Bikini season or not, fat reduction is a hot topic that sparks many a Google search. Perhaps you’ve fallen down this internet black hole in search of a solution for “bingo arms,” a muffin top, or a double chin. No matter how many calories you count or number of squats and sit-ups you do, there are some stubborn spots that simply refuse to surrender to sweat or a stringent diet — and that’s where modern technology has your back…upper arms, thighs, and other areas in-between.
In addition to surfing the Web, statistics from The American Society for Aesthetic Plastic Surgery showed that unwanted fat prompted plenty of action at licensed providers’ offices around the country in 2017. Liposuction was the second most popular surgical procedure (coming in close behind breast augmentation), while non-surgical fat reduction such as CoolSculpting® also landed in the top five of the non-surgical category. (By the way: Injectable wrinkle reducers and hyaluronic acid filler treatments were close behind — learn more about them here.) With so many body contouring options on the market, however, it can be difficult to decide which procedure is right for you.
Here, we asked pros to explain the ins and outs of two of the most popular in-office treatments: fat freezing and laser liposuction. Now, you can finally stop Googling and go straight to the source.
[Editor’s note: Talk to your doctor before starting or stopping any new treatment.]
How It Works: One of the most well-known cryolipolysis treatments is CoolSculpting, a non-invasive, FDA-cleared method that uses controlled cooling panels to freeze fat. This process causes the cells to crystallize, die, and ultimately be eliminated from the body, creating a more toned appearance. Since it reduces fat in treated areas up to 20 to 25 percent, CoolSculpting is an effective way to target stubborn bulges.
Who It’s For: Anyone who is around their ideal weight or who has a stubborn area of fat that won’t go away with diet and exercise may be an ideal candidate for CoolSculpting, explains Dr. Michele Green (a board-certified dermatologist based in New York City). Using applicators in various sizes and shapes, CoolSculpting treats tricky spots like back and bra fat, underneath the buttocks (i.e., the banana roll), the upper and lower abdomen, flanks, upper arms, outer thighs, and the area under the jaw line.
“Someone who has a lot of laxity of the skin is not a good candidate,” notes Dr. Z. Paul Lorenc, a board-certified plastic surgeon. Unlike laser liposuction, CoolSculpting has no tightening effect on loose or sagging skin. “Patients with a hernia, pacemaker, Raynaud’s disease, cold urticaria, diabetic neuropathy, open wounds, impaired skin sensation, paroxysmal cold hemoglobinuria, or cryoglobulinemia should [also] not do it,” adds Dr. Green.
What to Expect: Before treatment, a gel pad is applied to protect the skin. Then, the CoolSculpting applicator uses vacuum pressure to suck targeted fat into the device and the controlled cooling process begins. Some patients notice a little pressure and a stinging sensation at first, says Dr. Green, but as you get used to the cold, this feeling typically subsides as the area numbs. (Read more about the type of discomfort you might expect during a CoolSculpting treatment.)
The length of a CoolSculpting session varies depending on the size of the area, but the treatment can be done in as little as 35 minutes to one hour. During that time, patients can answer emails, catch up on social media, or even nap from the comfort of a reclining chair. While multiple machines can be used to address various areas at the same time and speed up the overall process, Dr. Green prefers to focus on one spot at a time to provide patients with the “most comfortable” experience. After the device and gel pad are removed, a licensed provider or technician massages the treated area as the body reheats itself.
The Post-Treatment Protocol: There is little to no downtime associated with CoolSculpting, meaning that you can return to work and your normal exercise routine immediately following treatment. “It is normal to feel tingling, itchiness, numbness, and/or cramping in the areas treated,” says Dr. Green. The experience can differ depending on the sensitivity of the patient and the spots addressed. While CoolSculpting does permanently eliminate treated fat cells, it is still possible to gain weight following the treatment. The number of fat cells in your body is set when you’re a teenager and, as you gain weight, fat cells expand, notes Dr. Green. In short, you don’t gain additional fat cells post-treatment.
The Results: It is possible to see changes as quickly as three weeks following the treatment, but the body continues to flush out fat cells for four to six months following a CoolSculpting session. According to Dr. Green, the most dramatic results are typically seen after three to four months.
The Risks: While it is unlikely, CoolSculpting can cause a temporary “hardening of the area” that can take some time to dissipate, said Dr. Lorenc. Typical side effects also include temporary redness, swelling, tingling, stinging, cramping, itching, and tenderness. There are also rare side effects that can occur in some people, so talk to your licensed provider to be sure it’s right for you.
The Number of Sessions Needed: The number of sessions needed to achieve desired results is unique to each person. Some patients may require multiple sessions depending on the area of the body and amount of fat being treated. Dr. Lorenc equates CoolSculpting to melting a stick of butter: Each time a patient goes in for treatment, it causes the butter (i.e. fat) to dissolve. The number of sessions is dependent on “how many sticks of butter” you have to begin with. Dr. Green recommends that patients wait four months before retreating any areas.
What It Costs: The price of CoolSculpting varies according to the area(s) being treated and the number of sessions required. The cost of a single session can range anywhere from “$750 for a small area to $1,500 for a larger area,” noted Dr. Green. Since most patients opt to receive multiple treatments, the final price tag tends to hover between $2,000 and $4,000, according to the CoolSculpting website.
Pro Tips: Dr. Green recommends looking for a board-certified dermatologist who is well-versed in the latest applicators and CoolSculpting techniques. “You have to do your homework,” said Dr. Lorenc, who encourages patients to ask about training and certification before undergoing treatment. Have more questions about CoolSculpting? Consult with our trained aesthetic specialists — they can also find a trained provider in your area.
Does not imply person featured in photograph had the CoolSculpting treatment.
How It Works: Laser liposuction — available from brands like SmartLipo® — is an outpatient procedure. It involves creating a small puncture in the skin and using a catheter with a laser at the end to liquify fat and “break up scar and fibrous tissue,” says Dr. Melissa Doft, a board-certified plastic surgeon based in New York City and Clinical Assistant Professor of Surgery at Weill Cornell Medical College. Next, a cannula (i.e., a small and hollow stainless steel tube) is inserted to suck out subcutaneous fat from the body using a vacuum pump.
The advantage of using laser light in conjunction with traditional liposuction is that it “tightens overlying skin” by stimulating collagen production, she added. Some physicians opt to leave the puncture sites open, while others (like Dr. Lorenc), use absorbable sutures underneath the skin to decrease the chances of infection. It is important to remember that laser liposuction is “not a method to lose weight,” says Dr. Lorenc. “It is a procedure that can be used to contour correct the body.”
Who It’s For: “Good candidates are healthy patients who are at or close to their baseline weights,” says Dr. Doft. “The best patients are those committed to a healthy lifestyle and who exercise.” Another important factor, adds Dr. Lorenc, is skin elasticity. “The better the elasticity of the skin, the better the result,” he says. “A patient with a lot of excess skin may have some skin retraction but may be better off with a tummy tuck or arm lift,” explains Dr. Doft.
What to Expect: “Laser liposuction can be performed in the office under local anesthesia or in the operating room under general anesthesia,” explains Dr. Doft. While the surface area and volume of fat being removed all play a role in determining a physician’s approach, Dr. Lorenc tends to treat smaller areas like the upper arms, medial thighs, or tummy under local anesthesia. This often involves prescribing a small dose of a mildly sedating medication such as diazepam to “take the edge off” and injecting the treatment site with numbing medication. “I can have a conversation about politics with a patient [during the procedure] but they don’t feel anything I'm doing,” he explains.
Some patients may feel “some pressure” under local anesthesia, says Dr. Lorenc, but it is a relatively painless process that lasts a few hours or less. For larger spots such as the thighs, hips, and abdomen, he often opts for twilight anesthesia (i.e., the patient is sedated but not unconscious). Any laser lipo procedure that involves taking more than 500cc of fat should not be done under local, notes Dr. Lorenc, and any procedure that involves taking over five liters should be done in a hospital so that a patient can be admitted overnight if necessary.
The Post-Treatment Protocol: After the procedure, patients wear a compression garment to minimize bruising, swelling, and possibility of seroma (i.e., a collection of fluid) for at least four to six weeks. After 48 hours, a patient can shower and put the compression garment back on. “I often advise patients to have a post-liposuction massage,” says Dr. Doft. She recommends seeing a massage therapist who specializes in lymphatic drainage. As for any discomfort, Dr. Lorenc shares that his patients routinely describe “feeling like they’ve worked out every day for a week.”
Swelling typically starts to subside after two weeks and bruising lasts anywhere from two to four weeks, depending on the extent of treatment. Patients are encouraged to start with low-impact exercise (stationary bike, elliptical, treadmill, etc.) one week after the procedure. “After two to three weeks, patients can do anything and everything,” he says. Dr. Doft says you can typically expect to be out of work three days to one week following the procedure, but individual recovery times vary.
The Results: “Unlike CoolSculpting, which kills some cells that are later absorbed [and flushed out] by the body, the liposuction cannula removes fat cells at the time of the surgery,” says Dr. Doft. Once those cells are removed, they can no longer expand or shrink. “Most patients tend to have one or two problem spots,” she notes. “Once the cells are removed from these areas, they gain and lose weight more evenly throughout their body.”
There is a little risk of noticeable scarring, but the punctures are small (approximately two millimeters in diameter) and are strategically placed in areas that can’t be seen, explained Dr. Lorenc. Follow-up visits generally occur within the first week following the procedure, and again at the four-week and three-month marks. There is some variability, but final results are usually seen after approximately six months, said Dr. Lorenc.
The Risks: “It is possible to burn the skin or damage the nerves in the area with heat,” warns Dr. Doft. Additionally, infection, hematoma, seroma, and scaring can happen, but all are very rare, says Dr. Lorenc. “The beauty of many lasers is that they provide feedback, so the doctor is aware of the exact temperature at all times,” he adds.
The Number Sessions Needed: While there is always the possibility of a second surgery, laser liposuction is a “one-and-done” procedure for the vast majority of patients, says Dr. Lorenc.
What It Costs: “As is the case with many things, the cost can vary greatly, depending on where you live and the size of the area being treated. Dr. Doft also points out that if you require the use of an operating room and anesthesiologist, that will bump up the price. For example, performing laser liposuction under the chin in Dr. Doft’s office hovers around $3,600, whereas a few hours of liposuction in an operating room under anesthesia will set you back closer to $10,000. For Dr. Lorenc, the base price for laser lipo is “in the neighborhood of $7,500 to $9,500,” but there could be “peripheral costs” related to the facility and anesthesia.
Pro Tips: “Many doctors and surgeons perform liposuction, but only a plastic surgeon does liposuction training during their residency,” explains Dr. Doft. “Remember that this is a real surgery, and thus you should have a surgeon performing it.” In addition to looking for a board-certified plastic surgeon with an accredited facility who is aligned with your aesthetic vision, it is important to ask what type of equipment is being used.
“Not all laser lipo is the same,” warns Dr. Lorenc. “There are a lot of machines coming into the [United States] from China that are knockoffs and the problem is that they aren’t subject to a stringent regulatory process, therefore you don’t really know how efficient they are.” He adds that it’s completely rational to ask your licensed provider what equipment will be used during your procedure, and how long he or she has used it. It’s critical that your surgeon uses machines that are well-tested and backed by reputable companies in case an issue arises.
Dr. Lorenc also suggests seeing two to three physicians for consultations before committing to make sure you are comfortable. Look at the before and after photos in the licensed provider’s office and ask to speak to a patient who has had a similar procedure so that you can get their perspective. Instead of asking “Dr. Google,” look to websites of professional societies, like The American Society for Aesthetic Plastic Surgery, that provide answers to common questions and are vetted by an entire committee — not just one individual surgeon who is trying to promote their services. After all, says Dr. Lorenc, “a well-informed patient makes for a much better experience on both sides.”
Does not imply person featured in photograph had the CoolSculpting treatment.
CoolSculpting is an Allergan®-owned non-invasive fat reduction treatment.
CoolSculpting® Treatment Important Information
The CoolSculpting procedure is FDA-cleared for the treatment of visible fat bulges in the abdomen, flank, thigh, submental and submandibular areas, along with bra fat, back fat, underneath the buttocks (also known as the banana roll) and the upper arm. It is also FDA-cleared to affect the appearance of a double chin with submental treatments.
During the procedure you may experience sensations of pulling, tugging, mild pinching, intense cold, tingling, stinging, aching, and cramping at the treatment site. These sensations subside as the area becomes numb. Following the procedure, typical side effects include temporary redness, swelling, blanching, bruising, firmness, tingling, stinging, tenderness, cramping, aching, itching, or skin sensitivity, and sensation of fullness in the back of the throat after a submental area treatment. Rare side effects may also occur. The CoolSculpting procedure is not for everyone. You should not have the CoolSculpting procedure if you suffer from cryoglobulinemia, cold agglutinin disease, or paroxysmal cold hemoglobinuria. The CoolSculpting procedure is not a treatment for obesity. Ask your doctor if CoolSculpting is right for you. To learn more about what to expect, visit the CoolSculpting website.