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Nonsurgical Fat Reduction Using the CoolSmooth Conformable Surface Cryolipolysis Applicator


By W. Grant Stevens, MD, FACS Plasticsurgerypulsenews.com

CoolSculpting is a safe and effective procedure for nonsurgical reduction of subcutaneous fat. The CoolSculpting System (Zeltiq Aesthetics, Pleasanton, CA) is a CoolSculpting technique that uses controlled cooling to selectively damage adipocytes. Because adipocytes are uniquely sensitive to cold, they can be frozen without inducing damage to overlying skin and surrounding muscle, nerves, and blood vessels. Controlled cold exposure subsequently induces apoptosis in the adipocytes and an inflammatory response in treated tissue. The damaged adipocytes are gradually removed by the body's immune system, resulting in permanent fat layer reduction in the treated area.

CoolSculpting received FDA clearance for treatment of the flanks, abdomen, and thighs. The procedure has also been used off label to remove undesirable fat in areas such as the back, arms, and male chest. Areas with easily pinchable subcutaneous fat can be treated using vacuum CoolSculpting applicators to pull the targeted tissue between parallel cooling plates. Areas such as the lateral thighs, however, have fibrous fat and cannot be treated using vacuum applicators. This article describes a new non-vacuum CoolSculpting applicator (Fig. 1) that allows nonsurgical reduction of fat in fibrous areas, such as the lateral thigh saddlebags and upper abdomen, which previously were not amenable to treatment by CoolSculpting.

The Marina Experience Our experience with CoolSculpting at Marina Plastic Surgery has been extremely positive. The first system was purchased in 2009, when nonsurgical fat reduction was in its infancy and we were unsure how CoolSculpting would contribute to our plastic surgery practice. Very quickly we realized that patients were eager to explore nonsurgical procedures not only for their faces but for their bodies, too. Our CoolSculpting business grew, and we added our second system in 2011. Demand for nonsurgical body contouring continued to increase, so we added our third system at the beginning of 2012 and our fourth at the end of 2012. Patient interest in nonsurgical body contouring continued to grow, and we added our fifth and sixth systems in mid-2013 and our seventh in 2014.

Marina Plastic Surgery now has five clinicians who perform CoolSculpting, with an average of over 100 treatment cycles per week. We are the top CoolSculpting practice in the United States, with over 10,000 cycles completed. CoolSculpting has brought in new patients to the practice. In a retrospective review of our CoolSculpting patients, we found that 66% were new to the practice. Of these new patients, 62% were aesthetic neophytes, and 40% became established patients who received secondary and tertiary procedures.

Our clinicians have revolutionized the practice of CoolSculpting, developing the assessment and treatment method that is now known as Treatment to Transformation. This is a nonsurgical CoolSculpting treatment protocol that can produce higher patient satisfaction and results that rival those of liposuction. We have explored CoolSculpting for fat reduction not only in the abdomen and flanks, but also in the inner thighs, arms, back, and male chest. We have successfully recontoured almost the entire body, but until a non-vacuum applicator was developed, we were unable to use CoolSculpting to treat fibrous, non-pinchable fat.


CoolSculpting the Whole Body
The conformable surface CoolSculpting applicator (CoolSmooth) addresses a previously unmet clinical need in nonsurgical body contouring. Non-pinchable fat in areas such as the lateral thighs can be treated without vacuum suction by applying surface cooling from conformable cooling plates. As shown for a lateral thigh treatment in Fig. 2, the patient's skin is covered by a protective gel pad, and a conformable surface CoolSculpting applicator is positioned over the saddlebag bulge on the lateral thigh and secured with a strapping system. Because the targeted fat cannot be pulled away from the body by vacuum suction, the treatment duration is 2 hours to deliver sufficient cooling to the subcutaneous fat layer.

Marina Plastic Surgery was a clinical study site for the new conformable surface applicator. Representative study subjects are shown in Fig. 3 and Fig. 4. The lateral thigh curvature is visibly reduced 4 months after treatment, resulting in a smoother contour. This applicator noticeably reduced undesirable saddlebag bulges.

In our study of 40 subjects, high safety and efficacy were observed. All side effects, including erythema (reddening of the skin), mild swelling, and numbness, were minor and transient. In an efficacy analysis, an independent, blinded review was conducted. Baseline and post treatment clinical photographs were correctly identified in 87% of patients. On ultrasound image analysis, the mean normalized reduction in fat thickness was 2.6 mm, a statistically significant reduction compared with the untreated, control thigh. Patient surveys indicated that 89% of patients would recommend lateral thigh CoolSculpting to a friend, 86% were satisfied with the treatment, 86% noticed visible fat reduction, and 97% were likely to have a second treatment.

Since the conformable surface applicator was commercially launched, we have explored it for CoolSculpting treatment of not only the lateral thighs, but also for the medial thighs and abdomen. For subcutaneous fat that is not readily pulled into a vacuum cup, the CoolSculpting surface applicator can be used for nonsurgical body contouring. With the addition of the non-vacuum conformable surface applicator, the CoolSculpting applicator portfolio provides options for nonsurgical contouring of the entire body.

Conclusion The new CoolSculpting conformable surface applicator provides safe and effective reduction of lateral thigh fat. Clinical study data demonstrate significant reduction of fat thickness and high patient satisfaction. The CoolSculpting conformable surface applicator noticeably reduced undesirable saddlebag bulges. In commercial treatments, we have also explored use of the CoolSmooth non-vacuum CoolSculpting applicator for treatment of the upper abdomen and inner thighs. The conformable surface CoolSculpting applicator and current portfolio of vacuum applicators allow safe and effective reduction of subcutaneous fat for the whole body. For patients who are reluctant to undergo surgery, CoolSculpting provides an alternative that may produce liposuction like results.

Disclosure: Dr. Stevens is the Director of Marina Plastic Surgery, Clinical Professor of Surgery and Director of the Aesthetics Division of the University of Southern California Division of Plastic Surgery, and the Director of the Marina del Rey–University of Southern California Aesthetic Surgery Fellowship.


  1. Stevens WG, Bachelor EP. CoolSculpting conformable surface applicator for non-surgical fat reduction in lateral thighs. Aesthet Surg J (in press).
  2. Boey GE, Wasilenchuk JL. Fat reduction in the inner thigh using a prototype CoolSculpting applicator. Dermatol Surg (in press).
  3. Stevens WG, Pietrzak LK, Spring MA. Broad overview of a clinical and commercial experience with CoolSculpting. Aesthet Surg J 33:835-846, 2013.
  4. Sasaki GH, Abelev N, Tevez-Ortiz A. Noninvasive selective CoolSculpting and reperfusion recovery for localized natural fat reduction and contouring. Aesthet Surg J 34:420-431, 2014.
  5. Dierickx CC, Mazer JM, Sand M, et al. Safety, tolerance, and patient satisfaction with noninvasive CoolSculpting. Dermatol Surg 39:1209-1216, 2013.

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