Here's How CoolSculpting and Other Body Contouring Methods Actually Work

One day on my ritual morning run at the gym, I stared blankly at the long line of television sets attempting to distract us 6 A.M. treadmill runners from the overwhelming feeling that we’re all hamsters on a wheel. On NBC the announcer declared, “The weather forecast for today is brought to you by CoolSculpting”; on the next screen an ad for plastic surgery featured a tummy tuck before-and-after photo; on the next screen a pop star writhed in a bikini; and on the next screen, another CoolSculpting advertisement. All of these not-so-subliminal messages did their dirty work on my subconscious, and post workout I found myself examining that lump of flesh right below my belly button.

These marketers know their audience: In a survey of over 7,000 people conducted last year, the American Society for Dermatologic Surgery found that, among those considering cosmetic surgery, “body sculpting”—minimally invasive fat-removal techniques used on “stubborn” areas—ranked as the most alluring of procedures. According to 2017 statistics from the American Society of Plastic Surgeons, noninvasive body contouring procedures are up 7 percent over the last year even as liposuction procedures are down 30 percent since 2000.

I get it. I work out religiously. I take really good care of myself, and I eat better than my nutritionist (her words, not mine). I am strong and flexible. I like my body. But I still found myself searching for ways to get rid of my personal pooch. It bugs me, it’s not going away, and I wanted to know what I could do about it.

On my search, I discovered there are a bunch of options for getting rid of a relatively small amount of fat, with little-to-no downtime. These procedures can freeze it, zap it, heat it, inject it, or suck it out. The new, noninvasive or minimally invasive methods—which seem to be multiplying every year, and were nearly non-existent 10 years ago—are meant for spot-reduction of fat, not major weight loss, Laura Dyer, a physician’s assistant and New York City provider of CoolSculpting (one of the leading procedures), tells SELF. This slate of so-called body sculpting or body contouring methods are for spot treating small areas with a bump or a bulge you don’t want. Even people who eat healthy and work out all the time aren’t necessarily going to have a six-pack—and spot reduction isn’t something you can do with exercise and dieting.

I spoke with leading dermatologists and plastic surgeons in the field of body contouring to find out all the latest details—and eventually found one that was right for me.

Note: Practitioners caution against body contouring if you are pregnant or breastfeeding because it’s unknown how these treatments will affect unborn children and newborns. In any case, it is best to consult with a physician that is aware of your full medical history before getting any procedure.

Here are the five most sought-after FDA-approved treatments for fat reduction and body contouring available today.

CoolSculpting

CoolSculpting is the most popular noninvasive treatments right now. In CoolSculpting, freezing cold temperature is concentrated on the fat just under the skin, destroying the cells.

How it works: During a treatment, a gel is applied to protect the skin from thermal damage and to increase suction, then the skin and excess fat is vacuumed up into the device that houses the cooling mechanism. In one round of CoolSculpting, 20 to 25 percent of the fat cells in the area—such as the lower belly, inner thigh, or upper arm—crystallize, freeze, and then die. (People typically do two treatments.) Fat cells freeze at a higher temperature than water-based cells in the body, so your other cells are unharmed. It’s the same reason that when you put chicken soup in the refrigerator, the fat solidifies but nothing else does, Dyer explains. Eventually those dead fat cells get processed through your lymphatic system and your liver, and are eliminated through your digestive system. This happens slowly. According to Dyer, who has worked with the company to design the 10 applicators that are used today, it can take up to 3-4 months to see the final results.

Things to consider: If you maintain your weight, you can maintain the results, but if you gain weight, it could come back where you had the procedure done. CoolSculpting, and body contouring overall, is an art as well as a science, Dyer explains. “Technique absolutely matters. Roughly 3-5 percent of new patients coming to me are seeking revisional work from a less experienced CoolSculpting practitioner. So it is important to validate a practitioner first,” she says. If you go to someone who doesn’t know what they are doing, you can walk away with lines of demarcation, skin damage, discoloration, or in very, very rare cases paradoxical adipose hyperplasia, where the fat cells enlarge rather than die.

CoolSculpting isn’t recommended if you have a disease which creates a hypersensitivity to cold such as cryoglobulinemia, a condition in which an abnormal level of proteins thickens the blood in cold temperatures, or paroxysmal cold hemoglobinuria, a blood disorder in which cold temperatures lead to red blood cell death. The FDA initially approved the technique in 2010 for the reduction of fat from the love handles and abdomen. Today it is cleared for multiple body parts and can treat several areas at once including the arms, distal thigh (above the knees), inner and outer thighs, saddlebags, hips, bra rolls, lower back, and double chin.

Cost and recovery: Prices start at $750 per cycle ($1,500 if you’re doing something on both sides) and sessions last between 35 and 45 minutes per area. You walk out of the office with no downtime, but there can be some soreness, bruising, or numbness afterward. (Spoiler: I ended up doing CoolSculpting. Read about my experience, below.)

BTL Vanquish ME

BTL Vanquish ME is a noninvasive fat removal treatment that uses radiofrequency to heat and destroy fat cells over larger areas.

How it works: The procedure heats fat to shrink and eventually dissolve the cells. Vanquish is best for treating larger portions of the body like the belly, love handles, and thighs, because it uses a large, wide machine that can treat a broad area at one time. According to Dendy Engelman, M.D., dermatologic surgeon at the Medical Dermatology and Cosmetic Surgery Center in NYC, this means you won’t get lines of demarcation, and it can deliver more overall reduction in significantly less time.

Things to consider: Like CoolSculpting, this treatment is not a solution for those who are looking to lose a significant amount of weight, but for those looking to treat those stubborn areas of fat that diet and exercise have not helped. Also, women who are pregnant, breastfeeding, or have a copper IUD should not get this treatment. Because it uses radiofrequency and heat, any metal, such as a pacemaker or IUD, would be a problem because metal conducts heat. Risks include mild-to-moderate redness and swelling at the treatment site which should go away in a few hours. In a recent clinical study sponsored by the makers of BTL Vanquish ME found that patients preserved an average 75 percent of the original body contouring effect four years after treatment. Again, if you gain weight your fat cells will expand and those bulges will come back.

If your local dermatologist or plastic surgeon doesn’t offer BTL Vanquish ME, there’s another radiofrequency treatment called TruSculpt 3D that works similarly. Liposonix is another treatment of note that uses heat to melt fat. The machine emits high-frequency ultrasound, which generates heat around the fat cells, causing them to disintegrate.

Cost and recovery: Dr. Engelman recommends four to six treatments at about $500-750 each, scheduled one week apart to achieve maximum results. Results are visible in four to six weeks, and Engleman says there is no pain, no downtime, no pre- or post-op instructions or care, and patients can go right back to normal activities.

Kybella

Kybella is an injection using synthetic deoxycholic acid, which is a naturally occurring molecule in the body secreted by the liver to break down dietary fat. It is the only FDA-approved injection to reduce fat under the chin (or what most people refer to as the double chin). It has been used off-label—that is, in non-FDA-approved ways—to treat areas like the arm, knee, and jowls.

How it works: Melissa Kanchanapoomi Levin, M.D., a board-certified dermatologist and clinical professor at New York University Langone and Mount Sinai Hospital, explains, “The injection causes fat cells to burst,” which causes a local inflammatory response that calls immune cells to the area to discard the damaged fat cells. This not only can result in fat removal but also collagen production and improved contouring of the jawline/under the chin. If you are going to spot treat a small area, Kybella is a great option.

Things to consider: Kybella has an affinity for fat cells. However, it could theoretically affect any cells in the body. That’s why it’s so important to go to an experienced injector who understands fat deposits, the mechanism of the drug, and how to administer Kybella safely, says Levin. A board-certified dermatologist or plastic surgeon is best. Also, just like Botox, Kybella is considered a neurotoxin, which means there are some risks of nerve weakness and damage.

Cost and recovery: Side effects include redness, swelling, bruising, burning, and numbness within the first hours after injection. Swelling and mild discomfort can last from four to six weeks. Prices range from $1,000-$2,400 per session, and it may require multiple treatments, depending on how much fat is to be destroyed.

Liposuction

According to plastic surgeon Joseph O’Connell, M.D., noninvasive treatments are the wave of the future, but liposuction has always been the “gold standard,” with immediate results, the ability to remove more fat in a single procedure, and greater sculpting control. According to the American Society of Plastic Surgeons, the number of liposuction procedures is up 5 percent from 2016, so despite a decline over the past decade, it’s still a popular fat removal method.

How it works: During the procedure, which is performed with either local or general anesthesia, a small incision is made and a cannula (or hollow needle) is inserted. The cannula is then moved back and forth as the fat is sucked up into the tube.

Things to consider: If you’re thinking about liposuction you might consider ultrasonic liposuction (UAL), which is a form of "energy based" liposuction. With UAL, the tip of the cannula vibrates in a way that creates a small ultrasound wave that precedes the cannula to emulsify the fat. “This is a safety advantage because the surgeon is not pushing the cannula through the tissues with the same degree of force as with traditional liposuction,” says O’Connell. “UAL also provides better fat removal from fibrous/scarred areas like the chest and in patients with prior liposuction because the ultrasound waves travel through tissue.”

Of course, because this is a surgical procedure there are risks, including anesthesia risks, bleeding, contour irregularities, possible nerve and blood vessel damage, cardiac and pulmonary complications, infection, deep vein thrombosis, and poor wound healing. Your doctor should discuss all possible risks prior to surgery.

Cost and recovery: Cost for the surgery depends on how many areas you are treating, how extensive the procedure is, where you live, the surgeon’s experience level, and the venue. A small in-office procedure on a limited area or two could be around $2,000, or it can be more than $10,000 for multiple large areas performed in a hospital or surgicenter.

BodyTite

BodyTite combines a mix of noninvasive and surgical techniques. "[BodyTite] is a game-changer because it has the advantages of liposuction plus meaningful skin tightening without the scarring of surgery, and there is less risk of lumps and contour irregularities compared to traditional lipo,” says O’Connell.

How it works: BodyTite is radio frequency assisted lipolysis (RFAL). In layman’s terms, BodyTite is a combination of a noninvasive treatment like BTL Vanquish ME and liposuction. During a procedure, a cannula is inserted to liquify and remove the fat, while the BodyTite wand heats the skin on top to tighten it. BodyTite can be performed without fat removal, if you just want to tighten sagging skin on areas like the neck, torso, arms, and thighs. “Skin tightening has been the elusive holy grail in cosmetic medicine and surgery,” says New York City-based plastic surgeon Adam Kolker, M.D. This method is considered minimally invasive because the incisions or needle pokes for BodyTite are generally small. “There has been a large gap between what can be achieved with nonsurgical energy treatments and more invasive surgery. RFAL bridges that gap,” says Kolker.

Cost and recovery: Prices can vary widely ranging from $6,000 to $15,000 depending on the size of the region, how many areas are treated, and what city you are receiving the treatment in (NY and CA are generally more expensive). The good news is that only one treatment is necessary to see immediate results, and they will continue to improve for up to 12 months. The level of pain during the procedure also varies according to the anesthesia used. BodyTite can be performed with local anesthesia or under deeper sedation. Post treatment you can expect swelling, bruising, and mild discomfort. Recovery is about 3-4 days, but if you treat multiple regions of the body, you will need more time to heal. The risks include bleeding, infection, fluid collection, skin or soft tissue irregularities, burns, sensory changes or nerve injury—but Kolker assures me that these are all rare.

Whatever option you choose, it is important to do your research.

O’Connell advises patients to ask the three crucial Ws when looking for a plastic surgeon or dermatologist to do the treatment. “Who” is performing the procedure? Are they accredited, board certified, are they performing the procedure often, and how many times have they performed it? "What" procedure is being performed and what do you know about it? Have you done your due diligence regarding the cost, number of treatments, downtime, and risks? "Where" refers to the type of environment where the procedure is being performed. Even when a procedure is noninvasive, you want to make sure it is being done in a sterile environment with properly cleaned devices and equipment.

After doing my research, I decided to go for CoolSculpting on my belly.

According to Dyer, I was the perfect candidate for freezing the fat away, as long as I maintain my current lifestyle and weight.

The procedure was a breeze. Dyer applied a gel that felt like a honey sheet mask below my belly button, then put the device on my belly. (Pro tip: Maybe don’t wear your favorite undergarments, as the sticky gel could get on them.) My flesh was sucked up into the machine, as though into the hose attachment on a very powerful vacuum cleaner. For the first few minutes it got progressively colder and then I didn’t feel a thing. In fact, I was so comfortable I managed to get some work done during the hour I was in the chair (the lower belly is done in two sections at 35 minutes each). Then, it was right back to life as usual.

It has been a little over two months since my first CoolSculpting treatment, and I haven’t noticed a difference—it could take another month or two to see if it worked—but I remain hopeful.