Despite the recent fat acceptance movement and how its arguably normalizing obesity and its associated health risks, there are still tons of people who try to get rid of it in all sorts of ways. We melt it, suck it out, burn it off, and try to swallow it away.

Having excess weight is certainly not a moral failing but oftentimes, losing extra pounds is a matter of optimizing one’s diet according to one’s personal goal and needs; and by cutting out processed foods, gluten, sugar, excess carbs, moving more, detoxing, and making sure the gut, adrenals, and hormones are balanced.

But sometimes fat can be pesky. Like really pesky. You can be absolutely fit, exercise and eat well but still have a banana roll (fat underneath the buttocks) or in my case my belly. Sometimes stubborn fat just doesn’t sit right and won’t go away. And that’s when the cold comes into play.

Experts are now freezing fat off in the name of “contour.” The FDA-cleared nonsurgical procedure, commonly referred to as “CoolSculpting,” destroys fat cells with precision. Once fat cells are frozen, they undergo apoptosis — also known as cell death. They’re then attacked by white blood cells, converted into triglycerides, metabolized by the liver, and eliminated by the body over a span of several weeks.

When I first saw the billboards throughout El Lay (Los Angeles) advertising fat freeze, I rolled my eyes at another snake oil treatment. According to Max, a manager of an aesthetic salon who preferred not to use his real name,  the coolsculpting industry spends about $100 million annually on marketing.

Yet with more than 6 million treatments to date and scientific data, the word in the waiting room is that cryolipolysis (the technical term) reduces the number of fat cells in treated areas by about 20 to 25 percent.

According to a few sites, cryolipolysis was originally founded from the far-out idea that kids who sucked on enough Popsicles would develop dimples in their cheeks. Fat freezing, however, isn’t for everyone. Unlike weight-loss surgery (e.g., gastric bypass), this is not a solution for obese people. Think pinchable fat for targeted loss.

“It’s only ideal for two types of candidates,” explains Beverly Hills physician Dr. Prokupek who heads a state-of-the-art beauty facility called Aesthetic Body Solutions:

1) Those who are generally fit and thin but have one or two areas — e.g., inner thighs, love handles, belly or bra fat — that hold fat regardless of exercise or diet.

2) Those who are perhaps a bit heavier and have two to 3 inches of subcutaneous fat in a certain area.

You probably don’t make the cut if you’re not within at least 30 pounds of your ideal weight. Prokupek turns 20 percent of patients away. “We don’t want to take someone’s money if this treatment isn’t suited for them.”

People with certain medical conditions such as hernias or cold insensitivity are also ineligible candidates, adds Tanya Kormeili, M.D., Board Certified dermatologist in Santa Monica, California.

Cold Vs Hot: The Battle Against The Bulge

During my research, I came across those who insist that melting fat is a more effective way to get rid of it. “The side effect,” says Max, “is smoother tighter skin, because you are applying radio frequency and going through the collagen layer.”

Heat generally works by necrosis, and cool by apoptosis, so the mechanism is slightly different. Heat has to get the fat cells in the subcutaneous layer to a certain temperature (45 degrees Celsius) in a uniform manner to be effective.

Those in the freeze fat team disagree that heat is superior for various reasons.

For starters, when heating, the likelihood of burning the epidermis is increased and you need to treat smaller areas, which means more treatments. And with heat there is always a chance of collateral damage to surrounding tissue and uneven fat loss, explains Kormeili. The dermis gets damaged with heat and cause a “pebbly” appearance.

“Worse, the fat cells sometimes burst open with the heat only and don’t die off, only to fill up again with fat at a later time. Because fat and water have different freezing points (think water and butter in your fridge!) there is little chance of damage to the dermis on top.”

It’s a complicated subject for sure, adds Carrie Gessler of Private Aesthetics, an internationally trained registered nurse practitioner with more than 12 years of experience.

“I have measured more fat reduction than the heat methods I’ve used in the past. This could be because fat cells are more susceptible to cold. I also see a bit of skin tightening. I’m not saying heat doesn’t work, I just find the coolsculpting to be more effective, obvious, and permanent overall.”

The Skinny On Fat

Fat has come a long way since the big lie of the 80s, telling us that low-fat diets were the way to go. Today, biohackers and scientists have praised the benefits of following a ketogenic diet which embraces eating 65 – 75 percent of calories from good fat to actually help us lose it. Recent studies actually show how low-fat may quicken demise. Fats are in and here to stay.

Meanwhile, some argue that fat is an organ of its own. “It’s an important component of cell membranes, a place to store energy and some vitamins, and it’s used to make different hormones we need to transmit messages throughout the body,” reports an article in Quartz titled “ Everything You Need to Know About Fat Cells.”

Like the article says, “we all need some fat.”

Fat experts will tell you that fat is a conscious organ that will comes back unless the root causality of why it’s there in excess in the first place is handled.

According to Dr. Tim Jackson, who is educated in nutritional biochemistry, digestive health, and functional endocrinology, fat will stick to an area depending on the hormone imbalance in question. So for instance, he says that belly fat likely has to do with cortisol, the hamstring has to do with estrogen dominance, and the skinfold caliper measurement above the scapula relates to insulin sensitivity

In 2008, Kirsty Spalding, a molecular biologist studying fat at the Karolinska Institute in Sweden, discovered that as adults, we keep the same number of fat cells throughout our lives, regardless of whether we gain 20 pounds or lose them over years.

In other words, once we get to be about 25, we have the designated fat cells that will simply shrink or grow in size. Scientists still aren’t sure why some people have more fat cells than others. “It’s as if we’re programmed, in a way, to have this number of fat cells,” says Spalding.

They do know that abdominal liposuction does not significantly improve obesity-associated metabolic abnormalities, according to a study in the New England Journal of Medicine. Another paper in a journal called Obesity, remarks Dr. Mikael Rydén, professor and senior consultant, of the Karolinska Institute, illustrates that removal of fat from one region via liposuction can result in a compensatory increase in fat mass in another region.

“Usually when old ones (cells) die, they are replaced by new fat cells,” Dr. Michael Jensen an endocrinologist and obesity researcher at the Mayo Clinic told the New York Times in Feb 2017. Cell death and production appear to be tightly coupled, so although about 10 percent of adipocytes (fat cells) die each year, they’ve replaced at the same rate.

Since fat freezing is only about 10 years old, long-term data doesn’t yet exist.

Nonsurgical Fat Reduction: Tips & Tricks

During the treatment, 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. They say many people will read, listen to music, or play with their phone (surprise!).

Following the procedure, typical temporary side effects include redness, swelling, blanching, bruising, firmness, tingling, stinging, tenderness, cramping, aching, itching, or skin sensitivity. Real Self is a good source to see what patients think.  

The only serious side effect I found was a rare complication called paradoxical adipose hyperplasia (PAH) in which a hardened area of localized fat develops post procedure, leaving patients with a bulge that requires the very treatments they tried to avoid for removal, i.e., liposuction or abdominoplasty, according to the July issue of Plastic and Reconstructive Surgery.

The root of this rare phenomenon is unknown. The onset of PAH is delayed two to three months after treatment following an initial reduction of subcutaneous fat in the treatment area. Plastic surgeons looked retrospectively for all PAH patients. They identified eight men and three women with PAH. All 11 of the patients were Hispanic.

If you think you may be interested in coolsculpting, do research on the person conducting your nonsurgical fat reduction procedure. The skill of the operator helps ensure the procedure is successful and symmetrical.  There is even an actual Coolsculpt University.

“Experience of practitioners is definitely important. I only used providers with a Diamond CoolSculpting rating,” says 33-year-old Allison Reinert, a marketing executive with Cardinal Digital Marketing. Reinhart underwent 2–3 treatments before seeing improvements on her stomach and arms. “Overall, I was happy.”

Keep in mind that it’s also standard practice to massage the area right afterward. In fact, one study showed that a massage could improve coolsculpting results by 68 percent. If you don’t properly massage, coolsculpting can result in an unattractive post-treatment look dubbed the “ butter stick.”

Bottom line, look for a certified technician with a minimum of three years of clinical experience to perform this nonsurgical fat reduction. The cost depends on the number of applicators you need. The more fat and the more areas you wish to treat, the greater the cost — expect to pay $1400 for love handles, for instance. It’s usually about $750 per area.