We have all heard the phrase “if it’s too good to be true, then it probably is”. In the world of cosmetics and plastic surgery the word “lunchtime” before any procedure immediately loses credibility.
For years we have heard of the minimally invasive “lunchtime facelift,” that was wrought with complications and worked in some most patients for up to a year. Now we are hearing about Zeltiq, the “lunchtime” liposuction, which boasts a noninvasive, painless way of removing unwanted fat.
Obviously as physicians trained in Plastic and Reconstructive surgery, we are very skeptical. We are always looking for the latest technology to reach an end result, but we are driven by evidence-based medicine and have yet to see the “quick and easy way” prove to be reliable and reproducible.
With that being said, what is the difference between liposuction and Zeltiq, a.k.a. “coolsculpting?” We will try to describe the main points below. Keep in the back of your mind the following: In general, with current technology, painless and noninvasive procedures are not effective for the masses. Sure, a few anectodal evidence may show improvement, but it can be extremely disappointing to pay a few thousand dollars, only for it not to work!
What is liposuction?
Liposuction, also called lipoplasty, liposculpture, suction lipectomy, or lipo, is a type of cosmetic surgery which breaks up and “sucks” fat from various possible parts of the body, most commonly the abdomen, thighs, buttocks, neck, chin, upper and backs of the arms, calves, and back. The fat is removed through a hollow instrument – a cannula – which is inserted under the skin. A powerful, high-pressure vacuum is applied to the cannula.
The procedure may be performed under general, regional, or local anesthesia. The safety of the technique relates not only to the amount of tissue removed, but to the choice of anesthetic and the patient’s overall health.
Liposuction is the most common cosmetic operation in America and the United Kingdom. Over 400,000 procedures are carried out in the USA each year.
Liposuction permanently removes fat cells from the body. It can alter the shape of a body. However, if the patient does not lead a healthy lifestyle after the operation there is a risk that the remaining fat cells grow bigger.
The amount of fat than can be safely removed is limited. Liposuction has a number of possible risks, including infection, numbness and/or scarring. If too much fat is removed there may be lumpiness or dents in the skin. The surgical risks are linked to the amount of fat removed.
Some medical conditions may benefit from liposuction, including:
• Lipomas – benign fatty tumors.
• Gynecomastia – where fatty breast tissue has developed in men.
• Lipodystrophy syndrome – a lipid (fat) metabolism disturbance in which there is too much fat in some parts of the body and partial or total absence of fat in other parts. Sometimes a side effect of some HIV medications.
Liposuction is not meant to be a treatment for the obese or extremely overweight but rather for generally fit people who are having issues losing fat in specific areas. As with all medical procedures, there is often a fairly large range of people treated by various practitioners and every case must be viewed individually. Lipo is meant to alter the shape/contour of the body, not as a substitute for proper diet and exercise.
What is ZELTIQ and how does it differ from all existing fat reduction procedures?
Coolsculpting by ZELTIQ is a new technology that is completely non-invasive and requires no downtime. Cryolipolysis which involves using“cryo” (freezing) to perform “lipolysis” (fat removal via destruction) to destroy unwanted fat cells. Much like newer alternative treatments, there is less risk with ZELTIQ than more invasive procedures. ZELTIQ freezes fat, unlike Smart lipo and Zerona which melt fat cells. The benefits of ZELTIQ Cool Sculpting include:
• No downtime
• No need for anesthesia
• No incisions
• Cheaper than traditional liposuction
SO…What’s the conclusion?
The above bullet points are the exact reason that there is a lot of skepticism regarding coolsculpting. It is obvious that the dramatic results that are obtained with traditional liposuction can not be obtained with a non invasive fat reducer, Zeltiq.
From our discussion with patients and doctors who have had experience with coolsculpting or other non-invasive means of fat reduction, it is clear that the claims that are made are for less than 50% of the patients treated. It is true that there is no downtime, however there CAN BE pain associated with the procedure which sometimes lasts for months and is a shooting and electrical pain that is very bothersome. This may be due to sensory nerve damage, and the shooting pains are nerve regrowth. Furthermore, the cost is variable and at times might run significantly higher than GOOD liposuction that gets rid of the problem areas once and for all with ONE procedure.
In our experience, we have been asked about every modality to reduce fat and have evaluated each modality’s effectiveness. Zeltiq looks like a variation on a very similar theme as each new laser surfaces. This time cold temperatures are used to kill the fat as opposed to ultrasound. There is, of course, no good objective evidence that this does much of anything. Current literature shows a decrease in fat layers by 1.8mm at 4 months. 1.8 MILLIMETERS! This was a multicenter, prospective, non-randomized study* that only included 32 patients that showed “promising results.”
We doubt this freezing non-invasive technique accomplishes much in the average patient. Safe and effective might be two different things here. We’ll see how this one is received as time passes.
Our Opinion: C-
Out of 10 patients who undergo this procedure…
2 are extremely happy with results = 20%
2 are somewhat happy with results = 20%
4 patients noticed minimal improvement = 40%
2 patients noticed no improvement = 20%
* Dover J, Burns J, Coleman S, et al. A prospective clinical study of noninvasive cryolipolysis for subcutaneous fat layer reduction: Interim report of available subject data. Lasers Surg Med. 2009;41:706.