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CoolSculpting - Worth It, or Worthless? (Ep. 61)

american society of plastic surgeons Fellow American college of surgeons American Board of Physician Specialties American College of Surgeons The Aesthetic Society American Society for Mass Spectrometry american cleft palate-craniofacial association International Society of Aesthetic Plastic Surgery
american society of plastic surgeons Fellow American college of surgeons American Board of Physician Specialties American College of Surgeons The Aesthetic Society American Society for Mass Spectrometry american cleft palate-craniofacial association american society of plastic surgeons Fellow American college of surgeons American Board of Physician Specialties American College of Surgeons american board of surgery The Aesthetic Society American Society for Mass Spectrometry american cleft palate-craniofacial association International Society of Aesthetic Plastic Surgery

The Trillium Show Podcast with Dr. Jason Hall

CoolSculpting - Worth It, or Worthless? (Ep. 61)

Disclaimer: The discussions on this podcast do not constitute medical advice, an evaluation, or a consultation. Nothing in the podcast episodes should be considered a replacement or substitute for a formal in-office evaluation by Dr. Hall or his associates. Explanation of off-label services and/or products do not constitute promotion and/or endorsement. Information and opinions presented here do not create a formal doctor-patient relationship. Discuss any potential medical procedures or interventions with your physician or surgeon first.

Show Notes

In this episode of The Trillium Show, I dive into the world of CoolSculpting, exploring its pros and cons. Learn about the differences between CoolSculpting and liposuction, who the best candidates are for each procedure, and the potential risks involved. Whether you're considering a cosmetic procedure or just curious about the science and business of CoolSculpting, this episode provides an in-depth look at what you need to know.

All right, welcome to The Trillium Show, where we discuss tips to help you improve your mind, your body, and your life. I'm your host, board certified plastic surgeon and medical director of Trillium Plastic Surgery and Trillium Aesthetics, Dr. Jason Hall. What's a good procedure to thin your wallet and maybe, or maybe not, thin out some fluffy spots that you've got?

Cool sculpting, freezing away fat, or known as cryolipolysis to us like nerdy medical types, isn't new. And it's been around for a while, its popularity kind of waxes and wanes, but it never really goes away. In this episode, at one of your requests, we're gonna break down the pros and the cons of of cryolipolysis or CoolSculpting.

Now, you can think of CoolSculpting essentially as liposuction. They're similar in how they work. They're similar who they work for. And more importantly, they're similar who they don't work for. And the potential final results are pretty much exactly the same. the same. So let's take a look at a list of pros and cons, and we'll kind of talk about the whole, how the whole business of CoolSculpting itself works.

So in terms of the pros, the big thing, and everybody out there who hasn't been living under a rock who has heard about CoolSculpting knows about this, is that unlike liposuction, CoolSculpting is an office based procedure. There's no operating room. There's no anesthesia. There's no need for somebody to drive you to the office and drive you home.

There's no prolonged recovery. There's no time off of work. You essentially walk into an office, you get hooked up to a machine, and between half an hour and an hour and a half, you get up, you walk out the door. The results, like liposuction, So, kind of breaking it down, it's fast, it's relatively painless, and it's permanent.

That's like the holy grail of any cosmetic surgery treatment. But before you jump to that conclusion, it's important to understand what the list of drawbacks are. So, what are some of the drawbacks of CoolSculpting? Well, first, the results of CoolSculpting are unpredictable. CoolSculpting works, and cryolipolysis itself works, by injuring the skin. So essentially it freezes the fat. It causes the fat cells to die. And then the fat cells and the fat that's in them are essentially reabsorbed by your body.

Sometimes this process works exactly like it should, but because the depth of freezing and the extent of tissue injury can only be sort of controlled, CoolSculpting sometimes leaves behind some fat. Sometimes it doesn't. It doesn't leave behind enough fat, and too much is injured, and you end up with a divot.

So, it can remove not enough, it can remove too much, and there's really not a way to control that. Sometimes, and this is one of the rare, unique problems with CoolSculpting, is that there's something called Paradoxical Adipose Hyperplasia, or PAH. And, as the word paradoxical implies, We really don't understand it and we don't know how to predict it.

And what happens is the areas that you've treated grow. So instead of reducing fat in these areas, the areas that are treated and they're usually like square or oval shaped areas where these applicators go overgrow. So you end up getting this. big fat growth on your abdomen or your flanks. And I've seen this a couple of times.

And as you can imagine, people who have this happen after CoolSculpting aren't happy and are forced to have surgery, sometimes a couple of different surgeries to correct it. Liposuction, on the other hand, is very predictable. The fat is physically removed. We use a hollow metal tube to, put in numbing solution and then suck the fat out.

And we know exactly how much is taken. We don't leave the operating room until it's complete. And we're happy with the contours that we've gotten. Yes, healing is longer with liposuction. Yes, there's more swelling with liposuction, but it is far more predictable than liposuction. non invasive fat reduction with CoolSculpting.

And you do not run the risk of the areas that you treat getting fatter with time. Another problem with CoolSculpting is that the skin can actually be damaged. So the applicator goes on, kind of sucks the skin and fat up into the applicator and freezes it. And that skin in some people can be damaged. It can get darkened.

It can get reddened. There can be like little vascular telangiectasias, which are like spider web veins. Or it can take on this like splotchy appearance. We don't understand exactly who's going to get that and who doesn't. And those results, if that happens, can be permanent and it can be difficult to treat or require other things to try and get rid of that.

after your CoolSculpting session. The other thing is that unlike liposuction, only small areas can be treated at a time. So the applicators for CoolSculpting come in defined shapes and sizes. You can't just essentially do your entire abdomen. You have to do your upper abdomen, you have to do your lower abdomen, you have to do each side of your love handles.

So in those Each one of those applicator treatments is referred to as a cycle in cool sculpting lingo, each one of those cycles you pay for. And so it can get pretty pricey pretty quickly. Each cycle is depending on where you are and who's doing it's roughly 800 bucks and so you can imagine if you have one, two, three, four areas, you know, that's 2, 400, 3, 200.

Sorry about my math. Pretty quickly. And if you figure the average area of liposuction can cost anywhere between 3, 500 and 6, 000, those cost lines cross pretty fast. So the major difference between liposuction on one hand and CoolSculpting on the other is that liposuction is a surgical procedure that is mainly the purview of surgeons.

CoolSculpting on the other hand CoolSculpting is a very expensive machine that anyone with a medical license can buy and then sell treatments to customers, consumers, patients, you. And that means that CoolSculpting is mostly the purview of med spas and non surgical aesthetic practices that don't and can't offer surgical treatment options.

Just as an example, my hometown, Knoxville, Tennessee, where I am, well, not right now, but where I practice is a metro area of 1. 2 million people. Looking on the CoolSculping website, there are 14 CoolSculping providers in the Knoxville metro area. Exactly two of those 14 are plastic surgeons. The rest are non surgical, either stand alone med spas, Or dermatology med spas.

So not surgeons that are running these things. Just as an aside about liposuction, liposuction can be a pain. tricky procedure for surgeons who do it every day. Knowing which patients are going to get a good result and which patients aren't takes time to learn. And there's a lot of art to it. There's, there's not a lot of, you know, sciencey stuff behind choosing an appropriate liposuction candidate versus a candidate that is not somebody who's not appropriate for liposuction.

If you think about the kind of the bell curve of patients who show up asking for liposuction. The two ends are pretty easy to identify the 20 percent on this end that are going to get a great result from liposuction and the 20 percent on this end that are not candidates for liposuction at all are pretty easy to pick out.

It's that so you have 40 percent that are easy. It's the 60 percent in the middle of that bell curve that really can become problematic. Does their skin have enough elasticity to shrink wrap down around? The rest of them after you suck out some of the fat or is their skin Damaged from stretch marks pregnancy time age genetics You know that list goes on where their skin is just going to end up hanging like a sharp hay As a surgeon, if I get that wrong and recommend liposuction, you have a patient with a bad cosmetic result.

You, you, they look like a sharp A. Now, I have to go back and do a second operation to remove that extra skin that they and I didn't anticipate. And as you can imagine, this is not a situation that any surgeon wants to find themselves in. It's not a situation that any patient wants to find themselves in.

Going in for a cosmetic treatment and then needing an unanticipated second operation. And this is why most surgeons are fairly conservative as to who we recommend liposuction alone to. Personally, in the 60%, I make the decision, I err on the side of recommending surgery. I know I can get a good result by removing fat with liposuction and then removing any excess skin that is left over.

You know, most commonly talking about abdominoplasty or tummy tuck surgery. And I would rather. Take the risk of having a patient walk in wanting liposuction recommending a tummy tuck and then having them say, you know I'm not ready for the scar not ready for a big surgery. Maybe let's wait on this one for a while Then having somebody who we do liposuction on that's kind of a marginal candidate And then they come back needing a surgery.

They weren't anticipating and being disappointed or angry or upset with me. So who are the good liposuction candidates in my practice as a general rule? And this is, this is me. This doesn't apply to every surgeon out there. If you're a woman who've had kids, especially multiples, if you've had significant weight fluctuations, so over 40, 50 pounds, , this refers to the, you know, semi glutide ozempic patients.

This refers to the, body contouring after massive weight loss, like bariatric surgery patients. This recurs to, it occurs to anybody who has lost a lot of weight through diet and exercise. You see a lot of that these days too. Or if you're over 50, just to, Strictly because of the changes that happen in your skin over time, it is unlikely that either liposuction or CoolSculpting by itself is going to be a recommended treatment option and that you have to consider excisional surgery.

So, tummy tuck surgery, body lift surgery, arm lift surgery, you know, neck lift or face lift surgery. Any area that you're looking for is probably going to need to be surgically corrected, not corrected with CoolSculpting or liposuction. I can't talk about CoolSculpting without really talking about the business behind CoolSculpting, because this is really Where the business of aesthetics comes into play.

And just for argument's sake, you can, I'm sure somebody's going to go out there and double check my math and say that's not exactly right. I'm going to be using kind of round numbers to make the math easy because I don't have a whiteboard and I don't want to get out a calculator and do all that. So, let's do a little bit of math.

Aesthetic industry math. So a practice, whoever it is, buys a cool sculpting machine, which costs around 150, 000. A lot of money. And if you, you know, you remember back earlier, 800 to 1, 000 is a typical treatment cycle. At 1, 000 a treatment cycle, you have to do 150 cycles. So you have to treat 150 patients.

to pay off that machine. Now, here's where the business part comes in. 50 percent of that thousand dollars roundabout gets eaten up in consumable costs. So the coolest company machines, you have to have a little card that fits into the machine for each cycle that you run. And those cards, about half of what you make goes back to Allergan, the manufacturer to pay them.

It's just how they make money. And so, Subtract 50 percent or 500 bucks. So now you make, instead of 1, 000, you make 500 off of each treatment. So now the number of patients you need to treat doubles, it's 300 to pay off your machine. Now you get a little bit deeper, the best run med spas. So the top industry, top, top 10 percent of med spas, their overhead is 8, 000.

So 80 cents on every dollar they make goes to pay for rent, marketing, staff, lights, you know, power, all of that stuff. So then 80 percent of your 500 is 400. So now you subtract that out of what you would have made, and off of each 1, 000 treatment you do, You make a hundred dollars. So now to pay off your machine that costs $150,000 instead of the initial 150 patients that you thought you were gonna have to treat, now you have to treat 1500 patients 10 times what you originally thought, and likely 10 times what the sales rep told you when they were doing their pitch in your office to try and get you to buy the machine in the first place.

So, there's significant financial pressures for the spa owners to sell any treatment on this machine to anybody that's going to pay for it. And let's face it, it is the holy grail of medicine. It's fast, it's painless with no downtime. I mean, who, who is not going to want that if it's an option? And what I've seen in, in my 15 years of experience in this field is that, you know, in that 60 percent where I typically air recommending surgery is that a lot of patients who show up wanting this in a non surgical practice end up getting recommended to have CoolSculpting.

The math simply doesn't work for the spas to send somebody away. So you end up getting patients who are marginal candidates. Quite a few patients who are marginal candidates getting offered treatments that may or may not benefit them. And this is really where I've seen this, like cool sculpting doesn't work, is that it's those patients, patients with poor skin quality, patients that are, quite frankly, just they have too much adipose tissue for even liposuction to be a good option.

They, need to have some weight reduction, weight counseling, even bariatric surgery, um, before looking at fat reduction.

that they get offered these treatments and when they get what is, in my mind, a, an anticipated marginal result, the typical non surgical practice answer is, well, you need to go see a plastic surgeon. There's nothing I can do. I mean, cool sculpting didn't work. You, you just need surgery when they probably, truth is they probably needed to see a surgeon from the start.

So in summary, does cool sculpting work? Absolutely, it works. Is it a viable alternative to liposuction by itself? Absolutely, it is. Are there drawbacks? There certainly are. And so, what I would recommend, this is not taking anything away from CoolSculpting itself, is that if it is something that you are interested in, and a lot of people are, that you need to make sure that you are making a decision Knowing what all of the options are.

Are you one of those 20 percent on either end or are you in there in the middle? And if you're in that middle 60% then you need to talk not only about CoolSculpting or liposuction, but you need to talk about excisional surgery so you can make the best decision possible for you. As always, thanks for listening to the show. If you enjoyed this show, please leave a review on Apple Podcasts. This helps other people find the show, and helps get this kind of information out. Do you have an idea that you'd like to see made into a show? This show, for example, was someone off the internet who had written in, wanted to know the pros and cons of, of CoolSculpting.

If you have an idea that you'd like to see made into a show, please leave a review. Email me media@drjasonhall.com. Drop me a DM on Instagram or X @drjasonhall. You can also, if you're watching this on Instagram, you can go to my link tree bio and you can actually leave a voicemail and be anonymously featured on the show as to the intro.

So thanks for listening and we'll see you on the next show.


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