Update: At the request of more than 14 million people, the FDA finally approved the use of CoolSculpting for the upper arm area. “Arms [are] the third most popular area for consideration of non-invasive fat reduction,” said Mark Foley, president and CEO of ZELTIQ, the medical tech company that developed the CoolSculpting treatment. To learn more about what it's like to undergo this procedure, check out our editor's firsthand account below.
This story was originally published July 24, 2015.
Belly pooch, muffin top, food baby, roll, love handles, saddle bags...the world has a lot of cutesy and derogatory ways to describe body fat. And despite eating healthy, exercising regularly, and generally kicking ass at living, we all have so-called "trouble areas" on our bodies. In fact, some people are just genetically predisposed to carrying and storing pockets of fat in different areas, and those people are often as healthy (or sometimes healthier) than their thinner counterparts. That said, recent advancements in the cosmetic dermatology field have led to a slew of new, surgery-free treatments and machines that claim to eliminate stubborn, fatty areas using heat, ultrasound, radio frequency, and freezing. What are all these treatments? Do they even work? And if they do, are they worth it?
Now, I interrupt your regularly scheduled article to address some very important points. Because I know many people are going to look at my headline, read the first paragraph (if I'm lucky), and then head to the comment section to tell me how I'm making women feel bad about themselves and setting back womankind with my superficiality. So, rather than wait until the end of the article, I'm just interjecting with my disclaimer now: I do not believe any woman needs to undergo the aforementioned treatments, nor do I think that your self-worth is defined by your waistline. I'm writing this simply as an informational piece for those who are curious. Okay, back to the story.
I spoke with three experts (Amy Wechsler, MD, Jessica Weiser, MD, and Laura Pietrzak, MSHS, PA-C) to get the lowdown on fat cells. The important thing to know, they explained, is that these cells are the underlying cause of weight loss and gain (I know, duh). Fat cells can expand due to things like a high-fat diet, caloric intake, and hormones, and this expansion causes weight gain. People are born with a certain amount of fat cells, and that number fluctuates until you hit puberty — after that point, the number stays constant. While some fat cells may die off naturally, they are replaced with new ones. Obesity is a whole different ball game, and researchers are still trying to pinpoint why some people generate extra fat cells, and how new fat cells are created.
Contouring treatments work by killing off a targeted group of fat cells. Since the cells are no longer there, and can therefore no longer expand, the idea is that the size and occurrence of those "trouble spots" will be reduced permanently. However, Pietrzak explains that each contouring treatment only reduces about 20 to 25% of fat cells. This means there are still around 75% of those cells left in that area. Yes, those that were treated are not going to grow back. But if you don't continue to eat well and exercise, you can still gain weight in that area, due to those remaining cells expanding.
According to the doctors I spoke with, the most promising treatment on the market is fat freezing, a.k.a. CoolSculpting. Unlike ultrasound- and heat-based fat-reducing treatments, which actually explode the fat cells, CoolSculpting works by freezing them — causing them to die and be removed from the body as waste. This has fewer side effects than other methods, which can cause bruising and soreness, and it's seen as more effective.
An important point about these treatments — and something every expert I spoke to really hammered home — is this: These are not weight-loss treatments. They are designed for people who live active lifestyles, experience minimal weight fluctuations, and are looking to target certain areas of the body that are resistant to exercise and healthy eating habits.
As someone who has always been a bit self-conscious about my stomach (and what my mother lovingly — and not-so-subtly — refers to as "child-bearing hips") the concept of body contouring has always sounded appealing to me. I'm in shape, active (although I prefer sweating on my bike to suffering in a gym), and I eat a mostly healthy diet. Yet I have, since puberty, carried some extra pockets of fat around my midsection. Clothes never fit me quite right around the waistband, which has led to more than a few instances of dressing-room meltdowns — and I was sick of always looking at myself critically in the mirror, wishing away my permanent burrito baby.
So when the opportunity presented itself to try out this supposedly side-effect-free contouring treatment (and at the hands of Pietrzak, one of its pioneers and foremost experts, at the Manhattan office of super-derm Dr. Wechsler), I didn't hesitate to take the chance.
When I went in for my appointment, I was nervous — I had visions of some Stepford Wives-esque glambot coloring all over my body with a Sharpie and telling me all the things that were wrong with it. Fortunately, Pietzrak put me right at ease. Instead of telling me what I needed to "fix," she asked me what areas concerned me and what I was hoping to get out of the treatment. And, while a Sharpie was involved, it was only on those areas I had pointed out — to help give Pietzrak a guide of where to place the applicators.
The CoolSculpting machine, says Pietrzak, features a vacuum-based applicator containing cooling panels. It brings fat cells to the ideal temperature: that which kills them off without harming the body's water-based cells. The entire procedure takes about 60 minutes per section. As I was having two parts of my body treated, this would normally require four hours — two treatments on the left side of my hips and stomach, two treatments on the right. But, as Dr. Wechsler is one of the few doctors with two CoolSculpting machines, I was able to get my treatment done in two hours, with one machine on my stomach and one my side.
As I sat back on the table, Pietrzak placed a very chilly gel pad over the area we were treating, to protect my skin from the freezing. Then, she attached the first handset on the right side of my abdomen. The sensation was akin to taking a large vacuum hose and pressing it against your skin. I heard an unpleasant sucking sound, felt a bit of dull pain, and then the handset was firmly attached to me. She repeated this process on my left hip, and I was hooked up. The cold sensation was a bit shocking, kind of like placing an ice pack on bare skin — an ice pack that was also simultaneously doing its best to give me a massive hickey. But as the treatment progressed, the sensation wasn't as intense, and I was able to email and do some work as I was being treated.
After my first 60 minutes was up, Pietrzak detached me from the machines — another semi-uncomfortable process. I looked down at my stomach and was horrified to see a solid mass of hardened fat —almost like a stick of butter — underneath my skin, where the handset had been placed. Pietrzak kept me from hyperventilating by explaining that because the fat was crystallized, it assumed the shape of the applicator. This is why it's important for your technician to then manually massage the area: "Manual massage helps break up the crystallized fat cells," she explained. "What we hypothesize is that there are a number of fat cells that crystallize but don’t quite die, but by bouncing them around, it might essentially push them over the edge to cell death."
It also hurts like a mother. I gritted my teeth and let her massage my skin, pleased to note afterwards that the stick of hardened fat had disappeared. She then switched the handsets to the opposite side, and I settled in for another hour. After my treatment (and second round of torture — I mean, massage) was finished, Pietrzak cleared me to go forth with my usual daily routine, noting that I may experience some numbness and tenderness for a few days. I proceeded on my merry little way, making an appointment for six weeks later for a second treatment. That's right, a second round. While most people will see some change in their bodies after one treatment, it is recommended that you undergo two courses of for optimal results.
Since Pietrzak had explained the reality of the treatment, I knew I wasn't going to walk out of the office with a Victoria's Secret-model six-pack. It takes your body weeks to process the dead fat cells. Pietrzak says that over the course of the next three months, my body's macrophages (a.k.a. the "garbage collectors" of my body) see those dead cells, take a "bite" out of them, and convert the fat into triglycerides, which are then metabolized by the liver and ferried out of the body. Yes, you pee them out. Or, at least that's what scientists think. It's possible you poop them out. Everyone's still a bit unclear about that part.
But, don't worry — Pietrzak assured me I wouldn't suddenly become a pooping machine, evacuating my bowels uncontrollably for three months. (I know you were all interested in knowing the specifics of my digestive process post-treatment, so there you go.) She says the amount of dead fat cells getting processed on a daily basis is the equivalent of the fat content in four french fries — so, not a lot.
Because of this cumulative loss, it was hard for me to recognize that my body was, in fact, changing. It wasn't until just before my second appointment, where I measured my waistline, that I realized I had lost about an inch from my hips and stomach. I still had belly fat, but it was a bit less prominent than it had been.
My second treatment was relatively similar, although the suction process was a bit more uncomfortable; there was less pinch-able fat for the machine to grab onto, hence it pulled my skin a bit tighter than my first treatment. After the treatment was over, I only had a day of numbness, plus tenderness that went away in a few hours.
It's now been three months since my second treatment, and I've clocked another two inches off my waistline. Was it a dramatic, transformative, three-dress-size-dropping treatment? No — I'm still the same dress size. But, my clothes fit me better, and I no longer have a problem with waistbands digging into my sides. My body shape is the same, just with fewer bulges than I started out with.
And while the doctors I spoke to all raved that CoolSculpting is a marked improvement over liposuction (and less invasive than other sculpting methods), keep in mind that there are some things to be cautious of: specifically, the possibility of asymmetry or indentations from a misplaced applicator. "I've seen people who have gotten inexpensive CoolSculpting done, where the applicator wasn’t placed properly or not on the right area," says Dr. Weiser, a board-certified dermatologist. "I’ve also seen lopsided [placement] — where the panel was crooked and created a fat protrusion above and below on either side. It’s hard to fix once it’s asymmetric."
The takeaway is that you need to do your research, and you shouldn't go chasing a bargain. CoolSculpting is expensive; you can expect to pay anywhere between $750 to $1,500 per area treated — but the price of fixing a botched procedure is going to be much more costly, both to your wallet and your self-esteem.
At the end of the day, I'm glad I got CoolSculpting. I give zero fucks about what other people think of how I look; I made this choice for me. Because, choosing what you want to do with your body is just that — your choice. We need to move away from making other women feel bad about the choices they make in order to feel good about ourselves. Acceptance is always easier, and it's far less expensive, but does that have to mean those of us who choose to modify something that makes us unhappy should feel like traitors to the cause? I know many of you are going to disagree with me, and that's your right. However, no one is telling you that you have to do these types of things to be beautiful. In the end, the methods you choose to silence that inner critic are whatever works best for you. As for me, I like living in a world with options, whether I opt to take advantage of them or not.