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Cool Sculpting: What it Is and What It’s Not

cool-sculptingRecent media attention (at least in Canada) has focussed on a procedure called cool sculpting (or cryolipolysis) that promises weight loss and fat removal. This prompted me to request one of my colleagues (Cindy Grand, PT) to look into the literature to see what all the fuss is about.

The following is a brief summary of what Cindy found out based on the published literature on this technique (citation list available on request).

Here is how it works: A proprietary coupling gel is applied to the skin and the fat deposit (e.g. “love handle” or “muffin top”) tissue is suctioned up with a vacuum that positions it between two cooling panels. It is then held there and cooled for a 30-60 minute exposure that apparently results in a cold-induced inflammatory response leading to the localised death of fat cells in the underlying tissue. Over the days and weeks that follow, the dead fat cells are absorbed by the healing process resulting in an about 20% reduction in skin fat in the treated area. There is some evidence showing that this “removal” may well last up to two years.

Here is what it is: A largely cosmetic technique that can remove (or reduce) discrete localised fat pockets (such as “love handles”). The treatment is apparently best suited for individual with normal weight, who have “troublesome” fat bulges or deposits.

Here is what it is not: It is most definitely not a treatment for obesity or even a reasonable technique for weight loss. The few studies that have looked at this, find no health benefits of cool sculpting (in terms of metabolic improvements) – nor would you expect a treatment that simply removes skin fat to have any such effect.

Cryolipolysis is approved by the US-FDA and Health Canada for the localised removal of fat and, as such, is generally deemed as safe. Common adverse effects include (mostly transient) pain, bruising, sensation changes and edema. Contraindications include but are not limited to: cold-sensitive disorders, including Raynaud’s phenomenon, cold urticaria, cryoglobulinemia, and paroxysmal nocturnal hemoglobinuria, and those with neurologic disease.

While I can perhaps see the value of such a non-invasive procedure for dealing with cosmetically “relevant” circumscribed fat deposits, the notion that such a procedure can be a meaningful part of managing overweight or obesity appears rather doubtful.

To their credit, this is not what the researchers who have worked on this have ever claimed.

As for how this procedure is sometimes advertised and marketed – well, that’s another story.

If you or someone you know has experience with this “treatment”, I’d love to hear about it.


Hat tip to Cindy for gathering and summarizing the literature on this.


  1. I have wondered for some time: do any of the procedures that cause fat cell necrosis result in a short term large increase in lipids being transported in the blood during healing? That is just an academic question that bugs me but I have not found the answer.

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  2. I would be concerned that, similar to liposuction, that weight gain down the road could be weight gain of the more harmful visceral (around the organs) variety, as this procedure destroys some of the subcutaneous (under the skin) fat cell stores.

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  3. Having experienced cold urticaria (not from this procedure!), I wouldn’t wish this side effect on anyone.

    I knew a very healthy and fit woman with a “great” body (yes, I know, please accept apologies for this stereotypical short-cut way to describe someone’s shape) but very big saddle bags. It definitely was disproportionational. She was getting liposuction and that was the very first time I understood why someone would want it done so badly that they would accept any risks. If this procedure is safer than liposuction than more power to those that it will really really help them to feel better about themselves. Putting aside weight prejudice issues, we have cosmetic issues for much pettier things. To take the risk of this procedure for minor cosmetic benefits I suppose helps support the Darwin theory.

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  4. My significant other had this procedure done recently. The second “installment” occurred April 18 & 19th nearly four weeks ago. He is suffering with pain, bloody diarrhea and abdominal complaints of “fullness” I am worried about him at this point. He is toughing it out because that is his nature. He is a 65yr old body builder weighing about 205 lbs and has been in good health…What is going on? Is this the way the body is shedding the fat? Any ideas?

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  5. Dear Dr. Sharma,
    I’m interested in the coolsculpting literature citation list gathered by your colleague Cindy Grand.
    May you e-mail it to me.
    Ana Moura

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