Coolsculpting is a medical device brand with an enticing premise: that using a physical device on the skin can reduce visible fat. This may sound impossible, but the device has been cleared by the Food and Drug Administration (FDA) for treatment of visible fat bulges, so we figured it would be worthwhile to critically investigate this product.
In this article we’ll review the medical research on Coolsculpting to determine whether we believe it’s actually likely to reduce fat, or if it’s just a marketing gimmick.
Does Coolsculpting Work?
The Coolsculpting device has been tested in clinical trials, as is required for FDA approval. One clinical trial tested the device on 28 middle-aged patients. Researchers found that skinfold thickness decreased significantly (40%), and there were no major side effects.
It was unclear from this study whether fat was lost or if it was just transferred elsewhere on the body, because no body composition data was collected. The study authors noted that “body contouring” improved, but this is a poorly-defined term.
It’s also important to note that one of the study authors is a paid consultant to Allergan, the company which manufactures Coolsculpting devices. This adds an element of inherent bias to the study.
A meta-review published in the Plastic and Reconstructive Surgery journal analyzed the results of 19 different individual clinical trials on cryolipolysis, which is the technology underpinning Coolsculpting.
The study authors found cryolipolysis to be a “promising procedure for nonsurgical fat reduction and body contouring.” The side effect profile in this larger study was minimal; most of the common side effects were bruising and sensitivity which resolved naturally after treatment. There was one case report of severe side effects (increased fatty tissue) out of around 1,200 patients that received the treatments.
One of the authors of this meta-review is a consultant for the company behind Coolsculpting, but the other 4 aren’t, so we see this publication as having less bias than the first one.
One medical trial found that manual massage immediately following Coolsculpting treatment made the treatment more effective for fat loss. The sites on the body which received targeted massage therapy post-treatment had a fat layer that was 68% reduced compared to sites which received Coolsculpting treatment without massage. This study had no funding bias.
Overall we can conclude that Coolsculpting is a promising treatment, especially in light of the minimal side effect profile. Cosmetic fat loss procedures like liposuction are riskier.
We don’t recommend this treatment for two reasons:
- The research is too early-stage. There aren’t enough unsponsored reviews of Coolsculpting proving it’s effective. There is also a lack of standardization of treatment. In the meta-review linked above, researchers tested the device across a wide range of time frames, and a wide range of body parts. There’s also no clear best practice for temperature control.
- We don’t yet understand exactly how it works. Even the researchers in the meta-review stated “the mechanisms of fat reduction are not entirely understood”. We believe that without a clear understanding of exactly what’s occurring biologically, it’s not yet time to recommend a treatment (even a promising one) to patients.
That being said, Coolsculpting does appear to be effective on average, and is backed by a lot more research than many fat loss treatments we’ve reviewed previously like Skald.
How Does Coolsculpting Work?
It’s suggested that cryolipolysis is effective because it destroys fat cells while maintaining the integrity of skin cells and vessels. Fat cells appear to be especially sensitive to extreme temperatures, and research reviews of Coolsculpting suggest that the cold temperatures directly applied to targeted zones on the body creates a localized inflammatory response which causes apoptosis (cellular programmed death) of fat cells.
It’s unclear from a thermodynamic perspective exactly what’s occurring, but early research suggests that this process does not elevate cholesterol in the body or damage the liver in any way.
We need more research to determine if there’s a limit to the efficacy of this treatment, and to elucidate why there isn’t a similar response when skin is exposed to ambient cold weather.
Natural Weight Loss Alternative
One weight loss treatment which may sound counterintuitive is consumption of blood oranges and blood orange extract.
As we discussed in our herbs for weight loss review article, blood orange is conclusively proven to be associated with reduced weight and body fat in a dose-dependent manner. This means that the more blood orange you consume, to a reasonable limit, the more weight you lose.
The reason blood orange is so effective for weight loss is that it can stimulate oxidation of fatty acids. We recommend whole blood orange fruit consumption over blood orange extract supplementation because it’s cheaper, safer and contains additional compounds like fiber which may further improve weight loss outcomes.
For patients considering the more potent blood orange extract, we recommend working with your doctor to establish a safe and effective dose.
A medical review of 42 individual trials on blood orange extract concluded that the compound “has an important role as a nutraceutical in the prevention of obesity” because it was so consistently effective in promoting fat loss.
However, the safety and toxicity of the extract specifically isn’t conclusively proven, which is why it’s so important for patients considering using the supplement to work with a medical professional to establish dosage, and why we recommend blood orange fruit consumption instead.