tape measure around belly

Cryolipolysis, also referred to as ‘cool sculpting’ or ‘fat freezing’, is a popular cosmetic procedure for fat reduction. It was first introduced in 2008 and became FDA-approved for the treatment of multiple areas between 2010 and 2016.1

Interest in cryolipolysis as a non-surgical modality for body contouring has grown as an alternative to invasive procedures such as liposuction that may carry an increased risk of complications. It appeals to both men and women for the treatment of different locations such as the abdomen, inner thighs, arms, ankles, lumbar rolls, enlarged male breasts, and submental area (double chin).1

How does cryolipolysis work?

Cryolipolysis is a non-invasive technique that depends on the inherent sensitivity of adipose (lipids/‘lipo’) tissues to cold injury (‘cryo’) to selectively induce apoptosis (cell death, ‘lysis’) of adipocytes (fat cells).2 It maintains a temperature of -10°C at the dermis-fat interface for around 45 minutes.

The controlled cold application to the skin surface triggers the selective destruction of fat cells and a decrease in superficial fat thickness. An inflammatory response occurs and peaks at 30 days post-treatment which results in the death of adipocytes.3 The surrounding water-rich tissues are not affected, and the viability of the dermis is preserved.3, 4

The lipid within the adipocytes is metabolized by the body and eliminated within four months.5 Multiple studies have shown that liver functions and serum lipid levels do not show any significant change and remain within normal limits during and after cryolipolysis.5

Cryolipolysis treatment

There is no consensus on the most appropriate device for cryolipolysis, ideal treatment protocol, ideal BMI range, or number of treatment sessions required per body region to achieve a favorable outcome for patients. Different devices are available, and they vary in temperature generation and application technique.5

Cryolipolysis is generally performed by applying an applicator with a suction cup to the treatment tissue. The surface applicator does not penetrate the dermis and maintains uniform cooling at a specific temperature for a pre-set period of time.3 The vacuum suction extracts heat and obstructs blood flow to the tissue. Crystallization occurs in the targeted adipose tissue inducing apoptosis and an inflammatory response.3

Post-treatment, the target tissue may become stiff but softens quickly with manual massage as blood flow to the area leads to localized warming.4 Within three months, macrophages clear the damaged adipocytes from the area. The targeted approach spares the surrounding nerves, muscles, vessels, and skin. 

Multiple sites may be treated during a single patient visit with a reported overall safety and tolerability.1 Research data suggests that a significant reduction in skinfold thickness was highest in patients receiving multiple treatment cycles.1

Relevant criteria for patient selection such as age, skin characteristics, sensitivity, or risk pathologies are not well known.5 To date, research shows that the ideal candidate should be in good health and have normal renal function.5 The procedure is safe for all skin types even with recurrent treatments.

Side effects of cryolipolysis

Cryolipolysis has a good safety profile and is considered a compelling alternative to surgical methods for localized adiposities.3 It offers the advantage of rapid recovery and minimal downtime away from other commitments. Hematomas, infection, blistering, bleeding, hyperpigmentation, or hypopigmentation have not been reported in research studies.

However, cryolipolysis should not be performed in areas with severe varicose veins, dermatitis, or other cutaneous lesions.3 It is also contraindicated for patients with cold-sensitive conditions such as Raynaud’s Syndrome or cryoglobulinemia.5

The following list of side effects are reported by patients but generally resolve within a few weeks after treatment.

  • Redness
  • Bruising
  • Discomfort
  • Temporary numbness

What does the research say?

Several clinical and case studies support the safety and efficacy of cryolipolysis. However, clinical outcomes have been primarily assessed using ultrasound, caliper measurements, observation, and patient satisfaction surveys. These methods are subjective, can be biased, and are not reliable for comparing photographic documentation particularly when the change in fat thickness is only a few millimeters.4

Caliper measurements can be imprecise, pre- and post-observations are not reliable for comparisons, and ultrasound imaging depends on the operator and the pressure applied on the transducer.5 Long-term monitoring is not accurate as weight gain or loss may occur.4

Outcomes reported in clinical studies varied greatly based on the treatment site and study design. Most of the studies evaluate reduction in fat thickness and very few evaluate changes in contour or skin texture.3 It is still unclear what areas are most responsive to treatment and what type of patients would benefit most from this procedure.3

Currently, most of the research on cryolipolysis lacks objective, quantitative studies to measure changes in the subcutaneous fat layer. Given the subjective nature of results and the lack of rigorous outcome measurements, claiming that cryolipolysis is an effective alternative to liposuction is not justified as a body contouring modality.4

Although the body of evidence is rather modest, cryolipolysis is a promising procedure for spot reduction of adipose tissue. It is becoming the leading modality due to its ease of use, limited side effects, and high patient satisfaction rates.3 It is well suited for patients who desire non-invasive spot reduction for modest size adiposities that do not resolve by diet or physical activity.3

References:

  1. Pennycook K, Lemchak D, Julian C. Cryolipolysis—An update. Dermatological reviews. 2020;1(4):118-122. doi:10.1002/der2.46
  2. Honeybrook A, Bloom JD, Woodard C, Bernstein EF. Three-Dimensional Photography for Measuring Volumetric Changes After Submental Cryolipolysis. The American journal of cosmetic surgery. 2018;35(3):135-142. doi:10.1177/0748806818754440
  3. Ingargiola MJ, Motakef S, Chung MT, Vasconez HC, Sasaki GH. Cryolipolysis for Fat Reduction and Body Contouring: Safety and Efficacy of Current Treatment Paradigms. Plastic and reconstructive surgery (1963). 2015;135(6):1581-1590. doi:10.1097/PRS.0000000000001236
  4. Atiyeh BS, Fadul J, Chahine F. Cryolipolysis (CLL) for Reduction of Localized Subcutaneous Fat: Review of the Literature and an Evidence-Based Analysis. Aesthetic plastic surgery. 2020;44(6):2163-2172. doi:10.1007/s00266-020-01869-x
  5. Meyer PF, Davi Costa E Silva J, Santos de Vasconcellos L, de Morais Carreiro E, Valentim da Silva RM. Cryolipolysis: patient selection and special considerations. Clinical, cosmetic and investigational dermatology. 2018;11:499-503. doi:10.2147/CCID.S146258
  6. Image by PublicDomainPictures from Pixabay 
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