The Science of CoolSculpting


CoolSculpting is based upon solid science. Studies show that this controlled chilling procedure kills just fat cells. It does not harm skin, nerve and other tissues.

The medical term for killing fat cells with cold is cryolipolysis. Cryolipolysis is safely performed with CoolSculpting®, a patented1 medical device.

The CoolSculpting procedure was cleared in Canada and Europe in 2009. It received FDA clearance as a class 2 medical device in 2010. At the time of this post, there have been over 5 million treatments performed, making CoolSculpting the world's most popular noninvasive fat reduction procedure.

It started with a Popsicle and Horseback Riding

The idea for CoolSculpting came from two medical studies. The initial study titled Popsicle Panniculitis2 was published in 1970. The other study titled Equestrian Cold Panniculitis3 was published in 1980. In both studies, subjects were exposed to cold for a prolonged period of time. This exposure resulted in the destruction of fat cells without harming skin, muscle or other tissues.

In the first study, parents had treated their toddler's teething pain with an orally placed frozen Popsicle®. The treatment killed fat cells, resulting in the formation of new dimples. In the second study, women had gone horseback riding upon frozen saddles. The exposure to cold killed fat cells along their inner thighs.

Development of the Medical Procedure

FDA clearance of CoolSculpting was a significant undertaking. The use of cold to kill fat cells was an entirely new procedure. To assure safety, the FDA required a series of tests. These tests included:

  • animal studies4
  • a small study of patients undergoing panoplasty (a tummy tuck)5
  • a large study of normal patients

These studies demonstrate that cryolipolysis is safe and effective. The studies also demonstrate the mechanism of fat cell death, which is apoptosis. Apoptosis is a biochemical pathway whereby a cell creates internal digestive enzymes. The last step in apoptosis is rapid cell death from the digestion (lysing) of the cell membrane.

Apoptosis can be triggered by damage to the cell membrane. It is thought that chilling the fat cell causes the fat to harden, which damages the cell membrane and triggers apoptosis. A study6 demonstrates that massage to tissue immediately after treatment kills another 68% of fat cells in the treated area.

The Skinny on Fat Reduction

Not all fat is created equally. The body has two major types of fat. The fat differs in location and function. Each type of fat has a different strategy for reduction, as well. The two types of fat are:

  • visceral - located between digestive organs and the abdominal wall
  • subcutaneous - located between the skin and underlying muscle

CoolSculpting cannot treat visceral fat. This is unfortunate, as this type of fat is unhealthy. Visceral fat releases hormones that contribute to high blood pressure, insulin resistance and heart disease. Fortunately this type of fat responds quite well to lifestyle changes, such as diet and exercise.

Figure 1 depicts subcutaneous fat. Subcutaneous fat is also termed resistant fat. That is, it resists the efforts of diet and exercise. Unfortunately as we age, more and more of our fat becomes resistant.

CoolSculpting is able to reduce areas of unwanted subcutaneous fat. The treatment is esthetic. You will love the new you*.

Immediately After CoolSculpting

Figure 2 depicts fat that has been treated. The fat cells shown in blue were killed by the treatment. The fat cells die within three days of treatment.

It takes about two weeks before the immune system starts to process and remove the dead fat tissue. To enable migration of the immune cells into the treated area, the capillary openings are enlarged. This enlargement allows for fluid leakage that may make the treated area feel bloated or itchy.

Beginning Fat Reduction

Figure 3 shows the treated area beginning to reduce. Reduction occurs as the immune system moves the tissue debris to the liver. The liver primarily uses the debris for energy.

Reduction is a slow process. Because it is a slow process, the lipids from the dead fat tissue does not present any health risk. There is no requirement for monitoring serum lipids or cholesterol after a treatment.

Most people begin seeing results about six weeks post treatment. The treatment is about 80% resolved at three months. It can take as long as five months to fully resolve the fat reduction.

CoolSculpting also results in skin retraction. Skin retraction occurs at a somewhat slower pace. Some patients continue to see skin retraction for a full 12 months.

Treatment Resolution

Figure 4 shows the treated area fully resolved. The treated area looks entirely normal, except that there are significantly less fat cells.

CoolSculpting Results Are Long Lasting

CoolSculpting results are long lasting*. In adults, fat cells have an extremely limited ability to regenerate. The first people to undergo CoolSculpting were test subjects treated in 2007. A follow-up study7 at 6 and 9 years post treatment demonstrates that the reduction of fat continues to persist. Since CoolSculpting kills fat cells, it is thought that the results will persist as long as liposuction*.


1 US Patent #9,308,120 details CoolSculpting

2 Epstein EH Jr, Oren ME. “Popsicle Panniculitis,” N Engl J Med. 1970 Apr 23;282(17):966-7

3 Beacham BE, Cooper PH, Buchanan CS, Weary PE. “Equestrian Cold Panniculitis.” Arch Dermatol. 1980 Sep;116(9):1025-7.

4 Zelickson B, Egbert BM, Preciado J, Allison J, Springer K, Rhoades RW, Manstein D. “Cryolipolysis for noninvasive fat cell destruction: initial results from a pig model.” Dermatol Surg. 2009 Oct;35(10):1462-70.

5 Coleman SR, Sachdeva K, Egbert BM, Preciado J, Allison J. “Clinical efficacy of noninvasive cryolipolysis and its effects on peripheral nerves.” Aesthetic Plast Surg. 2009 Jul;33(4):482-8.

6 Boey GE, Wasilenchuk JL. “Enhanced clinical outcome with manual massage following cryolipolysis treatment: a 4-month study of safety and efficacy.” Lasers Surg Med. 2014 Jan;46(1):20-6

7 Bernstein EF. “Long-term efficacy follow-up on two cryolipolysis case studies: 6 and 9 years post-treatment.” J Cosmet Dermatol. 2016 Jun 23.

*Results and patient experience may vary
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