by Jennifer Stieber, NP
Although Coolsculpting (also known as cryolipolysis or “fat-freezing”) and truSculpt may share similar names, they differ quite a bit in their mechanism of action and associated side effects:
|First clinical study||2008||2010|
|Mechanism of action of destroying fat||Cells containing a large proportion of fat are more prone to cell-death when exposed to cold than are water-containing cells.||15 minutes of thermal exposure at 43–45 degrees Celsius will result in fat cell-death|
|Permanent fat removal?||Yes||Yes|
|Time for one treatment||2-4 hours||30 min-75 minutes|
|Swelling||Moderate||None to mild|
|Weeks of swelling||0 weeks – 3 weeks||0 days – 4 days|
|Short-term side effects||swelling, pain, redness||small nodules, redness|
|Long-term adverse effects||neuropathic pain, delayed-onset pain, paradoxical adipose hyperplasia* (overgrowth of fat)||None|
|Estimated rate of adverse effects||1 in 100 patients||Not applicable|
|Effectiveness||Greater than 20% fat reduction||Greater than 20% fat reduction|
|Cost||$2250 and up for abdomen||$2000 and up for abdomen|
*Read below for information on paradoxical hyperplasia/overgrowth of fat
Although both modalities are effective at permanent fat removal, cryolipolysis does have more reported permanent side effects, as is reported widely in the literature. The most troublesome side effect of which is paradoxical hyperplasia, in which case the fat-frozen area becomes larger rather than smaller in the weeks after the procedure, leaving a painless, enlarged mass of fat beneath the skin.
Yes, SLK has witnessed both delayed neuropathic (nerve) pain and paradoxical adipose hyperplasia (unwanted fat growth) after Coolsculpting. SLK providers have not witnessed any permanent side effects of this nature following truSculpt iD.
Paradoxical adipose hyperplasia (PAH) is a condition in which case a fat-frozen area increases in size, rather than decreases in the weeks after the procedure, leaving an enlarged pocket of fat beneath the skin. This side effect is more common in men than in women and is thought to occur due to “natural selection” of more resilient fat cells during the fat-freezing process. PAH typically appears 5-6 months after the initial procedure. The frequency of this phenomenon has caught the attention of plastic surgeons in recent years:
“In the recent article, “Paradoxical Adipose Hypertrophy
(PAH) After Cryolipolysis” by Strouzma et al, the incidence
of PAH is estimated to be approximately 1/100 based on
their reporting on 4 cases in 398 patients. The authors state that this incidence is still most likely under-reported, and our experience with this technique is completely in agreement with this impression. We started performing CoolSculpting in 2014, and the enthusiasm we generated with this technique quickly generated about 150 patients over an 18-month period. During that short time, we experienced 2 patients with fulminant PAH. By personal recollection, at least 10 other patients had what we considered unchanged or even worsened “girth,” which in retrospect may represent a new classification of PAH considered to be mild to moderate… The fact that we experienced (unpublished) 2 cases out of approximately 150 treated patients in my solo practice alone speaks volumes about the under-reporting and likely true incidence of PAH.“
– Dr. James Vogel in the Aesthetic Surgery Journal, 2018
From left to right: pre-treatment, 2 months after, and 5 months after Coolsculpting. A visible fat pocket is developing in the 3rd column of photos. Credit: James Vogel, MD FACS 2018.
Although there is no known way to predict who will experience paradoxical hyperplasia, if you are male, you should be aware that you may possibly be at higher risk. All patients receiving cryolipolysis should also be aware that there is a 1% incidence, meaning 1 in every 100 patients could face PAH: