CoolSculpting is the latest device for non-surgical body contouring and is unique as it's the first to use targeted cold therapy to crystallize and kill fat cells. The device is not yet FDA approved in the US, but it has been used in Europe and Asia for years. The big question on everyone's mind though is does Zeltiq work?
Dr. Richard Fitzpatrick, an internationally recognized dermatologist and San Diego Zeltiq provider who was instrumental in the development of CO2 lasers for fractional resurfacing has worked closely with Zeltiq. It's important to remember that this treatment isn't for everyone, and there are certain patients for whom this treatment is better suited. "The ideal candidate is a patient who is close to their ideal weight but has spots that just don't respond to diet and exercise," he says. "Typically that's mid-abdomen, love handles and upper mid back in women, medial inner thighs. We have to be able to pull the skin and fat up into a vacuum applicator cup and once the skin and fat are pulled up into the cup then the cooling plates on both sides of the cup drop the temperature in a controlled manner and we hold it there for an hour. So there are some areas where we would like to be able to treat because patients frequently request it from the outer part of the thighs and under the buttocks where the skin just isn't very loose. We can sometimes get there but frequently it's just too tight and there are other areas that we hope to be able to treat like on the upper arms, under the chin, so this is such a new treatment that the company that's making the device needs to design a treatment applicator cup for each of these specific uses. Right now we have two applicator cups, a moderate size one that's a little bit smaller; there's a larger applicator that will be used across the mid abdomen that should be available soon and then they're going to the smaller applicator that might be used under the chin."
Zeltiq results of Dr. Richard Fitzpatrick
Dr. Fitzpatrick says that patients need to go into the treatment with realistic expectations because while Zeltiq does kill the fat cells, it is not intended as a weight loss solution or for those looking to get rid of a large volume of fat. "That's an important distinction and it's also important to realize that there's not a large volume of fat that's lost, you know it can be as much as 40% of the thickness of an area but if you have a thick fat area, as I mentioned earlier, that band that's treated is still going to be the same so if you're taking off a half inch and you have an inch and a half left, in a single treatment, you cannot make it go deeper than that but if you have an inch of fat and your taking off a half inch then the percentage reduction is going to be bigger, so it's a very predictable layer of fat that has been demonstrated and this has been visualized with ultrasound in the same way that you would visualize an embryo in utero. So with ultrasound you can get a very good image and you can measure the size and depth very accurately."
He says the treatment isn't painful, but there is a short period of a stinging sensation. "As we're treating, there is a period of about 10 minutes initially where it stings a bit but once the fat is frozen then there's no real sensation there so the patients are very comfortable during that hour of treatment and actually a number of our patients actually slept during that phase of it. So it's a very easy treatment that does require a time commitment because it's an hour per application spot but it's very easy to do we just have to be careful to get the applicator cup applied in a precise manner so that we are treating the bulge of the fat at its maximum point."
Zeltiq results of Dr. Richard Fitzpatrick
Patients don't need to alter their activities afterwards and there isn't any significant pain, but a slight soreness. "If you press against the site, if you lean on one of the areas of treatment, it kind of feels like a bruise or a muscle that's sore from working out and usually it will stay a little bit tender like that for sometimes a week to 10 days. There's also a kind of numbness to the skin that may persist for three or four weeks."
It does take around 3-4 months to get the final result, but you can begin seeing results sooner. Dr. Fitzpatrick says, "Usually you'll see improvement after about a month and very commonly there's significant improvement in a month so if an ideal patient has been treated, there's almost always a significant improvement by a month."
Dr. Fitzpatrick cautions that this is not a treatment to lose fat all over the body, rather it's for specific areas. "You have to have a high point mound that you can bring down to have the contour visibility that you want so its spot reduction not generalized fat reduction or change in contour." The treatment costs around $800 per area, and typically patients want a symmetrical treatment, so for the two, Dr. Fitzpatrick estimates it would cost $1400-$1500 for the two area treatment.
Patients are seeing significant success with this treatment, but it is important for physicians to manage their patients' expectations. "Dr. William Groff, who's my associate in the office and I have done two studies initially, two clinical studies for Zeltiq. There were 20 patients each in those. In those studies we were trying different parameters than what we're using now but in those studies probably I'd say 60% maybe 70% had results that they were happy with. Since we've been using it clinically, we've probably done an additional 40 ? 50 patients and I would say within that group there's about, oh I'd say probably 90% of the patients that I'm aware of are happy with their results." He says that the procedure is growing in popularity and he's seeing more and more patients. "Right now we're very busy with this, we're probably doing 10 or 15 patients a week so once the general public becomes aware of this and aware of the type of person whose going to respond well there's definitely a demand for it out there."
