Key Points

• 
  

  Cryolipolysis is based on the concept that lipid-rich tissues are more susceptible to cold injury than surrounding water-rich tissue (▶ Fig. 20.1 ). ^{1 , 2 , 3 , 4}

  
  
• 
  

  The method involves controlled application of cooling within the temperature range of -11 to 5°C. ^{1 , 5 , 6}

  
  
• 
  

  Cryolipolysis targets adipocytes while sparing skin, nerves, vessels, and muscles. ⁷

  
  
• 
  

  This technology appears to be safe in the short and long term. It has not been shown to have any effect on cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, liver function (aspartate aminotransferase (AST)/alanine aminotransferase (ALT) bilirubin), albumin, or glucose. ⁷

  
  
• 
  

  The mechanism for cryolipolysis is not fully understood. Theories include adipocyte apoptosis by cellular edema, reduced Na-K-ATPase activity, elevated lactic acid levels, and mitochondrial free radical release. Ultimately, an inflammatory process leads to adipocyte death and removal by macrophages within 3 months. ⁸

  
  
• 
  

  Complications are rare and typically resolve a few weeks after treatment. Adverse events include erythema, bruising, swelling, sensitivity, and pain. No persistent ulcerations, scarring, paresthesias, hematomas, blistering, bleeding, hyperpigmentation/hypopigmentation, or infections have been described. ^{8 , 9 , 10}

  
  
• 
  

  Few isolated case reports have described paradoxical adipose hyperplasia after cryolipolysis treatment (est 1:20,000). ^{11 , 12 , 13 , 14 , 15}