With beauty technology constantly evolving, it is critical to pay attention to what can be problematic or lead to serious side effects. When it comes to freezing fat through CoolSculpting, consideration for its efficacy and potential side effects should be weighed. The technology has recently made headlines.
According to a recent investigation by The New York Times that involved analyzing “internal documents, lawsuits, medical studies, and interviews,” it appears that the potential risk of a side effect resulting in unwanted fat growth — which can only be treated through surgery — may have been previously underestimated.
What is CoolSculpting?
CoolSculpting is the brand name for cryolipolysis (CLL), a fat-freezing method to reduce fat thickness in treated areas, explains Basel Sharaf, M.D., practice chair for the Center for Aesthetic Medicine & Surgery at Mayo Clinic in Rochester, Minnesota.
“CLL is a noninvasive body contouring approach based on the hypothesis that fat cells (adipocytes) are sensitive to cold temperature. Through controlled cooling, selective destruction of fat cells can be achieved due to cold-induced apoptosis (fat cell death). Initially, there is an inflammatory response followed by reduction in fat cells in the treated area over a three-month period,” says Dr. Sharaf. This technology promised reduction of unwanted fatty deposits in certain areas of the body without having surgery, hence its appeal to the public.
How long does a CoolSculpting treatment take and what areas can be treated?
Dr. Sharaf says that CoolSculpting treatment can take 35 minutes to 1 hour per treatment area. If more treatment areas are desired, then it may take several hours. The treatments are usually repeated within 1 to 3 months, and it involves an average 2 to 3 treatments per area. Additionally, up to 4 treatment areas — such as the abdomen and flanks — can be done at the same time.
In addition to the abdomen, the FDA has cleared CLL for the treatment of fat under the chin, under the jawline, thighs, upper arm, sides of the abdomen, underneath the buttocks and on the back.
Does CoolSculpting really work?
According to recent studies, the effectiveness of the treatment can be quite variable, with reported efficacy between a 10.3% and 25.5% reduction in fat thickness in treated areas.
CLL may not be nearly as effective or predictable as liposuction, which is still considered the gold standard for targeting areas of fat excess under the skin. Liposuction uses suction cannula to remove fat from specific areas of the body. The process of shaping the body with liposuction is called body contouring or liposculpture.
Is CoolSculpting safe?
According to Dr. Sharaf, much of CLL’s popularity is based on the fact that it is a noninvasive body contouring procedure that can be performed without anesthesia. In contrast, liposuction is typically done through small incisions and often requires sedation or general anesthesia.
With CoolSculpting, there have been concerns for paradoxical adipose hyperplasia (PAH). This is a term used to describe fat growth — rather than shrinkage — in the treated areas of CoolSculpting. It is difficult to predict who may develop PAH after CoolSculpting. This is one of the main reasons CoolSculpting is not offered at the Center for Aesthetic Medicine & Surgery, says Dr. Sharaf.
“A key factor when choosing which approach we use is efficacy, safety and predictability of the results long term,” says Dr. Sharaf. “There are several techniques to perform safe body contouring with either liposuction alone or with energy-based devices.” In 2022, liposuction was the most commonly performed cosmetic procedure in the U.S. by board-certified plastic surgeons according to American Society of Plastic Surgeons (ASPS). “While CLL may have potential utility in people who may not be good surgical candidates for liposuction, it’s critical that those who are considering it are aware of CLL’s efficacy and the risk of PAH,” says Dr. Sharaf.
“As with liposuction, CLL is not an alternative to weight loss,” says Dr. Sharaf. Patients have optimal cosmetic outcome after reaching ideal body weight and making healthy lifestyle changes prior to body contouring.
What are the potential side effects of CoolSculpting?
Like any surgical treatments, CoolSculpting has associated risks, despite its noninvasive nature.
Short-term side effects include the following and may last from hours to days:
- Redness or inflammation known as erythema.
- Swelling.
- Numbness of the overlying skin.
Serious side effects include:
- Motor neuropathy. This condition affects the nerves that control the muscles in the body, leading to weakness or paralysis.
- Prolonged pain or dysesthesia. This is persistent pain or abnormal sensations such as tingling, burning or numbness.
- Hyperpigmentation. This is darkening of the skin due to an increase in melanin production. It can be caused by various factors such as sun exposure, hormonal changes or certain medical conditions.
- Paradoxical adipose hyperplasia (PAH). This complication can occur after treatment, where instead of reducing fat, there is an increase in fat cells resulting in a visible bulge or lump.
PAH doesn’t show up right away — bulges or lumps typically appear a few months after treatment, Dr. Sharaf says. And it doesn’t go away on its own; surgery might be needed. There is still debate as to what is the best approach to address PAH.
Are there any alternatives to CoolSculpting?
While CoolSculpting is generally considered safe, patients who are interested in body contouring may want to consider more proven methods. There are currently many technologies and energy-based devices that are being marketed to improve body contour and reduce unwanted fat. It’s important that people are educated about these technologies, their effectiveness and side effects by their provider.
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