Coolsculpting one year on: Is the big freeze thawing?

from Cosmetic Surgery & Aesthetics Guide, September 2011

Last August, Zeltiq CoolSculpting launched in the UK to great media acclaim. One year later, we set out to investigate whether the treatment really lives up to the hype or if CoolSculpting is starting to feel the heat.

It's not often that a treatment comes along which is truly different. Over the past few years the body sculpting market place has become saturated with machines that promise to reduce fat without breaking the skin, but they all work on much the same principle.

When Zeltiq CoolSculpting came on the scene last year, however, it represented a departure from the tradition of using heat or light energy to break down fat and as a result the mainstream press leapt on it as the new buzz word in fat reduction.

Twelve months later, however, the media attention has dwindled down to a mere trickle and there are still relatively few clinics who offer the treatment. And let's not forget that even in the initial frenzy, several of the reviews from journalists who had actually tried Zeltiq were less than glowing.

So is this just a period of calm before fat-freezing fever kicks off in earnest, or was it all a big fuss about nothing? We decided to do a bit of digging within the industry to get the inside track.

Our first port of call was Dr Roberto Viel, lead surgeon at the London Centre for Aesthetic Surgery (www.lcas.com) and, together with his brother Maurizio, one of the first people to introduce VASER liposuction to the UK.

When CoolSculpting first launched, Dr Viel was openly sceptical about it, so what are his thoughts now?

"CoolSculpting is a very interesting and revolutionary treatment, but the question is: will the body be able to wash out all the destroyed fat and can the body cope with absorbing the damaged fat, metabolising and eliminating it with the urine?" Dr Viel cautions.

"If we are talking about a large amount of destroyed fat, then the liver could become overloaded and the body could struggle to function, causing lethargy.

"I wouldn't advise someone with liver problems to have a treatment like this."


Dr Nick Lowe (www.drnicklowe.com), consultant dermatologist, London and professor of dermatology at UCLA, Los Angeles, California, disagrees:

"I first came across CoolSculpting about three years ago. One of my colleagues at UCLA was involved in the clinical trials and so I was able to evaluate the results of those studies myself and to be sure of its long-term potential benefits before offering it to my clients.

"One of the good things about waiting until studies have been done in the States is that they are proper safety studies, unlike many instances in Europe, for example the ridiculous number of fillers that we now have available, most of which haven't been tested thoroughly.

"But CoolSculpting was thoroughly tested; they made sure it wasn't causing any unwanted, uncontrolled fat damage, that it wasn't creating any damage to nerves, blood vessels, muscles and so forth. It's been well shown that there's no risk of getting increased cholesterol or triglyceride levels in your blood."

So as far as safety concerns go, there doesn't seem to be a problem, but as we've seen in the past these studies can be open to interpretation, so we asked Mr Waseem Saeed (www.waseemsaeed.com), consultant plastic surgeon and an expert in invasive liposuction, to take a look and feed back his thoughts.

"From what I can tell from looking at the clinical trials, safety isn't an issue," he told us.

"The main concern would be whether those destroyed fat cells were going to enter into the blood stream and cause problems with cholesterol, but the studies show they don't seem to, and any damage to the skin or nerve endings is only temporary, in the form of discolouration and numbness.

"In fact, although I would want to see follow-up studies before taking it on myself, this could be very interesting. The main human study is on 32 subjects with love handles, all of whom saw some reduction in fat, with an average reduction of 22 per cent after four months.

"That's just after one treatment, so if it works with multiple treatments then after three sessions you could reduce fat by 60 per cent, which is very exciting for a non-invasive procedure."

Historically, plastic surgeons tend to be very sceptical of non-invasive body sculpting procedures, believing that the traditional method of breaking the skin and sucking out fat is the only true way to get results

So, with a strong evidence base and the backing of some big name practitioners, although it's still early days, perhaps it's true to say that when it comes to fat reduction, CoolSculpting really is hot stuff.

A patient's view
"I booked to have Coolsculpting to see if it would help me lose a very stubborn pocket of fat on my stomach below my navel. I never expected it to completely give me a flat stomach but was pleased with the effect after a few months.

I have a low pain threshold and so found the initial suction quite painful but this only lasted about ten minutes before the 'freezing' kicked in and then it just felt numb.

However, the machine is quite heavy and although it was supported by a pillow, I did feel it helped if I held it more in place and so it wasn't pulling my stomach further.

Other than the area being extremely cold and numb for quite some time after the treatment, I felt absolutely fine and was able to drive home. The area was numb-ish for several weeks and there was a bit of bruising but I could see the fat pocket getting smaller over the course of several weeks and it hasn't returned."