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As of the year 2012, it was approximated that over 10 million cosmetic procedures were performed in the USA alone, grossing over 11 billion dollars.

Specifically, the number of cosmetic surgical procedures has declined, while the number of minimally invasive procedures has increased by over 100%. Often deemed ‘lunchtime procedures‘ these modalities allow patients to return to normal activity almost immediately after they undergo the treatments, with down times of less than two hours.

Today, both men and women search for affordable, fast and safe ways to maintain their youthful appearance and improve their looks. These procedures are designed to treat the face and the body, whether lifting, tightening or sculpting.

Liposuction used to be the go-to procedure for body contouring but has only recently been matched by noninvasive techniques that don’t require general anesthesia, incisions or hospital stays. Even though the noninvasive procedures may not produce as dramatic a result as liposuction, the convenience is difficult to overlook.

Among the noninvasive techniques that have recently been introduced to the market is Cryoplipolysis, which is based on the theory that fat cells are more vulnerable to cold temperatures than other skin cells, This procedure has been available commercially for the longest period of all the other modalities. The use of cold temperatures to target specific areas of fat cell accumulation has been proven to kill fat cells. This in turn causes the body to have an inflammatory response, eventually digesting the dead cells via the surrounding white blood cells or macrophage.


Clinical studies reflected a 25% reduction of subcutaneous fat at the treatment areas. Noticeable improvements were seen in 86% of treated patients and there was a soaring 73% satisfaction rate, the highest of all other noninvasive methods of liposis.

Needless to say, Cryolipolysis is a safe and nearly painless procedure for body sculpting. Although no method is perfect, Cryolipolysis has the most positive results for doctors and patients with minimal side effects and above satisfactory results.

What is CoolSculpting?

CoolSculpting or Cryolipolysis is a non-surgical treatment for elimination of fat cells often named as an alternative to liposuction.

The procedure utilizes controlled cooling to around 4 degrees Celsius to freeze stubborn fat deposits and sculpt problem areas into a more pleasing shape. The cooling process is designed to cause the death of subcutaneous fat tissue without doing damage to the overlying skin.

Cleared by the FDA in 2010, CoolSculpting is used to reduce flank and abdominal fat. Later, in 2014, the FDA also cleared the CoolSculpting system to treat subcutaneous fat in the thighs.

The device has a cup-shaped applicator with two cooling panels that are placed on the area being treated. A vacuum then pulls the fat tissue into the hand piece, which is modulated by thermo-electrics and controlled by temperature sensors. Areas are treated for approximately 45 minutes and then massaged by a technician for 2 minutes post procedure. The patient can resume normal activities immediately after a CoolSculpting treatment. Each case varies but some patients may be asked to undergo additional treatments to an area for optimal results. The flanks are generally treated with just one session, but multiple treatments may produce the best results for the back, inner and outer thighs. Each treatment requires a waiting period before additional treatments can be performed in order to allow the inflammatory process to heal.

Two Harvard University Doctors, Dieter Manstein and R. Rox Anderson are credited with observing the effects of cold on fat cells that eventually lead to the development of the Cryolipolysis technique. They observed children eating popsicles and noticed that this caused dimples in certain children. This lead to the theory that cold can affect and eliminate fat cells without causing harm to the skin or other tissues. This is the science behind Cryolopolysis and the concept upon which the CoolSculpting process is based.

Candidates for CoolSculpting

Cryoliposis is safe for all skin types and can be repeated depending on the amount of subcutaneous fat in the area being treated. Candidates for this procedure should be within their ideal weight range, exercise regularly and maintain a healthy diet. They should have noticeable fat pockets that have not been eliminated by way of diet and exercise. These patients should have realistic expectations about the outcome of CoolSculpting and be willing to exercise and eat healthy to maintain their results.

Side Effects

Side effects that occur from this treatment are rare and are not permanent. Redness, bruising and numbness of the skin are common but subside within one month of treatment. Numbness was investigated and proven not to be permanent. Any sensory loss subsided after only a few days. A .1% prevalence of late-onset pain was reported, occurring two weeks after the procedure, but this pain was also temporary. No side effects were encountered during a follow-up time of six months.

How it works

How CoolSculpting Works

Popsicle panniculitis is a condition proving that subcutaneous fat cells are severely damaged when exposed to low or freezing temperatures, but the skin is not.

In order to avoid the effects of frostbite, a specific temperature level is determined and exposure is kept at a safe rate.

As mentioned above, Physicians Dieter Manstein and R. Rox Anderson at The Wellman Center at Massachusetts General Hospital originated the idea, tested it in numerous cases on pigs, and reported their findings in 2008.

Normally, when the human body is exposed to high levels of cold, its response is to cut circulation and maintain a correct core temperature. Cryoliposis utilizes a powerful vacuum, which increases the body’s inflammatory response by drawing blood to the upper layers of the skin. During the treatment, 20-25% of fat cells in the area are crystalized, destroying them entirely and causing them to be eliminated through the lymphatic system.


During the procedure, a vacuum applicator is placed on the skin to bring it into contact with cooling panels. Patients feel a cold sensation for a few minutes, as it produces an anesthetic effect. The fat is cooled for up to an hour and then massaged following treatment.

Alternative Techniques

High Intensity Focused Ultrasound

This approach utilizes an intense, focused ultrasound to administer focused acoustic energy at specific depths within the subcutaneous tissue and has been cleared by the FDA. The mechanics and thermal mechanism disrupt the cell membranes and cause coagulative necrosis (accidental cell death) in the small, targeted fat deposits, leaving the surrounding tissue mostly unharmed. In essence, the ultrasound creates tears in the fat cells, which are expelled and gradually eliminated by the body. Studies showed reductions of up to 2 cm in waist size over a 12week period after only one treatment.

Unipolar Radio Frequency

Radiofrequency devices have primarily been utilized for the tightening of loose skin as the thermal damage to cells causes a contraction of collagen. This all changed after a clinical study conducted by Franco Etal, which showed that the radio frequencies could be used to heat and destroy targeted areas of subcutaneous fat. Thermal exposures at 43 degrees to 45 degrees Celsius over several minutes caused a breakdown and eventual death of fat cells. After this procedure, a decrease of fat volume is generally seen 3-8 weeks after treatment.

Low Level Laser Therapy

This therapy is unique in that it does not rely on thermal tissue damage like the above-mentioned procedures. Its effectiveness is still under investigation but one of the principals is based on the concept whereby transient pores are produced within the subcutaneous fat cells, letting lipids leak out.

Acoustic Wave Therapy

Another noninvasive fat reduction technique is acoustic wave therapy. This process involves the application of short pulsed waves, which are thought to stimulate new collagen growth, encourage the development of new blood cells around the fat cells and activate lipases, an enzyme that breaks down fat. The results of this procedure are a skin tightening and a reduced appearance of cellulite.

Consult with Dr. Silvia Rotemberg

Dr. Silvia Rotemberg is a leading plastic surgeon operating in the city of Miami. Her technique incorporates the latest surgical advancements, combined with a vast knowledge of the foundations of plastic surgery. Whether you find yourself a candidate for CoolSculpting or other cosmetic techniques, Dr. Silvia Rotemberg will provide a comprehensive evaluation of your goals and develop a unique treatment approach. The end result will be a more confident and youthful version of you. To schedule a consult or for additional information on CoolSculpting, call us or fill out this online form.