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PST 018: CoolSculpting — Read the Transcript

July 30, 2018

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Welcome to Plastic Surgery Talk with Dr. Stephen Mulholland, brought to you by SpaMedica. Hello and welcome. Dr. Stephen Mulholland here in Toronto, Canada, Plastic Surgery Talk, and our podcast series today is on a very, very popular procedure, cool sculpting. Cool sculpting, what is cool sculpting? It is one of the most common and popular noninvasive, nonsurgical body contouring, body sculpting technologies. How does it work? As the name implies, cool sculpting uses cold temperatures to permanently shape, kill, destroy and modify localized areas and collections of fat. It uses suction and non suction coupled applicators that are fitted over top of unwanted localized bulges of fat that are resistant to diet and exercise.

Through a series of timed cold pulse releases, the fat cells are held down around 5 degrees celsius for between 40 and 60 minutes. And that will result in between 22 and 30% of the fat cells exposed to that temperature to die. A non inflammatory, non aggressive subtle or mellow fat cell death so there’s no redness, no inflammation, no prolonged side effects like you might experience with liposuction. Who’s cool sculpting in Canada? Well, anybody who has localized areas of fat, male or female, that are resistant to diet and exercise and a reasonable lifestyle. And so what are those common areas? Number one is the tummy or the pot. Followed by the flanks, the side love handles. Followed the outer, the inner thigh, the bra line, the arms and the double chin. These are the most common non surgical body sculpting areas that are treated by cool sculpting.

Men and women differ a little bit in the areas they treat. For men, it’s often the love handle and the tummy and sometimes when it’s non glandular breast tissue, gynecomastia can be treated as well. For women, it’s usually the tummy, the pot, the outer and the inner thigh. Candidates who are good for sculpting are realistic, they understand they’ll get a noticeable reduction of fat but it’s not as good as liposuction yet it has none of the risk for recovery of liposuction. So how does the program work? Cool sculpting is not a single treatment, it’s two treatment sessions per area six weeks apart. Two treatment sessions per six weeks apart. And then it takes some time for that second cool sculpting session to kill the fat, for the fat envelope to shrink before the cushion becomes smaller and for the final results become revealed. So it’s 12 weeks, two cool sculpting sessions, six weeks apart.

What kind of results can a cool sculpting patient expect? Well, two treatments, six weeks apart. I may or may not add other technologies while you’re sitting around for that, that sixth week and we’ll talk about that later in the podcast but just cool sculpting alone, two treatments, six weeks apart, six weeks after the second treatment. One should expect a noticeable, pinchable reduction in fat and in general circumstantial reductions of one to two centimeters are entirely possible. Or going down a dress size or a skirt size or your slacks feel better or there’s a demonstrable diminishment of that area that’s always bothered you that’s been resistant to diet and exercise. So not quite the wow results of lipo but still for a more affordable, no down time procedure, you can kill forever the fat cells that annoy you without surgery.

So sounds great, cool sculpting sounds amazing. What’s the difference between it and more surgical liposuction like traditional liposuction or smart lipo or body tight lipo or vaso lipo? Anything that has liposuction associated with it, is minimally invasive. Meaning we put local freezing in the fat. There’s no freezing needed for cool sculpting. We stick probes into the fat, directly into the fat, and we heat the fat and then we aspirate, suck and remove the fat with liposuction. Hence the name suction and lipo. And therefore, using the surgeon’s hand with his minimally invasive technique, we remove fat immediately until we see the contour we want to achieve. It has more risk recovery but also greater benefits. Cool sculpting has nothing invasive, nothing goes under your skin. It’s all external, on top of the skin. There’s nothing invasive about it.

It uses cooling to terminate fat cells, to kill them. Hence cool sculpting. It’s also called cryolipolysis. So what is cryolipolysis? It is the process of using cool sculpting at sustained hypothermia to kill a certain percentage of fat cells. Sometimes we wish that cool sculpting would kill more fat than it did but the amazing thing about it, it consistently well over 90% of the time will kill measurable amounts of fat that nothing else will touch with diet and exercise. So it has become the most popular way that we do body sculpting. The question becomes while you’re twiddling your thumbs or you’re sitting around waiting between the first treatment and the second treatment or after the second treatment, is there something we can do at SpaMedica to improve your result? Non-noninvasively, the answer is yes.

We can take other technologies that work in different ways to kill a fat cell. So we take cool sculpting and hypothermia or cryolipolysis and cooling to kill the fat cells but week two, three, four and five while we’re waiting, we use technologies like the vanquish, which uses microwaves or ultra shape, which uses ultra sound waves or body effects, which uses electroporation to kill the fat cells that are resistant to cooling. So the SpaMedica non invasive body sculpting program is Canada’s best because we deploy five or six different technologies. We layer them on, providing additional fat cell death where one mechanism leaves off, another takes over. So we don’t leave any fat behind with our non invasive body contouring program that can’t be killed with one of the four or five top non invasive fat cell destruction technologies and the lead top technology is generally cool sculpting.

A frequent question I get, okay, cool sculpting can kill the fat but what about my skin? If I kill the fat and I orphan the skin, could it be loose and saggy after? The question is maybe but at SpaMedica, if we identify that your skin tone is not as tight as we would like, we combine other technologies with your cool sculpting that will tighten the skin simultaneously. So we take bulk heating and radio frequency devices with common well known names for tightening skin, products like the Venus Freeze, parts like the Forma, products like Thermage, products like Body FX, the Excelis or the Accent. These are many of the bulk heating radio frequency non invasive devices that we will use on week two, three, four and five to ensure that we’re tightening your skin while we’re killing your fat. So one of the risks of cool sculpting is loose skin. How do we manage that? We tighten your skin while we’re doing it.

What other risks could occur with cool sculpting? Well, it’s non invasive so it has nowhere near the risk profile of say liposuction but it still has some side effects. You can have bruising and swelling for a couple of days. Many patients get a hyper sensitivity of the skin from the prolonged cooling and the nerve endings get a little bit raw from that cooling. It generally resolves. You can sometimes get a demarcation where the cool sculpting ended and the non cool sculpting contour takes off and those demarcations can be blended with some of our other technologies that kill fat, such as sculpture, Body Effects, ultra shape, Venus Freeze. We can use these to blend in the contour. Loose skin, we talked about, we use skin tightening if cool sculpting is gonna kill the fat but not provide the tightening that you need.

And the final and the most rare side effect or complication of cool sculpting is that some of the primordial fat cells get stimulated by the cooling experience and they think that maybe the owner is in the Arctic and needs more warmth and therefore we develop an overgrowth of fat in the cool sculpting area, which is completely the opposite of what you paid for. You paid for the fat to go away and this complication, thankfully rare, leads to an overgrowth of fat. It’s called paradoxical, that means sudden, expected, adipose hyperplasia or overgrowth. So if you end up with an overgrowth of fat, thankfully, I own SpaMedica, I’m a plastic surgeon and I provide some complimentary local liposuction to cure the problem. So cool sculpting, not without its side effects. Very safe, very affordable. It works and it’s non invasive and that fat is dead.

So the last question I often get asked, “Hey, is this cool sculpting permanent? Will these fat cells come back?” The answer is no. This fat ell technology, cool sculpting, kills fat dead. The cells that are terminated by cool sculpting are never coming back. That means you need to have some sense of weight neutrality. Meaning you maintain your cool sculpting weight. Don’t put on weight or the fat cells that didn’t die will expand and bring back that unwanted collection again. But the fat cells we killed are gone forever. So as long as you maintain your weight within five pounds of your cool sculpting weight, you results and the contour improvements will last a lifetime. So again thank you for joining me, Dr. Stephen Mulholland here in Toronto, Canada with Plastic Surgery Talk on our very popular podcast series. If you’ve found this podcast on cool sculpting interesting, informative, entertaining, please share it on all your social media channels and we’ll see you again very soon.

Dr. Stephen Mulholland
Posted by Dr. Stephen Mulholland
Dr. Stephen Mulholland has been practicing Plastic Surgery for over 20 years. He is one of Canada’s most renowned and best plastic surgeons in Toronto with his wealth of experience, artistry, and humbleness towards his patients.

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