- CoolSculpting is a fat loss technique that involves a combination of cold temperatures and suction to destroy fat cells.
- A few studies have shown that CoolSculpting does in fact smooth out and remove small amounts of body fat directly beneath the skin.
- CoolSculpting can’t help you lose large amounts of fat, but if you’re willing to spend several thousand dollars, it can help you get rid of “stubborn” fat deposits.
The name itself reminds me of the 70s, perhaps an artist scene. Rebel against the government by making radical statues (back when radical was less “feminist” and more “Sonic the Hedgehog on a skateboard”.)
Fight against the institution like Greek statues fight against pornographic standards of penis sizes.
Then I learned it was a fat loss technique popular with middle-aged mothers with too much money and instantly felt like I needed to apologize to sculptors everywhere for the comparison.
Then I looked into it.
Boy, does this shoe taste bad. Shouldn’t have stepped into the realm of judging things by their cover if it just made my foot go into my mouth.
Can’t really blame me though.
After browsing a ton of CoolSculpting reviews I felt like I was so far into mommy blog territory that I needed to bring spare nappies and a welcoming gift of scented candles and wine just to continue reading.
It was only after I googled the scientific name, cryolipolysis, that I understood how such a cool process with such a cool name could catch on.
So what is CoolSculpting? Who thought of this positively radical name, and will it help my kickflips and graffiti?
Not much, but it could help your family members from looking like bulldogs with their jowls … if they have the money for it.
Table of Contents
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What Is CoolSculpting?
CoolSculpting is the marketable term for the process of cryolipolysis.
The process of cryolipolysis is a topical (on the surface) proposed alternative to liposuction, for medically assisted fat loss. While liposuction is indeed effective, it has metabolic side-effects that could result in regaining weight and, rarely, has resulted in deaths.
Liposuction has saved more lives than it has ended but that doesn’t mean medical professionals can’t try to find something even safer, better, and more well tolerated—which is what they think they’ve found in cryolipolysis.
The theory dates back to the 70s.
It started with observations on cold-induced panniculitis (inflammation resulting in fat loss), specifically the term “popsicle panniculitis” where an infant got necrosis of adipose tissue after eating a popsicle.
Given how just the adipose was destroyed, but neither nerves nor the skin, this led to a theory where perhaps the ability of cold to kill fat cells could be used in a more controlled and targeted manner.
The published knowledge that cold kills fat in general dates back further. A historical review even traces it back to 1902 by the French researcher H. Haxthausen.
However, it took until 2007 until it was first tested by Dr. Dieter Manstein and his team for targeted weight loss.
By localizing the area that is exposed to cold, and by keeping it at a reasonable temperature, fat cells experience a stimuli where they proceed to undergo cellular death whereas other cells such as skin cells and neurons do not.
Despite some safety questions still being up in the air (let’s be honest, nothing will ever not have safety questions) it is well researched and safe enough to get FDA clearance for cryolipolysis of the abdomen and thighs.
However, as one review puts it, the precise mechanisms are not yet known despite there being numerous clinical trials conducted on cryolipolysis.
We do have some leads though.
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How Does CoolSculpting Work?
The core premise of CoolSculpting is a difference in sensitivity to cold.
Specifically, adipose tissue seems to be more susceptible to damage from cold exposure than do other types of tissue that we would rather not destroy, like neurons and skin tissue.
Cells, when frozen, thaw.
While that’s obvious enough it can also be dubbed a “freeze-thaw” cycle of sorts. Cells are normally well equipped to handle this, given how we travel from one environment to the next, but even topical cells (which are the most resilient) are irreversibly damaged at -196°C.
It’s why liquid nitrogen can be used to remove warts. It damages the cells in the wart to the point where they can no longer recover on their own and only death awaits.
Now, bathing in liquid nitrogen remains a horrible idea, but the aforementioned “popsicle panniculitis” led to the first discovery of sensitivity which was later tested in pigs by Manstein’s group. They showed that using a significantly more moderate temperature of -7°C in the range of 5-21 minutes could result in fat loss without skin damage.
It should be noted that research only delves into -7°C or warmer temperatures, since this is the temperature range where we have evidence of nerves being mostly unharmed (or more specifically, damage that can be reversed with the passage of time).
Anywho, the pathology looked very similar to other forms of panniculitis, inflammation is increased and correlates with damage. After time, the selected tissue is targeted for elimination. If the cell can protect itself, like nerves, it can survive; if the cell cannot, it gets removed.
It was also noted it (the inflammation) only penetrated about 2 to 4 mm into the fat layer so this is most definitely a very topical effect. That’s good for health, you don’t want inflammation to be induced all the way to your bones.
What was the fate of the outermost fat layer in this study? Well, the superficial fat layer was reduced by 33% after a single session of cryolipolysis! Lucky little piggies.
Just to be clear, the superficial fat layer. Not whole-body fat, that would be asinine.
CoolSculpting is causing cold damage to the outermost layer of fat at a temperature that irreversibly damages fat cells but allows skin and nerves to repair themselves. Over time, inflammation removes a chunk of fat cells from the area.
But enough about the pig data, if this has FDA clearance it has to have human studies on it, right?
What Does the Science Say About CoolSculpting?
First, let’s assess the overall body of evidence.
While rudimentary, a search on Pubmed (the most popular online database for scientific articles) returns 16 dedicated human trials on “cryolipolysis.”
While this is far less than say, something like “fish oil supplementation” (1,695 hits) or even “citrulline supplementation” (64 hits) it’s enough that we can cross compare the results with a nice degree of faith—it’s a good amount of studies, enough to get some reviews.
Now, in an atypical manner, I want to start with a conclusion and then break it down. This review study on the topic (and other forms of non-invasive fat loss techniques) had this to say:
“In summary, using cryolipolysis for body contouring is effective for patients with separate fat bulges. However, it seems that the procedure is not pronounced for obese patients with considerable skin flaccidity [loose skin].”
In other words, it can help contour your outer layer of fat but doesn’t look that obvious when you have a ton of fat on your body.
It’s a fair conclusion looking at the evidence.
From studies on breast tissue in men (pseudo-gynecomastia) and women, the abdomen of women and teenagers, the arms and the thighs, and even the pouch fat on the throat, cryolipolysis has stunning reliability and effectiveness.
Most studies use pictures (before vs. after) and patient-reported satisfaction as their end goals but, when skin is measured outright, it does seem to be physically reduced.
A single session, with a follow-up after 2 to 3 months, seems to reliably induce positive changes in a manner that is not too dependent on the operator (i.e. hard to get a “bad” practitioner) and the review states collectively has about a 70% approval rating.
I’ll be honest. Going into this article I thought I was going to end up bashing this but it turned out to be a pleasant surprise for me. Will have to keep my eyes and ears out for subsequent data.
Does CoolSculpting Have Any Side Effects?
The side effect profile of CoolSculpting is surprisingly small.
I know I have to be pedantic, and will get into theoretical side-effects in a bit, but for now there are no major red flags being waved. A large chunk of the side effects seem to be mitigated simply by how CoolSculpting doesn’t force major whole-body fat loss.
The side effects are limited to the area of the sculpting, in particular the nerves.
The process of cryolipolysis will result in temporary nerve impairment, specifically reduced sensitivity to mechanical and heat stresses. Hot won’t feel as hot, pinches won’t hurt as much as they did, that sort of thing.
However, these side effects as well as potential damage to the nerves seem to be transient and last for no longer than a month. For all intents and purposes this is a mild inconvenience.
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Aight, cool, now how about theoretical?
Theoretically there are a few things that could go wrong.
The first is the “genetic monkey wrench” that has yet to rear its ugly head but eventually will with time. I wouldn’t be surprised if somebody has long-lasting nerve damage at some point.
Genetics are weird, it’s bound to happen, and probably more likely in people who already have impaired nerve health and function (like uncontrolled type II diabetes.)
Secondly, the inflammation it causes is well controlled because these studies are a single session followed by not doing cryolipolysis for up to three months. This is ample time for your body to recover from the damage.
If somebody does cryolipolysis multiple times a week, which I know is going to happen somewhere in California, then it’s possible that the inflammation simply doesn’t go away. If the inflammation doesn’t go away then you can throw that “doesn’t harm the skin” claim right out the window.
And, finally, perhaps humorously even, the benefits of cryolipolysis are based on the average person’s skin quality and resilience. It’s applied to the breast, arms, thighs, and abdomen to help with sagging or loose skin—these areas of the body have similarly tough skin.
Areas with sensitive skin may not yield the same results, or put in other words …
If your nuts hang low then please don’t cryo them. Embrace the sag, wear a kilt.
But, if you take some basic cautionary advice:
- Keep the cryolipolysis to areas that cryolipolysis has been tested for.
- Don’t do it too often, let your body take care of the inflammation first.
- Don’t cryolipolysis on areas with weaker, or damaged, skin.
- Understand that genetics, much like death, comes for us all at some point.
Then you should be good to experiment with this technique if you so desire.
How Much Fat Can CoolSculpting Help You Lose?
There are a few practical considerations that I want to outline before we end this article.
The first, and I want to make this clear, is that the name “CoolSculpting” is very appropriate. This technique is most definitely “sculpting” or “contouring” the body to smooth out a bit of fat here and there, or to get rid of unsightly clumping skin.
If you want to look into cryolipolysis for cellulite, that makes sense.
If you think this is a good way to lose weight fast, you are sorely mistaken.
While cryolipolysis started out as an investigation into whether or not it could replace liposuction it quickly turned into another direction once it was realized it only got rid of a thin layer of subcutaneous fat.
To use cryolipolysis in an attempt to lose large amounts of fat would be like spending twenty minutes chipping away at a rock, in the attempt to create a statue, but then after twenty minutes you just leave the rock and return three months later to chip for another twenty minutes.
If you actually want to lose large amounts of fat then, perhaps try proper dieting and exercise?
Furthermore, if you’re in a state where liposuction is the only option for you (or a gastric bypass) then stick with those options—CoolSculpting is not a viable alternative.
Now, moving on to the opposite end of the adipose spectrum—bodybuilders.
At this moment in time there are no studies conducted on already very lean individuals, so we don’t know how exactly cryolipolysis would affect you when that 2 to 4mm layer also includes your bulging six-pack rather than just adipose, but it’s an enticing idea.
Perhaps a cryolipolysis session three months before a show could help a bit with the trace amounts of fat left? Who knows, won’t replace normal contest prep but might be something to look into as an additional technique.
And most notably, cryolipolysis is a completely different beast than cold exposure.
Cold exposure refers to being exposed to whole-body cold air in an attempt to have your brown fat cells go into overdrive, to burn more calories via what we call “uncoupling proteins” and hopefully result in weight loss over a long period of time.
The theory of cold exposure has led to people having cold showers, lowering their heating bills, and braving Canadian winters more willingly than before—not like we had a choice up here, Michigan can join us at the pity party.
But cryolipolysis? Targeted suction of an area for localized cooling effects rather than whole-body cooling. The intention isn’t to encourage the fat cells to become more energy hungry, it’s to break their knee caps so the immune system can hunt them down easier.
So end story, cryolipolysis is not a reliable way to improve whole body thermogenesis. Cryolipolysis is not classical fat loss. It’s technology-assisted makeup.
Despite being unified by the theme of “cold,” claims for both should remain wholly separate from each other.
→ I Took A Cold Shower (Almost) Every Day for a Year. Here’s What Happened.
How Much Does CoolSculpting Cost?
Short answer, entirely too much in my opinion.
Prices do vary depending on where you go in person and where you browse on the Internet, but it’s not unreasonable to see claims around $400 for a session and remark at how cheap that is.
Other places sell sessions for upwards of $750 to $1,000, at times being a “per hour” charge.
There is really no reason for the cost being so high based on how much it costs to actually use the machine. Googling around for the actual cost of the cryolipolysis machines seems to return numbers in the $500 to $5,000 range as well, so it’s not like people who have these machines need to recoup costs from a half-million dollar purchase.
Charge what people are gonna pay I guess.
If you’re looking into cryolipolysis you just need to determine whether or not you want to spend such money. A little bit of fat off your tummy may not be worth a grand but, if aging has made your face resemble your bulldog’s, then it may totally be worth it.
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The Bottom Line on Coolsculpting
At the end of the day, this is pretty cool “spa toy.”
Something that exists, and perhaps one to two times a year you just go for a little trim. Get the nails done, get your hair did all up, then sculpt a bit of fat off your jowl and tushie. A nice little maintenance to stay in tip top shape that doesn’t take a daily investment.
Aesthetically, it’s the equivalent of your I.T friend getting a new electric toy to add to the repertoire of a dozen things that I don’t understand enough to finish the analogy—it’s just cool and why not? I had the spare money.
But if you don’t have the spare money, or can live with a little bit of flab here and there, and would rather just eat less or move more, then it’s no big loss.
It’s reliable, effective, and novel but it isn’t revolutionary. (At least not to most of us. Dr. Manstein and his team must be elated that their application of a discovery is getting attention—kudos to them, doesn’t happen often and they, and all researchers who pioneered this, deserve a beer.)
So remember, the next time you’re in an area with your pockets as filled with money as your triceps or jowls are with fat, that won’t go away, you can give cryolipolysis a spin and see how it goes.
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What’s your take on CoolSculpting? Have anything else to share? Let me know in the comments below!
+ Scientific References
- Garibyan L, Cornelissen L, Sipprell W, et al. Transient Alterations of Cutaneous Sensory Nerve Function by Noninvasive Cryolipolysis. J Invest Dermatol. 2015;135(11):2623-2631. doi:10.1038/jid.2015.233
- Kilmer SL, Burns AJ, Zelickson BD. Safety and efficacy of cryolipolysis for non-invasive reduction of submental fat. Lasers Surg Med. 2016;48(1):3-13. doi:10.1002/lsm.22440
- Zelickson BD, Burns AJ, Kilmer SL. Cryolipolysis for safe and effective inner thigh fat reduction. Lasers Surg Med. 2015;47(2):120-127. doi:10.1002/lsm.22320
- Wanitphakdeedecha R, Sathaworawong A, Manuskiatti W. The efficacy of cryolipolysis treatment on arms and inner thighs. Lasers Med Sci. 2015;30(8):2165-2169. doi:10.1007/s10103-015-1781-y
- Mostafa MSEM, Elshafey MA. Cryolipolysis versus laser lipolysis on adolescent abdominal adiposity. Lasers Surg Med. 2016;48(4):365-370. doi:10.1002/lsm.22475
- Meyer PF, Furtado ACG, Morais SFT, et al. Effects of cryolipolysis on abdominal adiposity of women. Cryo Letters. 38(5):379-386. http://www.ncbi.nlm.nih.gov/pubmed/29734405. Accessed March 2, 2020.
- Harrington JL, Capizzi PJ. Cryolipolysis for Nonsurgical Reduction of Fat in the Lateral Chest Wall Post-Mastectomy. Aesthetic Surg J. 2017;37(6):715-722. doi:10.1093/asj/sjw250
- Munavalli GS, Panchaprateep R. Cryolipolysis for targeted fat reduction and improved appearance of the enlarged male breast. Dermatologic Surg. 2015;41(9):1043-1051. doi:10.1097/DSS.0000000000000415
- Alizadeh Z, Halabchi F, Mazaheri R, Abolhasani M, Tabesh M. Review of the mechanisms and effects of noninvasive body contouring devices on cellulite and subcutaneous fat. Int J Endocrinol Metab. 2016;14(4). doi:10.5812/ijem.36727
- Zelickson B, Egbert BM, Preciado J, et al. Cryolipolysis for noninvasive fat cell destruction: Initial results from a pig model. Dermatologic Surg. 2009;35(10):1462-1470. doi:10.1111/j.1524-4725.2009.01259.x
- Coleman SR, Sachdeva K, Egbert BM, Preciado J, Allison J. Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on Peripheral Nerves. Aesthetic Plast Surg. 2009;33(4):482-488. doi:10.1007/s00266-008-9286-8
- Manstein D, Laubach H, Watanabe K, Farinelli W, Zurakowski D, Anderson RR. Selective cryolysis: A novel method of non-invasive fat removal. Lasers Surg Med. 2008;40(9):595-604. doi:10.1002/lsm.20719
- Karow AM, Webb WR. Tissue freezing. A theory for injury and survival. Cryobiology. 2(3):99-108. doi:10.1016/s0011-2240(65)80094-3
- Ingargiola MJ, Motakef S, Chung MT, Vasconez HC, Sasaki GH. Cryolipolysis for Fat Reduction and Body Contouring: Safety and Efficacy of Current Treatment Paradigms. Plast Reconstr Surg. 2015;135(6):1581-1590. doi:10.1097/PRS.0000000000001236
- Manstein D, Laubach H, Watanabe K, Farinelli W, Zurakowski D, Anderson RR. Selective cryolysis: A novel method of non-invasive fat removal. Lasers Surg Med. 2008;40(9):595-604. doi:10.1002/lsm.20719
- Jalian HR, Avram MM. Cryolipolysis: A historical perspective and current clinical practice. Semin Cutan Med Surg. 2013;32(1):31-34. https://www.ncbi.nlm.nih.gov/pubmed/24049927/. Accessed March 2, 2020.
- Epstein EH, Oren ME. Popsicle Panniculitis. N Engl J Med. 1970;282(17):966-967. doi:10.1056/NEJM197004232821709
- Rao RB, Ely SF, Hoffman RS. Deaths related to liposuction. N Engl J Med. 1999;340(19):1471-1475. doi:10.1056/NEJM199905133401904