Dr. Lena Fan: CoolSculpting in 2021 – Obsolete or still an essential treatment?
|Dr. Lena Fan
I’ve consulted patients over the past months who were looking for help getting rid of stubborn fat that did not respond well to exercise or dieting. In recent times, there has been some growing resistance with Coolsculpting as a body contouring treatment option:
- Doc, I heard CoolSculpting is really expensive nowadays! Isn’t there a cheaper option?
- I read in an article that lasers are much more effective now, why are you offering me an outdated treatment?
- Doesn’t CoolSculpt have a LOT of bad side effects? I heard of patients who even got fatter post-treatment!
With a myriad of options for non-invasive body contouring available on the market today, many of my patients’ concerns are valid, and it can be tempting to chase the newest trend and latest technology. However, they should never compromise the safety of any treatment you undergo. The safety of body sculpting procedures has been in and out of the spotlight for some time, most recently with a botched liposuction procedure resulting in the unfortunate demise of a young lady in Kuala Lumpur in Oct 2020. I’d like to give an overall picture of where CoolSculpt stands in today’s aesthetic landscape, and why I strongly recommend that CoolSculpt be the front line treatment for stubborn fat. Before this, let’s talk about some of the popular non-invasive fat lipolysis treatment brands on the market – the list isn’t meant to be exhaustive, but here is the low-down on some of the more popular treatments available.
A non-invasive 1060nm diode laser lipolysis treatment that induces programmed fat cell death through heating instead of cooling, with additional skin tightening effects on top of the ability to eliminate stubborn fat pockets. It is FDA approved for treatment over the abdomen, flanks, back, inner thighs, outer thighs and submental area.
A non-invasive radiofrequency lipolysis treatment that removes unwanted fat cells similarly via programmed cell death, that also has skin tightening effects. Vanquish treatments are contactless as panels are used to surround treatment areas, instead of placing applicators onto skin. It is currently FDA approved for circumferential reduction of the abdomen.
Ultraformer III HIFU
A treatment that uses high intensity focused ultrasound waves, where energy is focused at specific depths, and in the case of body contouring, in the subcutaneous layer where fat cells are found. Elevated temperatures above 58 degrees are created in these localised areas which absorb ultrasound energy, leading to fat cell death via a process called coagulative necrosis.
With various modalities of body contouring treatments to choose from, fat freeze treatments have come under attack for being outdated and expensive, and many complain about the long wait time for results to become apparent (up to 3 months). However, in 2021, I still believe CoolSculpt is the premier first line fat lipolysis technology available today. I favour it over other forms of body contouring treatments, and it is my choice treatment to get rid of stubborn fat bulges in areas that do not respond well to a regime of diet and exercise. Here’s why.
First of all, what is CoolSculpt?
CoolSculpt is a fat freezing technology that employs cryolipolysis, a method to freeze and destroy fat cells using controlled cooling. These cells are then naturally excreted and removed from the body over the next 3 months. It has been FDA cleared for treatment of fat bulges in 9 target areas, namely:
- Submental (under the chin)
- Submandibular (under the jawline)
- Abdomen & flanks
- Bra fat
- Below the buttocks
- Upper arms
This isn’t just a throwaway point: There isn’t any other fat freezing, much less fat lipolysis machine on the market, that has FDA approval for these many target areas, especially for larger ones like the back or flanks. CoolSculpt’s unique versatility makes it easy for me to prescribe holistic treatment programmes for my patients. With a newly released emotional attributes consultation guide, patients are better able to consolidate which areas of their body would most benefit from CoolSculpt too.
Above: Allergan’s emotional attributes guide
Above: Allergan’s recommended areas to target for CoolSculpt based on your individual goals
Compared to Coolsculpt, the number of FDA-cleared treatment areas for other brands of fat lipolysis trail behind, which means that for certain individuals with multiple target areas, other brands simply aren’t even an option.
So how does Coolsculpt match up with the rest of the competition?
Much of the criticisms levied against CoolSculpt include its intra-procedural pain, side effect profile, as well as its safety and efficacy. We can address these in turn, while contrasting them with other technologies on the market.
Treatment comfort level
While some patients report some mild discomfort experienced during CoolSculpting treatments, fat freezing at low temperatures is generally more tolerable compared to fat reduction involving heat. Using HIFU as an example, this treatment usually involves a significant amount of heat and discomfort, depending on how intense the settings are. A milder treatment will reduce the level of discomfort, but may, in turn, compromise the end result.
Side effect profile and consistency in effects
When radiofrequency treatments are used for body contouring, there may be a variation in effectiveness from person to person. This is because each individual’s skin impedance is different, which in turn affects treatment depth and intensity, therefore, side effects such as burns may also occur as a result of this. In the same vein, when non-invasive laser treatments are used to sculpt the body, results may not be consistent across individuals, as varying amounts of laser energy is first absorbed by the skin depending if you are fair or dark toned, before reaching the subcutaneous layer of targeted fat cells. As cryolipolysis is not dependent on skin tone or skin impedance, Coolsculpt delivers more consistent results with fewer complications when it comes to body contouring. After a CoolSculpt treatment, there may be localised temporary swelling, numbness and bruising, which usually resolves within 14 days. Often, patients are able to return to work post-procedure, deserving its label as a “lunchtime procedure”
Total number of treatments needed
After a CoolSculpting session, a distinct reduction of up to 27% of total fat can be seen 3 months after treatment, and further improvements seen when a second treatment is done. With radiofrequency treatments such as Vanquish, 4 to 6 treatments are usually recommended for optimal results depending on the amount of subcutaneous fat present, while it takes 2 to 3 sessions of Sculpsure to get a more contoured appearance.
Safety & Patient Satisfaction
CoolSculpt enforces the highest standard of safety on both its equipment and operators, with one-of-a-kind built-in safety technology such as Cool Control and Freeze Detect in its machines, as well as training and regular upgrading provided to clinic staff. Well regarded as a safe modality for fat lipolysis, CoolSculpt’s clinical efficacy have been documented in both human and animal trials, with an impressive patient satisfaction track record – out of 528 patients surveyed from 2010 to 2012, only 6 had a negative experience with CoolSculpting. Upon a second treatment, this number was reduced to 2! (2)
Here’s a table that shows where CoolSculpt stands when compared to other popular body contouring technologies on the market.
As you can tell, by almost any metric, CoolSculpt matches up quite favourably to other treatments currently available. While low level laser therapy and acoustic wave therapy might look favourable in terms of pain and side effect profile, they are relatively new and unresearched technologies for fat lipolysis. Strong and conclusive studies on their consistent efficacy as fat reduction treatments are much harder to come by and I’d be hesitant to recommend them as of yet.
Are other fat lipolysis treatments ineffective?
Absolutely not, and I believe there are body sculpting and fat lipolysis treatments available which have a ton of merit. SculpSure, perhaps CoolSculpt’s biggest rival, is also FDA-approved and boasts an impressive resume that is comparable to CoolSculpt in many aspects. It has skin tightening advantages due to its neocollagenesis effect, and there are flat applicators which can be used in areas with a smaller bulge and lesser pinchable fat. However, when it comes to my patients, I tend to favour patient satisfaction and safety as the biggest priorities as an aesthetic doctor.
Simply put, CoolSculpt has the best safety track record and consistency of any body sculpting technology currently on the market. I think that such statistics should not be viewed in isolation; CoolSculpting treatments have gone through rigorous testing and been involved in multiple peer-reviewed studies over more than a decade. As of last month, more than 8 million treatments have already been successfully done worldwide!
It could be that other body sculpting technologies seem equally or more effective than CoolSculpt, but I wouldn’t buy into the hype just yet. Until more studies and patient experience surveys are published, I will still prescribe CoolSculpt in 2021 as my choice option for targeting stubborn pockets of fat.
Do you have a question for me?
Nils Krueger, Sophia V Mai, Stefanie Luebberding, and Neil S Sadick. Cryolipolysis for noninvasive body contouring: clinical efficacy and patient satisfaction. Clin Cosmet Investig Dermatol. 2014; 7: 201–205.
W Grant Stevens, Laura K Pietrzak, Michelle A Spring. Broad overview of a clinical and commercial experience with CoolSculpting. Aesthet Surg J. 2013 Aug 1;33(6):835-46.
Jason C. McBean, MD, Bruce E. Katz, MD. Laser Lipolysis: An Update. J Clin Aesthet Dermatol. 2011 Jul; 4(7): 25–34.