Coolsculpting, Is It For You?

Natalie Proviano
Independent Research GT
June 3rd 2016
Advisor: Dr. Guy Cappuccino
Instructor: E. Leila Chawkat

Proviano 2
Abstract
This research paper discusses the efficacy, procedural process, recovery period and early
development of Coolsculpting. It defines a noninvasive cosmetic plastic surgery procedure in
which fat reduction is broken down to the cellular level and compared to the well-known, world
renowned Liposuction procedure. The purpose of this was research was to explore patients
results and opinions after full recovery of these procedures. Multiple interviews were conducted
in order to meet the requirements of complete patient analysis. In conclusion, it was found that
100% of the candidates that received treatment in their flanks and stomach, were pleased with
their results whereas 0% of the candidates that received treatment in their inner-thighs were
pleased with their results. Therefore, the choice of treatment depends on patient preference. Both
procedures are recommended only for healthy men and women who do not have obesity issues
but only localized areas of deposited fat that have not been reduced with healthy diet and
exercise.

Proviano 3

Introduction
At the beginning of this course, the original question proposed was, after accepting
liposuction as the primary form of fat removal for the past 40 years, what does coolsculpting
offer? And what are the primary differences between the two? After progressing further and
answering that question, the new focus is solely on the product of Coolsculpting. This new focal
point will be not only the treatment and collecting more knowledge, but to also identify how this
procedure works on a cellular level. If more people were educated on the different methods to fat
removal, such as the newest revolution in cosmetic plastic surgery, Coolsculpting, rates in
procedures could increase. Coolsculpting provides the opportunity to remove fat, but not
requiring the patient to undergo surgery, use of anesthetic, or any downtime. That being said,
candidates are permitted based on the structure of their fat.

Review of Literature
Liposuction has been ranked third on the list of most frequently performed surgical
procedures in the plastics field in 2014 and 2015 (American Society of Plastic Surgeons).
Whereas the procedure of Coolsculpting, under the category of minimally invasive
treatments/procedures, does not rank at all. This is due to a multitude of different factors. The
most pressing being the general publics lack of knowledge on this rather new opportunity at fat
reduction. Coolsculpting has been around since 2012 but for many people, it's been determined
that they have heard of this product through radio advertising, but have not expanded their

Proviano 4
knowledge any further. This is unfortunate due to the fact that Coolsculpting does in fact have
the same effects as Liposuction, meaning its main purpose of removing fat, but does also offer
different opportunities.
Coolsculpting is a non-invasive procedure in which excess fat in smaller portions are
removed through freezing the fat cells in the adipose layer. The excess fat will then diminish. It is
non-invasive and will not require surgery. This approach to fat removal cannot be applied to
obese people. It is strictly used on stubborn fat that cannot be removed by dieting or exercise
(Krueger). Fat freezes at 40 degrees Fahrenheit whereas water freezes at 32 degrees Fahrenheit.
This is the key to this treatment; if you apply 40 degrees Fahrenheit to fat cells, they crystallize
and kill themselves off. This procedure takes place in increments of 45-60 minutes in which the
area of interest is found and put into this clamp that can almost double as a vacuum. It pulls the
layer of skin away from the Adipose tissue in order to get more direct contact (Cappuccino).
If more people were educated on the different methods to fat removal, such as the newest
revolution in cosmetic plastic surgery, Coolsculpting, rates in procedures could increase. This
being due to the fact that Coolsculpting provides the opportunity to remove fat, but not requiring
the patient to undergo surgery, use of anesthetic, or any downtime. That being said, candidates
are permitted based on the structure of their fat.
Liposuction is the only basis that researchers and surgeons have to refer to in their studies
of fat removal being that it was the primary approach before the creation of Coolsculpting.
Liposuction was initially developed in the late seventies in Italy and France. At that time,

Proviano 5
liposuction was performed under general anesthesia without any introduction of fluid (Klein).
Following this, a new method was created, called the wet technique but this caused large
amounts of blood loss and it became necessary for many of the patients to undergo blood
transfusions post procedure. Liposuction was revolutionized by Dr. Jeffrey A. Klein, a
dermatologist in California, who created the tumescent technique. This technique is Liposuction
using local anesthesia and minimal surgical blood loss by use of injecting a liquid anesthetic and
then removing the fat post injection.
The tumescent technique has changed the face of fat removal. Tumescent liposuction is
the only technique that permits liposuction to be accomplished totally by local anesthesia. It is
the only technique that virtually eliminates both the need for general anesthesia and surgical
blood loss as a routine problem of liposuction. It becomes the first step in revolutionizing the
first known fat removal procedure.
Fat is in the Adipose Tissue of the body; Weight gained is caused by the creation and
expansion of white fat cells, or adipose tissue. Dieting can shrink fat cells but not eliminate
them (Hathaway). This is where all fat removal techniques are applied. After cells from this area
are removed, they will not be produced again unless malnourished. If malnourishment became a
concern to the body, it would begin to turn cells over into sustenance within the body. In a
specific case of the bodys need to turn cells over into substance, the production of cells is
necessary for the health of a person; Lying three layers deep under the skin, the adipose tissue is

Proviano 6
composed of a loose collection of specialized cells, called adipocytes, embedded in a mesh of
collagen fibers. Its main role in the body is functioning as a fuel tank for the storage of lipids
and triglycerides (Blamire). The purpose of the cells are what makes them vital to the human
body.
Cryolipolysis is the combination of latin roots with the meaning the destruction of fat
cells with cold temperature (UT Southwestern). The development behind cryolipolysis stems
from the clinical observation of cold-induced panniculitis, inflammation of the subcutaneous fat
especially on the abdominal wall. This clinical observation took place in 1970; Epstein and
Oren coined the term popsicle panniculitis after reporting the presence of a red indurated nodule
followed by transient fat necrosis in the cheek of an infant who had been sucking on a popsicle
(Ingargiola et al.). The medical breakthrough that was then later discovered was that lipid-rich
tissues are more susceptible to cold injury than water-rich tissues. This is due to the fact that
water freezes at 32 degrees whereas fat freezes at 40 degrees. Your body is made up of 70%
water, therefore applying temperatures of 32 degrees or below can cause very serious damage,
but doing the same thing at 40 degrees will not.
The process of Coolsculpting begins when the applicator is applied to the area of interest
for 45-60 minutes. It acts as a double vacuum, separating the skin and adipose tissue by suction
(Aesthetic Surgery Journal). After the time interval, the double vacuum is then removed and the
procedure is complete. The recovery period has been documented in intervals of one month

Proviano 7
periods in which fat volumes become more apparently decreased; At 1430 days after
treatment, macrophages and other phagocytes surround, envelop, and digest the lipid cells as part
of the bodys natural response to injury (Krueger et al.). Post procedure at a four week follow
up, inflammation is no longer apparent and fat volume has in fact decreased, but it's not
necessarily apparent to the human eye. It does though become apparent in the last interval, Two
to three months after treatment, the interlobular septa are distinctly thickened and the
inflammatory process further decreases (Krueger et al.). By this time, volume of fat in this area
is very apparently decreased.
The most appealing aspect to Coolsculpting is the fact that it is non-surgical and requires
no downtime period afterwards. Not only that but based on statistics, its efficacy rate is
extremely high and leaves many patients more than satisfied with their results, Investigators
reported that 86% of 518 subjects showed improvement. The body sites at which cryolipolysis
was most effective were the abdomen, back, and flank. Patients completed a satisfaction
questionnaire, with 73% reporting being satisfied and 82% being prepared to recommend
cryolipolysis to a friend (Krueger et al.).
Coolsculpting has been on the fast track to taking over the fat reduction sector of
cosmetic plastic surgery. On average, Plastic Surgeons are seeing a decrease of Liposuction at
rates of fifty percent due to the increase of Coolsculpting (Cappuccino). Due to the fact that this
procedure is highly convenient. Each treatment requires 45-60 minutes, and following that, there

Proviano 8
is no required downtime. This allows patients to continue their daily schedules without any
inconvenience. Rather than physically removing the fat cells from the body, Coolsculpting relies
on cryolipolysis. After the cold temperatures are applied, the cells crystalize and kill themselves,
never returning (American Society for Dermatologic Surgery). This does require the patient to
keep up a healthy diet, and exercise along with the fact that it is only plausible in situations
where desired fat to be removed is in small portions. If more people were informed of this
procedure and what it does, its believed that more people would finally go through with fat
reduction. The pamphlet that will be created with this information will include diagrams of fat
cells, a list of their function and purpose, background information on Coolsculpting, a summary
of the procedures process, and it will be concluded with transcribed interviews with patients that
have participated in it.

Research Methods and Data Collection

The most appropriate and effective method to gather data for this research topic was a
collection of interviews. Interviews allowed patients who have actually undergone Coolsculpting
to share information about recovery and their overall thoughts about their experience once they
saw their results. Months have been spent researching and learning from scientists who have
studied Coolsculpting as well as surgeons who have performed it. The last thing needed for the
public who will be reading my final product was the opinions of people just like them that had
made the choice to get the treatment done.

Proviano 9
If I were to collect data again for this project, interviews would still be the method of
choice, but next time it would be more beneficial to delve deeper into the recovery process after
receiving Coolsculpting. This is a crucial part of the information that must be included in the
product because recovery is one of the two largest differences between Liposuction and this
alternative method of freezing the fat cells away rather than surgically removing them. As well as
an added analysis of why patients may have chosen specific areas of the body as this is often
times the most uncomfortable aspect of their decision process to have a cosmetic procedure.
Therefore, a direct approach might not be best in this situation. The advisor in which I worked
with, Dr. Cappuccino, only had a limited amount of patients in which he rendered this treatment
method. It may have been better to include other patients from other practices to obtain a broader
perspective by having an increased number of patient surveys to analyze their data.

Results and Data Analysis

Participant 1 underwent Coolsculpting several times (10/31/2013, 5/8/2014, 5/15/2014,
12/10/2015, 2/1/2016). The area of treatment was the flanks, stomach, and axillary fat.
Differences in the flanks and stomach were observable, but changes in the stomach were only
noticed by the use of pictures at the end of the process. This person was very pleased will all
results and recommended the treatment due to the fact that it is non-invasive, doesnt require
surgery, and consists of no necessary downtime. Participant 2 revealed that she had the procedure
done just a week prior to the interview on 4/1/2016. This allows us to observe a very recent
procedure and get a different perspective on post-procedure pain as well as very minimal
differences in the area of treatment. After a week, the participant says that there was very
minimal swelling that has since subsided. This person feels very strongly in their

Proviano 10
recommendation to others, because of simply the science behind the procedure. As well as the
fact that it is low risk. Participant 3 received treatment in October of 2014 and was extremely
impressed with the results. The area targeted was the flanks, mostly upper and around the hips.
After measuring the area of treatment everyday and documenting the length around this area of
the body, they began to notice substantial changes a month later (Fultz). Overall, two inches of
excess fat on each side of the body had diminished. There was one candidate (Participant 4) that
was not impressed with one of their areas. The participant had treatment on the flanks and thighs
last year in late October (thighs) and early November (flanks). The difference in the flanks was
noticed within the first 6 weeks whereas there were no differences seen in the thighs (Swales).
The participant was overall unimpressed because it was costly and time consuming as well as
there was mild discomfort that lasted a few weeks. Participant 5 had their treatment done on their
flanks as well. They had worked for years to lose weight in this area, but after consistent dieting
and exercising, they made the decision to get Coolsculpting. They were a perfect candidate due
to their healthy lifestyle. After a month they began to notice very substantial differences. A year
after the procedure has taken place, a four pound difference has been noticed in the patients
weight, and pictures have uncovered that these differences were in the specified area.
The interviews showed that 100% of the candidates that received treatment in their flanks
and stomach, were pleased with their results whereas 0% of the candidates that received
treatment in their inner-thighs were pleased with their results. As well as the fact that 100% of
the candidates interviewed were women between the ages of 30 and 60. Data collected gave
practical evidence that fat reduction procedures vary not only from patient to patient, but also
body area to body area.

Proviano 11
Of the five candidates interviewed, all five received the treatment on the area of their
flank. Interestingly enough, only one candidate had the treatment on their stomach and innerthighs. Further studies could include a social analysis as to why the flank area is more popular
during this time in history. Inclusive in these further studies could compare fat cell differences in
different body areas to cause varied success rates. In a call to action, there should be an effort to
increase patient awareness of the varied treatment success rates in different body areas.
Psychological considerations that are seen with the physical body changes should be taken into
consideration.

Discussion and Conclusion

American Culture puts great emphasis on a perfect body achieved with minimal effort in
minimal time. Both Liposuction and Coolsculpting are plastic surgery procedures performed to
remove unwanted fat cells in isolated areas. Liposuction often requires general anesthesia or
other anesthesia method for patients comfort and anxiety reduction. Liposuction is performed
through small incisions in the skin after local anesthesia is infused to reduce bleeding in the area.
Then a thin cannula is inserted in the skin opening to loosen excess, unwanted fat using a raking
type motion. The dislodged fat is then suctioned out of the body using as small surgical vacuum.
Before an improved body contour becomes apparent, selling and fluid retention post-operatively
must subside.
Coolsculpting targets and eliminates unwanted fat cells in a non-intrusive manner. The
procedure is performed without any type of anesthesia thus reducing its procedures risks. The
Coolsculpting apparatus is applied to the fat tissue with the objective of destroying the fat by
lipolysis. The fat cells are cooled to 40 degrees fahrenheit causing the fat cells to crystallize and

Proviano 12
be eliminated permanently. Optimum results are seen 2-4 weeks after treatment. Side effects of
Coolsculpting are minimal other than bruising. Patients sometimes must have certain areas
treated more than once.
The choice of treatment depends on patient preference. Both procedures are
recommended only for healthy men and women who do not have obesity issues but only
localized areas of deposited fat that have not been reduced with healthy diet and exercise.

Works Cited
ASDS American Society for Dermatologic Surgery." Cryolipolysis. American Society for
Dermatologic Surgery, 2016. Web. 12 May 2016.

"BIOdotEDU." BIOdotEDU. N.p., n.d. Web. 13 Mar. 2016.

Broad Overview of a Clinical and Commercial Experience With CoolSculpting | Aesthetic

Surgery Journal." Broad Overview of a Clinical and Commercial Experience With
CoolSculpting | Aesthetic Surgery Journal. Ed. Nahai Foad. Oxford University Press, 1
Aug. 2013. Web. 12 May 2016.

Cappuccino, Dr. Guy. "Coolsculpting vs. Liposuction." Personal interview. 1 Jan. 2016.

CoolSculpting: Nonsurgical Body-Contouring Treatment." Plastic Surgery. UT Southwestern

Medical Center, 2016. Web. 12 May 2016

Fultz, Marissa. "Coolsculpting Analysis." Phone Interview. 1 Apr. 2016.

Proviano 13
Ingargiola, Michael J., Saba Motakef, Michael T. Chung, Henry C. Vasconez, and Gordon H.
Sasaki. "Cryolipolysis for Fat Reduction and Body Contouring: Safety and Efficacy of
Current Treatment Paradigms."Plastic and Reconstructive Surgery. Lippincott Williams &
Wilkins, n.d. Web. 13 Mar. 2016.

Krueger, Nils, Sophia V. Mai, Stefanie Luebberding, and Neil S. Sadick. "Cryolipolysis for
Noninvasive Body Contouring: Clinical Efficacy and Patient Satisfaction." Clinical,
Cosmetic and Investigational Dermatology. Dove Medical Press, n.d. Web. 13 Mar. 2016.

"New Fat Cells Created Quickly, but Losing Them ..." Yale News. N.p., n.d. Web. 13 Mar. 2016.

Swales, Jen. Coolsculpting Analysis. Phone Interview. 10 Apr. 2016.