An innovative medical device relies on controlled cooling for the noninvasive local reduction of fat deposits, thus helping to reshape body outlines.

The CoolSculpting procedure and device work by cryolipolysis, the noninvasive cooling via energy extraction of adipose tissue to induce lipolysis--the breaking down of fat cells-- without damage to other tissues or apparent damage to the overlying skin. The resulting fat cell apoptosis is a natural, controlled cell death, which leads to the release of cytokines and other inflammatory mediators that gradually digest the affected fat cells in the months after the procedure, reducing the thickness of the fat layer. The lipids from the fat cells are slowly released and transported by the lymphatic system to be processed and eliminated, much like that of fat from food.

The CoolSculpting procedure, a trademark of Zeltiq Aesthetics (Pleasanton, CA, USA), is fundamentally different from procedures that involve necrotic cell death by damaging fat with heat, high-intensity focused ultrasound, or chemical injections, since each of these approaches poses challenges, particularly regarding reaching the right tissue depth and unintended damage to other structures close to or within the fat layer. While the process is not fully understood, it appears that fatty tissue cooled below body temperature, but above freezing, undergoes local panniculitis.

“CoolSculpting requires minimal time on my part, which ultimately increases the overall bottom line for my practice. After I assess the patient, my medical assistant helps me with the actual procedure, allowing me to see other patients,” said Elizabeth Tanzi, MD, codirector of the Washington Institute of Dermatologic Laser Surgery (Washington DC, USA).

The CoolSculpting device uses a specially designed cooling applicator that is applied to the desired area of fat reduction via an applicator cup that generates a gentle vacuum pressure, drawing the tissue between the cooling panels.

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