The procedure, CoolSculpting, is performed by a device manufactured by Zeltiq. Freezing fat kills the fat cells. 20% reduction in fat thickness is noted by ultrasound measurement at four months for the majority of patients. Treatment can be repeated for improved reduction of fat volume. The amount of fat lost is less than that with liposuction but this may be an ideal treatment for those patients who are not candidates for surgery. Other treatments may loosen the fat cells but this may only temporarily reduce the triglyceride volume from the fat cells but without necrosis of the adipocyte (death of the fat cell) it could be expected that fat will re-accumulate readily.
Many patients are not able to take time off work to undergo a procedure while other patients are anxious of any surgery including liposuction and other patients are taking medication or have cardiac or other conditions which preclude them from having surgery. Fat reduction techniques are not replacements for exercise and diet. It is very important to maintain good health habits. CoolSculpting, a non surgical fat reduction treatment from Zeltiq, Zerona a laser device, external ultrasound (Ultrashape purchased by Syneron and not yet FDA-cleared in the U.S.), Exilis (radiofrequency)and liposuction are not weight loss treatments. They are meant to reshape. There is a lack of evidence comparing the results between these new devices, but Zeltiq is one treatment that is known to not only rupture, but cause death of fat cells.
A stubborn bulge that doesn’t go away despite diet and exercise is often an inherited condition. This is the ideal situation for liposuction or non-invasive fat reduction. Patients should be in good health, eating a healthy diet that does not involve more calories than their daily energy expenditure consumes and exercises regularly, and at the most, ten pounds overweight, having focal bulges.
During the consultation, the doctor reviews the medical history and examines the area to determine the skin quality and the fat placement. If the complaint is abdominal bulging but most of the fat is behind the muscle wall which means it surrounds the intestinal tract, that fat can be reduced with diet and exercise and can not be reached by liposuction or CoolSculpting. It also could be that the bulge is related to a weakened fascial (connective tissue layer) wall that normally holds back the strong abdominal muscle wall but could have been weakened by pregnancy or distension from prior obesity. Such a diastasis of the muscle would require an abdominoplasty (tummy tuck) to flatten the wall. For those patients who have localized fat above the muscle of the abdomen, some may need the upper, some the mid and some the lower abdomen treated. Many patients will benefit by treating the upper and lower areas.
It had been reported in the medical literature that some young children who were given popsicles to pacify them and had the frozen item rest in their oral cavity developed a permanent loss of mid cheek fat. This popsicle necrosis was then thought of years later as a possible beneficial use of freezing. Controlled freezing of the fat, sandwiched between the skin after being sucked into the applicator of the Zeltiq unit, is accomplished via electrochilling plates. There is purposeful tapered cooling so that the periphery is more gently frozen than the center of the mass and in this way there isn’t a sharp cutoff of the zone of fat loss and the normal contour of the surrounding skin. The first 5 to 10 minutes is uncomfortable as the skin feels the suction and cold temperature, but then the sensation becomes numb to it and patients comfortably sit for an hour total per site of treatment, watching TV or a movie on the flat screen, their lap top or IPad,reading a book or Kindle, listening to music, texting, or just chllin’. The last 10 minutes involves a programmed massage of the tissues by the applicator while it remains in place.
Once the applicator is removed, there is a “slab of butter” very cold pocket of skin and fat that sticks up for a few minutes and is very red with possible bruising on and around the area from the suction (a big hickey). There is no true downtime except for the appearance of bruising so one should not do this procedure two weeks before traveling to a vacation that might involve wearing a skimpy bathing suit. There is no prohibition against exercising or travel after the procedure as there is no wound. There may be some focal or generalized soreness or sensitivity or numbness which can resolve. Asymmetry is a possibility especially if one has scoliosis and a pretreatment accentuation of fat on one side or a higher placement on one side than the other.
As there is only a fraction of the fat cells that will die after one treatment, the treatment can be repeated in two months for a few treatments if desired. About 80 % of patients studied obtained 20% reduction in thickness, not circumference of the fat layer seen on ultrasound measurement after four months. One could choose to wait for four to six months, while maintaining a good diet and exercises program and then repeat the treatment if further improvement is desired.