What is CoolSculpting?

CoolSculpting is a nonsurgical body contouring treatment that uses cryolipolysis (the medical term for fat freezing) to target and reduce stubborn areas of fat that have resisted diet and exercise.

First cleared by the FDA in 2010, this fat reduction procedure has become so popular because it freezes and destroys fat cells without harming the surrounding tissues, so it carries a low risk of serious side effects and comes with no downtime.

Over several weeks following the treatment, the body naturally metabolizes and permanently eliminates the fat cells.

CoolSculpting is FDA-cleared for treating stubborn pockets of fat on several areas of the body, including:

the abdomen

the flanks (aka love handles)

double Chin

bra and back fat

the inner and outer thighs

the upper arms

buttock rolls (also called banana rolls)

It's also FDA cleared to treat submental fat (commonly known as a double chin) and submandibular fat (under the jawline) with a smaller applicator called the CoolMini.

Providers commonly use CoolSculpting off-label (beyond its FDA approval) to tone knees, hips, and other stubborn fat bulges, like the mons pubis.

What are the pros and cons of CoolSculpting?

Pros

Reducing excess fat can be a strong motivator to kick-start a more active, healthy lifestyle.

This noninvasive fat reduction procedure has fewer risks than surgical procedures like liposuction, which requires anesthesia and incisions.

Most patients don’t need any downtime, making it much more convenient for busy people than surgical fat removal.

The results of CoolSculpting are “Worth It,” according to 74% of patients who reviewed the treatment on RealSelf. Happy patients often cite a significant improvement and natural results.

Because the injured fat cells are fully eliminated, the body sculpting results from this treatment can be permanent (as long as you maintain a stable weight).

Cons

It's not a one-time treatment: Most people need at least two and often three or more treatments (several weeks apart) for optimal results.

While the average cost is less than half of what most people pay for liposuction, CoolSculpting can still get expensive.

As with other nonsurgical body contouring treatments, you’ll have to be patient to see results: it can take two to three months for the body to process and eliminate the fat cells.

Typically, fat reduction results from this and other nonsurgical options aren’t as dramatic as what you’d get from lipo.

RealSelf members who rated the procedure “Not Worth It” didn’t see much of a difference or had side effects like soreness, hyperpigmentation, and lingering numbness and nerve pain.

Others were surprised by sagging skin after losing underlying fat deposits. Older patients with less skin elasticity may need to combine fat reduction with a dedicated skin tightening treatment.

There’s a small risk of developing paradoxical adipose hyperplasia (PAH), an increase in hardened fat at the treatment site.

How much does CoolSculpting cost?

Average Cost:

$2,711

Range:

$750 - $6,600

Your cost will depend on the details of your treatment plan, your provider’s credentials, their location, and a few other key factors. Most providers accept financing options like CareCredit.

Who is a good candidate for CoolSculpting?

Ideal candidates for CoolSculpting are healthy adults within 20 pounds of their ideal weight, with good skin elasticity (so it can bounce back once the fat is removed) and a body mass index (BMI) of 30 or less. Another requirement is having at least ⅔ of an inch of pinchable fat, to fit into the CoolSculpting applicator.

“The best candidate is one that is already fit with small problem areas that are resistant to diet and exercise,” explains Dr. Emer. “The bigger someone is, the more treatments needed to see an outcome, and the less substantial the results will be.”

Women who are pregnant or breastfeeding, or people with poor circulation, neuropathy, a pacemaker, or a defibrillator should avoid CoolSculpting treatment. You should also avoid this treatment if you’ve been diagnosed with cryoglobulinemia, paroxysmal cold hemoglobinuria, or cold agglutinin disease.

If you have open or infected cuts or wounds, eczema, dermatitis, or a rash in the treatment area, you won’t be able to have this treatment until those conditions are resolved.

What happens during a CoolSculpting procedure?

CoolSculpting takes 35 to 60 minutes, depending on the size and number of areas being treated. Some doctors offer “DualSculpting” or CoolSculpting Elite, to target multiple treatment areas simultaneously and reduce treatment time.

Here’s what to expect.

First, you’ll lie down, and your provider will map out the specific areas you want to target with a pen.

They’ll lay a protective gel pad over your skin before applying an applicator to the treatment area. Some applicators have a vacuum that sucks in skin and fat, while others simply apply pulses of pressure.

You’ll feel the applicator lower your tissue temperature to -10ºC. This extreme cold can feel uncomfortable until your tissue goes numb.

When your treatment time is complete, your provider will remove the applicator and massage the frozen fat (which some doctors call a “butterstick” because it looks so much like a frozen lump of butter) to smooth out the area and kick-start the elimination of injured fat cells.

Does CoolSculpting work?

Clinical evidence shows that CoolSculpting does work to reduce fat:

An independent study published in Plastic and Reconstructive Surgery showed that CoolSculpting reduces fat cell volume in the treated area by between 14.7% and 28.5%.

Clinical trials funded by the device manufacturer showed similar results, with a 20–25% reduction in fat-layer thickness after a single treatment. Treatments on the inner thighs have the highest patient satisfaction levels, while abdominal-area results get lower marks.

“Coolsculpting works, and impressively so,” says Dr. Cameron Chesnut, a dermatological surgeon in Spokane, Washington. “Like many things, it is all about patient selection and expectations.”

Does CoolSculpting hurt?

The intense cold and pressure during the first few minutes of a CoolSculpting treatment can be uncomfortable and even painful for some people. The device's manufacturer says that “you may experience sensations of pulling, tugging, mild pinching, intense cold, tingling, stinging, aching, and cramping at the treatment site.”

As the area becomes numb, these symptoms should subside. Some RealSelf members say they felt comfortable enough during their treatment to read, watch TV, or nap.

Applicator updates in recent years have made the treatment more comfortable and effective. “The original applicators required significant suction to get each bulge of fat positioned between two cold panels,” explains Dr. Heidi Waldorf, a dermatologist in Nanuet, New York.

Is CoolSculpting safe?

CoolSculpting is FDA cleared and widely considered to be a safe cosmetic treatment option for good candidates.

What are the dangers of CoolSculpting?

CoolSculpting side effects are usually mild and resolve on their own, but you and your provider should still discuss them prior to your treatment.

Patients can experience redness, swelling, tenderness, blanching, bruising, firmness, tingling, or cramping in the treatment area for a few days to several weeks afterwards.

Some reviewers on RealSelf say they developed nerve pain in the treated area about five days post-procedure. If you have any pain that lasts more than a few days and feels too intense for over-the-counter pain medication, talk to your provider.

After CoolMini treatment for a double chin, some patients have reported a feeling of fullness in the back of the throat for one to two weeks.

It’s also possible to experience “tongue deviation,” lower lip weakness, or dry mouth for a few days or weeks after treatment under the chin or jawline.

There has been at least one report of serious burns (frostbite) as a direct result of CoolSculpting.

It’s not advised to have this cosmetic procedure while you’re pregnant or nursing, but it won’t affect your future fertility or damage any abdominal tissue or organs.

Contour irregularities or asymmetry can be a problem. “CoolSculpting can sometimes create a depression or area of uneven fat loss in the shape of the paddle,” says New York City–based plastic surgeon Dr. Lara Devgan. This undesirable result can be treated with Kybella injections (to dissolve fat) or fat transfer from other areas, to fill in the indentation. Dr. Emer treats indentations andirregularities with Renuva, “a synthetic matrix that helps to regenerate your own fat in the indented area.”

CoolSculpting also carries a risk of paradoxical adipose hyperplasia (PAH), an increase in fatty tissue at the treatment site. PAH happens when fat cells expand in reaction to extreme cold.

In reported cases, PAH occurred two to five months post-procedure, after an initial fat reduction.

The manufacturer says PAH has been estimated to occur in 1 out of every 3,000 treatment cycles (an incidence of 0.033%). However, a study reported in the 2018 issue of Plastic and Reconstructive Surgery suggests that it might have an incidence as high as 0.72%, or 1 out of every 138 cryolipolysis treatments.

“I’ve never seen it, but I do discuss it as part of informed consent,” says Dr. Waldorf, and your doctor should too.

Dr. Klein agrees that it’s extremely rare. “We have four CoolSculpting devices and have been using [the technology] for over 15 years. We’ve done thousands of cycles and I have seen only one case of PAH.”

Based on what he’s seen, Dr. Emer believes PAH is more of a risk when applicators have been used in areas that don’t align with their FDA clearance.

The excess fat from PAH can be treated with liposuction, and Allergan will cover at least a portion of the cost of liposuction to treat confirmed cases of PAH.

Patients have to wait several months for the fat to soften, to reduce the risk of recurrence. Some patients even need two rounds of liposuction, as well as additional procedures, potentially at their own expense.

What is CoolSculpting recovery like?

Most people don’t need actual downtime after a fat freezing treatment, but there's still a recovery process that varies in intensity, depending on how your body responds and how many areas you’ve had treated.

Here’s what you can expect.

You should be able to carry on with your normal activities, but you may feel sore or notice swelling in the treatment area.

Take it easy for the first 24 hours, avoiding any vigorous exercise or heavy lifting (which could make swelling worse).

Some providers recommend wearing Spanx or a compression garment for the first few days, to help ease swelling and discomfort, while others recommend wearing loose clothing. Ask yours what they recommend.

After about five days, you’ll probably feel nerve twinges in the treatment area. Sometimes described as stinging, cramping, or tingling, this is a normal sensation as damaged nerves regenerate. If it lasts longer than a few days or feels intensely painful, reach out to your provider for their recommendations on pain medication.

One to two weeks post-procedure, it’s common for the treated area to feel itchy. This is a histamine reaction to the inflammatory process of clearing fat cells, and it can be treated with oral antihistamines.

Numbness in the treated area typically resolves within three weeks, as the nerves come back online.

How long does the swelling last?

CoolSculpting swelling takes about two weeks to resolve, though it can linger for up to a month for some patients, according to Dr. Adam Hamawy, a plastic surgeon in Princeton, New Jersey. “I have seen patients who experience very minimal swelling for just a few days and others who feel swollen for up to four weeks. For the majority of CoolSculpting patients though, swelling has almost entirely dissipated within two weeks.”

You can minimize swelling by wearing a compression garment, drinking lots of water, and exercising.

How soon can you schedule a second treatment?

“Doing a second treatment within 30 to 60 days can enhance your treatment results,” according to Dr. Lori Brightman, a dermatologic surgeon in New York City.

How long does it take to see CoolSculpting results?

You should start to see some results about 30 days post-procedure, with more significant results visible within two to three months of your final treatment.

Even after that, you may continue to see some improvement. “Your body will continue to eliminate the treated fat cells for up to six months post-treatment,” according to Mississauga, Ontario, plastic surgeon Dr. Frank Lista.

Why does the process take so long? “Unlike liposuction, where the fat is removed, CoolSculpting releases the fat to be metabolized and eliminated by your body,” explains Dr. Andrew Lyos, a plastic surgeon in Houston. The rate at which the fat is naturally eliminated depends on your own biological processes.

As we’ve mentioned, you may need two or more treatments to see the results you want.

How long does CoolSculpting last?

CoolSculpting results can be permanent, as long as you don’t gain weight afterward. The fat cells eliminated after the treatment are permanently gone, but any remaining cells can still expand. Weight gain can even lead to contour irregularities, if more numerous fat cells in surrounding areas expand.

A healthy diet and regular exercise will help you make the most of your investment.

CoolSculpting vs. Emsculpt: What's the difference?

Emsculpt Neo is a body contouring procedure that uses high-intensity focused electromagnetic (HIFEM) technology to induce nearly 24,000 muscle contractions in one 30-minute session. Like CoolSculpting, it reduces fat, but it also offers muscle toning.

We dug into the difference between CoolSculpting and Emsculpt and found out that the two procedures can provide even better results when used together.