Cryolipolysis: Realistic Expectations Key to Patient Satisfaction

CHICAGO - In contrast to claims made about some noninvasive body-contouring devices, cryolipolysis can and does work, Dr. Elizabeth Tanzi said.

However, careful patient selection and realistic expectations – on both the part of the patient and the physician – are essential to a successful outcome, said Dr. Tanzi, a private practice dermatologist in Washington, D.C.

"Noninvasive removal of fat to contour the body is a reality. However, as we've all been told: If something seems to be too good to be true, it probably is," Dr. Tanzi said. "There are limitations."

Educate patients that cryolipolysis is not a replacement for liposuction to remove large amounts of fat. The technique, instead, is best suited to flatten discreet bulges of fat – around the abdomen, the back, or the "love handles," for example, that are resistant to diet and exercise, Dr. Tanzi said at the annual meeting of the American Society for Dermatologic Surgery, which was held jointly with the American Society of Cosmetic Dermatology and Aesthetic Surgery.

You may need to counter some patient misperceptions about cryolipolysis as well. "This is not 'fat freezing,' no matter how many times you hear that in the media," she said.

This procedure, instead, relies on precise, controlled cooling of fat cells or adipocytes. This strategy exploits the natural vulnerability of adipocytes to prolonged cold exposure, Dr. Tanzi said, and causes the death of these cells without damage to surrounding tissues. The destroyed fat cells are cleared through the body's natural clearance mechanisms. The Food and Drug Administration approved a cryolipolysis device (CoolSculpting, Zeltiq) for marketing in September 2010.

You can tell inquisitive patients that a single cryolipolysis treatment reduced the fat layer an average of 22% for 32 patients in a prospective multicenter study, Dr. Tanzi said. Dr. Jeffrey Dover presented the results at the 2009 American Society for Laser Medicine and Surgery annual meeting.

Counsel patients that cryolipolysis results are not immediate, Dr. Tanzi said. Adipocytes appear intact immediately post treatment, followed by an inflammatory response seen at days 3, 5, and 7. It can take several months for fat cell clearance and full clinical results.

Patients also can expect temporary dulling of sensation in the treated area that typically resolves in 1-2 weeks, Dr. Tanzi said. Erythema can last minutes to hours post treatment but purpura is uncommon. In addition, patients might experience a "dull, deep soreness for several days. It is tolerable, and feels like they have just done a lot of sit-ups."

Patient and physician expectations have to be realistic, Dr. Tanzi said. "I get asked questions by patients over and over again. Does it really work? The answer is yes, but you have to define the terms." Cryolipolysis will improve the body’s contour, but it is not for skin tightening, for example, and it is not a weight loss strategy. "Yes, clothes fit better," she said. "Patients tell me about that, and now it’s part of my conversation in my consultation."

The noninvasive fat removal field – including cryolipolysis and the other body-contouring devices – is still in its infancy, Dr. Tanzi said in a follow-up interview.

Technology changes underway will expand the application of these technologies beyond the abdomen and love handle areas. "Soon we’ll be able to treat other areas, such as arms and thighs, to really get a nice contour improvement there as well," she said.

Dr. Tanzi disclosed that she is on the medical advisory board for Zeltiq.

CHICAGO - In contrast to claims made about some noninvasive body-contouring devices, cryolipolysis can and does work, Dr. Elizabeth Tanzi said.

However, careful patient selection and realistic expectations – on both the part of the patient and the physician – are essential to a successful outcome, said Dr. Tanzi, a private practice dermatologist in Washington, D.C.

"Noninvasive removal of fat to contour the body is a reality. However, as we've all been told: If something seems to be too good to be true, it probably is," Dr. Tanzi said. "There are limitations."

Educate patients that cryolipolysis is not a replacement for liposuction to remove large amounts of fat. The technique, instead, is best suited to flatten discreet bulges of fat – around the abdomen, the back, or the "love handles," for example, that are resistant to diet and exercise, Dr. Tanzi said at the annual meeting of the American Society for Dermatologic Surgery, which was held jointly with the American Society of Cosmetic Dermatology and Aesthetic Surgery.

You may need to counter some patient misperceptions about cryolipolysis as well. "This is not 'fat freezing,' no matter how many times you hear that in the media," she said.

This procedure, instead, relies on precise, controlled cooling of fat cells or adipocytes. This strategy exploits the natural vulnerability of adipocytes to prolonged cold exposure, Dr. Tanzi said, and causes the death of these cells without damage to surrounding tissues. The destroyed fat cells are cleared through the body's natural clearance mechanisms. The Food and Drug Administration approved a cryolipolysis device (CoolSculpting, Zeltiq) for marketing in September 2010.

You can tell inquisitive patients that a single cryolipolysis treatment reduced the fat layer an average of 22% for 32 patients in a prospective multicenter study, Dr. Tanzi said. Dr. Jeffrey Dover presented the results at the 2009 American Society for Laser Medicine and Surgery annual meeting.

Counsel patients that cryolipolysis results are not immediate, Dr. Tanzi said. Adipocytes appear intact immediately post treatment, followed by an inflammatory response seen at days 3, 5, and 7. It can take several months for fat cell clearance and full clinical results.

Patients also can expect temporary dulling of sensation in the treated area that typically resolves in 1-2 weeks, Dr. Tanzi said. Erythema can last minutes to hours post treatment but purpura is uncommon. In addition, patients might experience a "dull, deep soreness for several days. It is tolerable, and feels like they have just done a lot of sit-ups."

Patient and physician expectations have to be realistic, Dr. Tanzi said. "I get asked questions by patients over and over again. Does it really work? The answer is yes, but you have to define the terms." Cryolipolysis will improve the body’s contour, but it is not for skin tightening, for example, and it is not a weight loss strategy. "Yes, clothes fit better," she said. "Patients tell me about that, and now it’s part of my conversation in my consultation."

The noninvasive fat removal field – including cryolipolysis and the other body-contouring devices – is still in its infancy, Dr. Tanzi said in a follow-up interview.

Technology changes underway will expand the application of these technologies beyond the abdomen and love handle areas. "Soon we’ll be able to treat other areas, such as arms and thighs, to really get a nice contour improvement there as well," she said.

Dr. Tanzi disclosed that she is on the medical advisory board for Zeltiq.

CHICAGO - In contrast to claims made about some noninvasive body-contouring devices, cryolipolysis can and does work, Dr. Elizabeth Tanzi said.

However, careful patient selection and realistic expectations – on both the part of the patient and the physician – are essential to a successful outcome, said Dr. Tanzi, a private practice dermatologist in Washington, D.C.

"Noninvasive removal of fat to contour the body is a reality. However, as we've all been told: If something seems to be too good to be true, it probably is," Dr. Tanzi said. "There are limitations."

Educate patients that cryolipolysis is not a replacement for liposuction to remove large amounts of fat. The technique, instead, is best suited to flatten discreet bulges of fat – around the abdomen, the back, or the "love handles," for example, that are resistant to diet and exercise, Dr. Tanzi said at the annual meeting of the American Society for Dermatologic Surgery, which was held jointly with the American Society of Cosmetic Dermatology and Aesthetic Surgery.

You may need to counter some patient misperceptions about cryolipolysis as well. "This is not 'fat freezing,' no matter how many times you hear that in the media," she said.

This procedure, instead, relies on precise, controlled cooling of fat cells or adipocytes. This strategy exploits the natural vulnerability of adipocytes to prolonged cold exposure, Dr. Tanzi said, and causes the death of these cells without damage to surrounding tissues. The destroyed fat cells are cleared through the body's natural clearance mechanisms. The Food and Drug Administration approved a cryolipolysis device (CoolSculpting, Zeltiq) for marketing in September 2010.

You can tell inquisitive patients that a single cryolipolysis treatment reduced the fat layer an average of 22% for 32 patients in a prospective multicenter study, Dr. Tanzi said. Dr. Jeffrey Dover presented the results at the 2009 American Society for Laser Medicine and Surgery annual meeting.

Counsel patients that cryolipolysis results are not immediate, Dr. Tanzi said. Adipocytes appear intact immediately post treatment, followed by an inflammatory response seen at days 3, 5, and 7. It can take several months for fat cell clearance and full clinical results.

Patients also can expect temporary dulling of sensation in the treated area that typically resolves in 1-2 weeks, Dr. Tanzi said. Erythema can last minutes to hours post treatment but purpura is uncommon. In addition, patients might experience a "dull, deep soreness for several days. It is tolerable, and feels like they have just done a lot of sit-ups."

Patient and physician expectations have to be realistic, Dr. Tanzi said. "I get asked questions by patients over and over again. Does it really work? The answer is yes, but you have to define the terms." Cryolipolysis will improve the body’s contour, but it is not for skin tightening, for example, and it is not a weight loss strategy. "Yes, clothes fit better," she said. "Patients tell me about that, and now it’s part of my conversation in my consultation."

The noninvasive fat removal field – including cryolipolysis and the other body-contouring devices – is still in its infancy, Dr. Tanzi said in a follow-up interview.

Technology changes underway will expand the application of these technologies beyond the abdomen and love handle areas. "Soon we’ll be able to treat other areas, such as arms and thighs, to really get a nice contour improvement there as well," she said.

Dr. Tanzi disclosed that she is on the medical advisory board for Zeltiq.