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CoolSculpting®

‘Eliminating fat in a problem area through diet and exercise can be difficult; CoolSculpting® can remove fat in selectively targeted areas of your choosing without the need for surgery’

What is CoolSculpting®?

CoolSculpting® is an in-office procedure that allows for safe and effective fat reduction without the need for surgery or downtime. The procedure is FDA-approved and can achieve noticeable, long-lasting results. CoolSculpting® works by using precision-controlled cooling to target the fat cells underneath your skin. As fat cells freeze, they crystallize and your body naturally processes and eliminates these non-viable cells in the weeks following the procedure. The visible changes occur gradually, leaving the treated area with a smoother, flatter appearance.

Is CoolSculpting® the right procedure for me?

Diet and exercise can shed fat, but the areas where fat is lost cannot be controlled. There is no way to selectively eradicate fat, despite “working out” a specific area. Your body is programmed to maintain fat stores in your “problem” areas.

In female patients, these areas tend to be the thighs, abdomen, flanks (love handles), back, and buttocks. In men, they are usually the flanks, abdomen, and chest. The distribution of your fat stores is set, determined by your sex and genetics. Consequently, when the rest of your body loses weight, these “problem areas” may remain the same – weight loss may even emphasize these undesirable areas.

CoolSculpting® and liposuction procedures are the standard methods of selective fat reduction when diet and exercise are unsuccessful. Both can achieve results by removing fatty tissue in the desired areas of your choosing. The main difference between the two is that liposuction is a surgical procedure, while CoolSculpting® is non-surgical. With CoolSculpting®, there is no need for anesthesia, incisions or stitches, or time off of work to recover. If you desire targeted fat removal without surgery or downtime, CoolSculpting® may be the appropriate procedure for you.

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Who is a candidate for CoolSculpting®?

Anatomy/Weight

If you have areas of unwanted fat that persist despite regular diet and exercise, you may be a candidate for CoolSculpting®. Ideally, excellent candidates have well-defined areas of fat accumulation, but are not obese. Patients should have a BMI (body mass index) that is below 35, and ideally, less than 30. As BMI increases, the result from CoolSculpting® is typically less optimal.

Body mass index (BMI) chart (in feet and lbs.):

21 22 23 24 25 26 27 28 29 30 31
4’10” 100 105 110 115 119 124 129 134 138 143 148
5’0″ 107 112 118 123 128 133 138 143 148 153 158
5’1″ 111 116 122 127 132 137 143 148 153 158 164
5’3″ 118 124 130 135 141 146 152 158 163 169 175
5’5″ 126 132 138 144 150 156 162 168 174 180 186
5’7″ 134 140 146 153 159 166 172 178 185 191 198
5’9″ 142 149 155 162 169 176 182 189 196 203 209
5’11” 150 157 165 172 179 186 193 200 208 215 222
6’11” 159 166 174 182 189 197 204 212 219 227 235
6’3″ 168 176 184 192 200 208 216 224 232 240 248

Anatomy/Skin

The condition of your skin is an important consideration to make. The success of CoolSculpting® is predicated on your skin having an acceptable degree of elasticity; patients with poor skin elasticity, stretch marks, or scars may not be good candidates for the procedure.

Health

Because CoolSculpting® is a non-surgical procedure, patients with medical conditions that would be excluded from having surgical procedures (i.e. liposuction) may be candidates for CoolSculpting®. However, patients with a history of certain diseases related to cold exposure are not candidates for CoolSculpting®. These may include the following:

  • Cryoglobulinemia or paroxysmal cold hemoglobinuria – known sensitivity to cold, such as cold urticaria or Raynaud’s disease
  • Impaired peripheral circulation in the area to be treated
  • Neuropathic disorders, such as post-herpetic neuralgia or diabetic neuropathy

Dr. Tong can examine your medical history and determine whether you are a good candidate for a particular area.

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Important considerations about CoolSculpting®

1. Not a weight loss procedure

CoolSculpting® is not designed to be a weight loss procedure. Although the visible effects to your appearance can be significant, your actual weight may not change much.

2. Will not help cellulite

CoolSculpting® does not improve cellulite. Cellulite is a condition that occurs near the skin’s surface; CoolSculpting® targets fat cells under the skin, but it will not minimize the appearance of cellulite. (Unfortunately, there is currently no procedure, surgery, or technology that can consistently, reliably, and safely eliminate cellulite.)

3. The number of treatments may vary

The number of CoolSculpting® treatments required to achieve a desired result is affected by:

  1. The size of a region that needs treatment
  2. The number of regions to be treated
  3. The thickness of the fat in a given region

Size (Surface area): The procedure is performed using an applicator device that is placed on the skin’s surface. A patient with a larger frame may need more applications to cover a given area, compared to a smaller patient. (Example: a patient with a large lower abdomen may need 4 applicators instead of the usual 2 applicators).

The  number of applicators per region are indicated in the chart below:

Area Number of applicators per region (avg. patient)
Upper abdomen 2 (one per side)
Lower abdomen 2 (one per side)
Flanks (love handles) 2 (one per side)
Submental (double chin) 1
Mid back (bra-line area) 2 (one per side)
Arms 2 (one per side)
Inner thighs 2 (one per side)
Outer thighs 2 (one per side)
Knees 2 (one per side)
Anterior axilla 2 (one per side)
Banana roll (under the buttocks) 2 (one per side)

Number of regions to be treated: Notwithstanding the previous point regarding the size of the patient, the number of applicators per region is relatively consistent for most people. The usual reason for increased treatment time is an increased number of regions to be treated. Each applicator represents approximately 35 minutes of treatment. Patients treating multiple regions may choose (or be advised) to break up their treatments over several visits, particularly if the total treatment time is more than 5 hours.

Thickness of fat: CoolSculpting® tends to reduce the fatty thickness in a given treatment area by 20-30%. If a patient has a thicker layer of fat, he or she may need more than one cycle of treatment (at that same area) to achieve the desired result. The decision to perform additional cycles can be made after final results are visible (approximately 12 weeks). If more than one cycle is anticipated at the initial consultation, the additional cycle(s) can be started as early as 6 weeks after the initial treatment (before initial results are fully visible), in order to decrease the time necessary to realize the final outcome.

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Liposuction Vs. CoolSculpting®

Although CoolSculpting® and liposuction are designed to achieve the same goal – selective fat reduction – the approach of both procedures differs. CoolSculpting® has several advantages over liposuction. These include:

  • Non-invasive procedure
  • No anesthesia
  • No downtime/no need to take time off work
  • No incisions
  • Minimal discomfort/pain during and after treatment
  • More flexibility to schedule treatments

As a non-invasive procedure, CoolSculpting® has all of the inherent advantages associated with a treatment not requiring surgery. Some patients may question why anyone would choose liposuction over CoolSculpting®. In some situations, liposuction has distinct advantages over CoolSculpting®. The principle reason why, is that liposuction is performed by a surgeon who is able to make certain decisions during surgery that can achieve optimal results for the patient.

Advantages of liposuction over CoolSculpting® may include:

1. Liposuction has the ability to remove more fat during a single treatment. CoolSculpting® removes approximately 20-30% of fat thickness during a single session. If more fat reduction is required, more cycles to the same area are necessary. In contrast, liposuction can remove much more fat in one procedure since fat reduction is controlled and judged by the surgeon.

2. Liposuction is more time-efficient for multiple areas of treatment. In the case of a single area of concern, the procedure time for both liposuction and CoolSculpting® is comparable. For multiple areas of treatment, liposuction generally takes less time. Additionally, with CoolSculpting®, if the fat is too thick, additional cycles may be necessary. With CoolSculpting® technology, multiple treatment areas and thicker fat adds more procedure time and/or treatment sessions, whereas liposuction usually requires only one procedure to treat fat in multiple areas, irrespective of fat thickness.

3. Liposuction results are immediately visible. In fact, this is one of the ways a surgeon judges the surgical endpoint. In contrast, results from CoolSculpting® occur gradually, generally taking several weeks to become visible. Liposuction may be more beneficial for patients that desire a noticeable result within a certain time constraint.

4. Liposuction is more effective when the distribution of fat is unusual or irregular. CoolSculpting® is best utilized in patients with typical regions of problem fat. In cases where fat may have an unusual location, distribution, or regularity, treatment may not be possible. If it is possible, multiple CoolSculpting® cycles may be required. With liposuction, a surgeon is able to customize a single procedure to address a patient’s unique needs and achieve the most optimal result.

5. Liposuction can be performed in some areas where CoolSculpting® cannot. Although CoolSculpting® can address the most common, standard areas of liposuction, there are still some areas where liposuction is the only solution.

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A Summary of CoolSculpting® Compared to Liposuction

CoolSculpting® Liposuction
Type of Procedure Non-surgical Surgical
Procedure Venue In-office Operating room
Procedure length 35 minutes per CoolSculpting® applicator; most regions require 2 applicators (one for each side of the body) Approximately 1 hour per area (eg. liposuction of left and right love handles = 1 hour)
Amount of fat removed at a procedure Each treatment reduces fat by approximately 20-30% in a given applicator area; thicker fat may require more than one treatment Surgeon controlled; significantly more can be removed than a single session of CoolSculpting®
Multiple areas May require more than one session of treatment Usually only requires one procedure
Anesthesia None General anesthesia or sedation
Incisions None Small 3-4 mm at strategic locations around the area
Blood loss None Mild to moderate
Treatable areas Most areas of the body amenable to standard liposuction All areas of the body amenable to liposuction
Results timeline Delayed; appearance  continuously improves over first 12 weeks Immediate and continues to improves with time (as swelling resolves)
Irregular fat distribution May require more cycles Single treatment
Number of treatments needed Depends on area(s) and quantity of fat in the area(s) One procedure
Post-procedure pain None to mild Mild to significant
Most efficient use

(not all need apply)

  • Patients with “average” sized fat deposits
  • Patients with fewer number of areas to be treated
  • Patients with standard fat distribution pattern
  • Patients who do not wish to have surgery
  • Patients with “thicker” fat deposits
  • Patients with multiple  areas of fat deposits
  • Patients with unusual distribution of fat deposit (requires surgical “finesse”)
  • Patient wanting more aggressive and immediate results

CoolSculpting® Procedure Details

CoolSculpting® is performed in Dr. Tong’s office at 199 Avenue Road in Downtown Toronto. As a non-surgical treatment, there is no need to go to the operating room. We ask patients to wear loose-fitting clothing and expect to undress to their undergarments (depending on the areas to be treated). You will be sitting in a comfortable procedure chair during treatment.

The procedure begins with determination of the best positioning of the applicator(s), based on your anatomical features. Usually, one applicator for each side of the body is required (e.g. one applicator per inner thigh). In some cases, larger regions, such as the abdomen, will require two (or more) applicators per side. A gel pad is positioned over the area to help maintain good contact between the applicator and your skin. The applicator is placed on the pad and the treatment is initiated. A gentle vacuum lifts the tissues into the applicator head, against cooling plates that line the applicator’s inner surface. The plates begin to cool the tissues to a certain temperature for a specific duration of time. The temperature and duration are pre-programmed specifically for each area. A typical treatment takes 35 minutes per applicator.

During this time, you will rest comfortably in the treatment chair. You can read, use a mobile device, or simply relax. You may feel slight discomfort or tingling as the tissues begin to cool. When the tissues are cool enough (usually 5 minutes after starting), the area will become numb for the remainder of the treatment. After the prescribed treatment time has elapsed, the applicator is removed. A firm massage is performed on the area for two minutes. The massage breaks down the crystallized fat cells, increasing the effectiveness of fat elimination. The next area is treated in the same manner until all planned areas of the session are completed. Once finished, you will get dressed and be able to go back to work or home with no downtime.

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Recovery from CoolSculpting®

Afterwards, you may notice that the area feels sore and slightly numb. This soreness typically lasts for 3-4 days. The numbness resolves after a few weeks. Patients may return to work and exercise immediately. You may begin to notice results in as little as 4 weeks after treatment, with the full outcome typically realized at 12 weeks. Photos are taken at certain intervals to document your progress. The photos are for your medical record and are not disclosed without your written permission.

Like any procedure, CoolSculpting® has risks and complications associated with it. The risks are low, but they do exist. At your consultation, Dr. Tong will go over the pertinent risks and complications associated with CoolSculpting®.

Specific Areas for CoolSculpting®

CoolSculpting® the Abdomen

Fat removal of the abdominal (tummy) region is one of the most popular CoolSculpting® treatment areas. Abdominal CoolSculpting® is a great option if you can “pinch more than an inch.” The treated area extends from the bikini line to the edge of the ribs, and side-to-side at approximately the hip bones. The most common applicator configuration is: 2 applicators on the upper (left and right side) abdomen and two applicators on the lower abdomen. More or less of the abdomen can be treated, depending on your needs.

The love handles are not addressed directly with abdominal CoolSculpting®, but may be treated simultaneously if desired.

Important Considerations for Abdominal CoolSculpting®

If you have stretch marks or hanging skin (e.g. over a C-section scar), you may not be a good candidate for abdominal CoolSculpting®. In these cases, you can end up with a more wrinkled appearance after treatment. An abdominoplasty (tummy tuck) or mini tummy tuck can be considered in these situations.

Some patients have bulging of the abdomen caused by fat collections stored inside the abdominal cavity and around the organs (visceral fat). CoolSculpting® solely addresses the layer of fat under the skin (the subcutaneous fat), and does not treat visceral fat. Unfortunately, no known procedure (including liposuction or tummy tuck) is able to remove/treat visceral fat. In a patient with some visceral fat, the improvement from CoolSculpting® (and also liposuction) will be limited to improvements in subcutaneous fat. Patients with significant visceral fat are typically recommended to undergo weight loss prior to or after CoolSculpting® in order to achieve the best results.

Some patients may have abdominal muscle laxity after pregnancy (diastasis recti). These lax muscles can create the appearance of a bulging abdomen. Neither CoolSculpting® nor liposuction corrects this laxity. If a patient wishes to correct bulging due to rectus diastasis, a tummy tuck is a more appropriate procedure.

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CoolSculpting® the Flanks (“Love Handles”)

If you have concerns about “love handles” or a “muffin top”, you can achieve great results with CoolSculpting® treatment. CoolSculpting® of the flanks ranks as one of the most popular areas of treatment, and is the most commonly treated area for men. The goal is to give you a more tapered, hourglass-like waistline without the roundness and bulges of flanks.

CoolSculpting® of the flanks is generally performed with two applicators (left and right). The actual area of CoolSculpting® depends on the anatomy of a given patient. Larger flanks may require four applicators or additional cycles.

CoolSculpting® the Inner and Outer Thigh

Do you have outer thighs that bulge outwards? Do your inner thighs rub together? The thighs are a particularly effective area for CoolSculpting® treatment because fat deposits are well-localized. The most popular areas for thigh-targeted CoolSculpting® are the outer and inner thigh.

Outer thigh fat deposits are unflatteringly referred to as “saddle bags.” The goal is to achieve a natural outer curve and a slimmer silhouette. CoolSculpting® of the outer thigh involves a larger applicator to treat the area.

The aesthetic ideal for the inner thigh is to have a small gap when standing with the feet shoulder-length apart (i.e. not rubbing together). CoolSculpting® of the inner thighs involves one applicator per side.

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Mid-Back CoolSculpting®

The mid-back refers to the back above the waistline (immediately above the flanks). Commonly, patients are concerned about a “roll” of fat and the associated crease that runs just below the bra line. Dr. Tong refers to this area as the “bra roll.” CoolSculpting® of this area can be quite effective in eliminating the roll and decreasing the depth of the accompanying fold. Women love the results of CoolSculpting® treatment because it allows them to wear form-fitting tops or backless dresses without fear of exposing bulges and folds. One applicator per side is used.

Inner-Knee CoolSculpting®

The inner knees often form a bulge of fat that can be effectively reduced with CoolSculpting®. One applicator per side is used.

CoolSculpting® of the Arms

If you have thick or bulky upper arms, CoolSculpting® may be your answer to a leaner and trimmer look. The procedure is only performed on the upper arm. Unfortunatley, f you have any significant hanging skin or flabbiness in the upper arm, CoolSculpting® can make this appear worse. Some patients seeking CoolSculpting® in their arms may be better candidates for an arm lift (brachioplasty), which is a combination of liposuction plus direct skin and fat removal.

Dr. Tong will determine whether CoolSculpting® of the arms would be beneficial for you. In the right patient, CoolSculpting® of the arms can yield excellent results by making arms more proportional to the rest of your body. One applicator is used per side.

CoolSculpting® Under the Chin (Submental Region)

CoolSculpting® under the chin helps to reduce the fullness caused by fat accumulation. The result can be a better profile, more defined neck/jawline, and a look of apparent weight loss. A special single applicator is used for the area.

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Miscellaneous Areas of CoolSculpting®

CoolSculpting® can be performed on additional areas of the body. Dr. Tong treats these areas as well:

  • Anterior axillary fold (excess fat at the front of the armpit region)
  • Mons pubis (fatty excess around pubic region)
  • Inner knees

Get Educated about CoolSculpting®

To learn more about CoolSculpting®, please set up a consultation by giving our practice a call at (416) 972-0999, or allow us to call you. Simply fill out our contact form and we will call you on the same or next business day. No referral is needed.

We are Yorkville Institute of Plastic Surgery.
We practise The Art of Beauty.