding that the typical female will usually undergo two or three rounds of treatment.
Now here's the best part: Once those fat cells are destroyed, they're gone for good. If you do gain weight at some point down the road, it will distribute evenly, just not in the places you targeted.
Swelling, bruising and skin sensitivity at the treatment site are common side effects of CoolSculpting. According to Rapaport, "the areas treated will fear tingly for two to four weeks. At about four weeks, you start to see less fat."
The procedure does freeze fat, though there's no risk of frostbite. One very serious, but rare side effect is paradoxical adipose hyperplasia. According to a study published in the journal JAMA, this can cause a gradual enlargement of the treatment area (in other words, the fat in the treatment area becomes hardened rather than dissolving over time). The good news: In the cases studied, PAH was successfully treated.
The Final Takeaway
Rapaport says CoolSculpting is ideal for adults with stubborn pockets of fat that have been resistant to healthy diet and exercise. While it is cheaper than the other permanent solution—liposuction—the costs can add up, depending on the number of areas treated.
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