Cryolipolysis (Fat Reduction by Cooling): Who Is It For, How Effective Is It, and What Are the Risks?

What is cryolipolysis, and how does it work?

Cryolipolysis is made up of the words “cryo” (cold) and “lipolysis” (the breakdown of fat). The method is based on the observation that fat cells are more sensitive to cold than the surrounding skin, nerve and blood vessel tissue. The device’s applicator is placed on the area to be treated, and the fat tissue is cooled in a controlled way for a set time.

The fat cells affected by the cold are slowly removed by the body over the following weeks. This is why the result appears not on the day of the procedure but over weeks and months. Although new fat cells do not easily form in place of those that are removed, the remaining fat cells can grow again if you gain weight.

With most devices, the area is drawn into the applicator by suction; some applicators are instead placed flat on the skin. The type of applicator is chosen according to the shape of the area and the amount of fat that can be pinched.

Cryolipolysis is performed with devices that have different technical specifications. Most studies were carried out with specific devices; results obtained with one device may not apply to every device.

What is it used for?

• Limited fat deposits in the abdominal area
• The flanks (the area popularly known as “love handles”)
• Fat deposits under the chin
• Areas such as the inner and outer thighs, the backs of the arms, the back and the bra line

The aim is not to reduce body weight, but to improve body contours by reducing the thickness of fat in a particular area to some extent. A marked change on the scales should not be expected.

Who is it suitable for?

The people most suited to cryolipolysis are usually close to their ideal weight, have had a stable weight for some time, and have limited fat deposits that can be pinched and do not go down despite diet and exercise. Good skin elasticity helps the result look smoother.

Who is it not suitable for, and what needs attention?

Some diseases cause an abnormal reaction to cold. In these situations, cryolipolysis should not be performed:

• Cryoglobulinaemia: a condition in which the blood contains proteins that clump together in the cold
• Cold urticaria: hives (itchy raised welts) appearing on the skin after contact with cold
• Paroxysmal cold haemoglobinuria: a rare blood disease in which red blood cells break down on exposure to cold

In the following situations, the procedure is either not performed or decided on only after a detailed assessment by the physician:

• A hernia (for example an umbilical hernia or an incisional hernia at a surgical scar) or a suspected hernia in the treatment area
• Recent surgery, an open wound, an active skin disease or infection in the area
• Loss of sensation, poor circulation or Raynaud’s phenomenon (fingers turning white in the cold) in the area
• Pregnancy and breastfeeding: because there are not enough data on its safety, it is usually recommended to postpone it.
• Taking blood-thinning medicines may increase the risk of bruising; do not stop your medicine on your own, talk to your physician.
• Previous procedures on the same area, or an implant in the area

If you are not sure whether you have a cold-related health problem, or if you have had raised welts on your skin, darkening of your urine or colour changes in your fingers in the cold, be sure to mention this at the examination. Suitability can only be decided after a physician’s assessment.

Who should perform it, and where?

Cryolipolysis is a medical procedure with risks such as cold injury and paradoxical fat increase. It is recommended that the suitability assessment, in particular the questions about hernias and cold-related diseases, is carried out by a physician and that the procedure is performed under a physician’s responsibility. Make sure there is a physician you can reach if a problem arises.

Attempts at “do-it-yourself fat freezing” with devices of unknown origin and unclear technical specifications, or at home with ice or cold packs, can cause serious cold burns; avoid such practices. When choosing a centre, you can use the article “A 10-Point Safety Checklist for Choosing a Clinic and Physician for Medical Aesthetics”.

Preparing for the procedure

• Discuss your expectations openly; show your physician which area you hope to change and how.
• Your physician assesses the area by hand, checking whether the fat can be pinched and whether there are any signs of a hernia.
• If your physician wishes, photographs and measurements are taken before the procedure; since the result appears months later, these are useful for comparison.
• Tell your physician about the medicines you use, any operations you have had and any cold-related complaints.
• Because the procedure can take a long time, wear comfortable clothes; you can bring something to read to pass the time.

The day of the procedure, step by step

1. Your medical history and expectations are discussed; the area is assessed and a suitable applicator is chosen.
2. The informed consent form is read; the risks, including the uncommon paradoxical fat increase, and realistic results are discussed, your questions are answered and the form is signed.
3. The area is marked, and a protective gel pad is placed to protect the skin from the cold.
4. The applicator is placed on the area; with suction applicators, the tissue is drawn into the applicator. In the first minutes you may feel pulling, pressure, intense cold and aching.
5. Within a few minutes the area usually becomes numb and the discomfort decreases. You can sit or lie down during the cooling.
6. If the discomfort increases or a burning sensation does not go away, tell the practitioner immediately.
7. When the applicator is removed, the area may look firm and cold for a while. Some centres give the area a short massage.
8. The skin is checked and aftercare advice is given; you can go home the same day.

After the procedure: the first 24 hours and the first week

Immediately after the procedure, redness, swelling, bruising and tenderness to touch in the area are common. After the massage there may be brief stinging or aching. These symptoms mostly decrease within days.

• Most people return to work and daily life the same day.
• Numbness and tingling are common and may last a few weeks.
• Some people, especially after treatment of the abdomen, may have pain that starts a few days after the procedure and may get worse at night. This pain usually goes away within a few days to a few weeks.
• Do not use painkillers or other medicines that your physician has not recommended.
• Ask your physician before applying a heater, hot-water bottle or ice to the area; the risk of burns is higher on numb skin.
• Choose loose, comfortable clothing.

Expected side effects

• Redness, swelling and bruising: usually decrease within days.
• Numbness and reduced sensation: common; mostly resolve within a few weeks, but may last longer in some people.
• Tenderness, itching, tingling: may occur temporarily.
• Delayed pain: may appear a few days after the procedure, especially in the abdominal area.
• With treatment under the chin, there may be a temporary feeling of fullness or tenderness.

Uncommon but important risks: paradoxical fat increase

Paradoxical adipose hyperplasia is when, instead of decreasing, the fat in the treated area increases over months, forming a firm, noticeable swelling that often resembles the shape of the applicator. It is uncommon; however, the reported frequency varies between studies, and it is being debated whether it may be more common than was previously thought. Some publications report that it occurs more often in men.

This condition may not go away on its own and does not improve if cryolipolysis is repeated; it often needs to be corrected with a surgical procedure such as liposuction. That is why it is important that this risk is clearly explained to you before the procedure and that you are followed up afterwards.

Apart from this, cold burns and blistering, contour irregularities or dimpling in the area, changes in skin colour and problems at the site of a hernia have occasionally been reported.

When will I see the result, and how long does it last?

The change usually begins a few weeks after the procedure, and in most people it can be assessed more clearly within two to three months. During this time, the body slowly clears away the affected fat cells.

Studies have reported a measurable reduction in fat thickness in the area treated with a single session; however, the amount of reduction varies from person to person and is generally moderate. For some people, a second session on the same area may be recommended.

Maintaining the result depends largely on keeping your weight stable. If you gain weight, the remaining fat cells can grow, and fat may increase both in the treated area and in other areas.

Realistic expectations: what cryolipolysis cannot do

• It does not make you lose weight; it is not a treatment for obesity or excess weight.
• It does not affect the fat around the internal organs; the health risks of this fat should be assessed separately.
• It does not improve the appearance of cellulite.
• It does not correct sagging skin; in some people, looseness may look more noticeable once fat is reduced.
• The result does not appear immediately but over weeks and months.
• The same level of fat reduction as with liposuction should not be expected.
• It does not replace healthy eating and regular physical activity.

Alternatives

If skin laxity is the main concern, you can look at the articles “Radiofrequency Skin Tightening and Radiofrequency Microneedling” or, for the face and neck, “HIFU (High-Intensity Focused Ultrasound)”. For general aftercare principles after any procedure, the article “Aftercare Following Medical Aesthetic Procedures” can also guide you.