90 Cryolipolysis

Nathaniel L. Villanueva, Daniel J. Gould, Cory Felber, and W. Grant Stevens

Abstract

Cryolipolysis provides a nonsurgical modality to treat regional lipodystrophy in appropriately selected patients seeking to avoid surgical procedures and the downtime associated with liposuction. There are various treatment applicators, which have contour attachments to treat areas throughout the body. An important distinction in selecting applicators is whether or not the fat in the treatment area can be pinched. If so, applicators that have vacuum assistance can be used, whereas nonpinchable areas require flat applicators. Following the procedure, the treatment area should be massaged to improve the efficacy of treatment. Overall, cryolipolysis is a safe and effective treatment for nonsurgical subcutaneous fat reduction.

Cryolipolysis – CoolSculpting – noninvasive – body contouring – paradoxical hyperplasia

90 Cryolipolysis

Key Points

Cryolipolysis is a safe and effective procedure for nonsurgical reduction of subcutaneous fat.
Many areas on the body can be treated including submental, submandibular, arms, back, chest, flanks, abdomen, back, and thighs.
Pinchable, subcutaneous fat can be treated with suction-assisted applicators, whereas nonpinchable fat (i.e., lateral thigh) can be treated with nonsuction, flat-panel applicators.
Massage immediately following treatment of the treated areas improves efficacy of cryolipolysis.

90.1 Preoperative Steps

Perform a standard history and physical including a whole-body assessment.
- Contraindications include: Cryoglobulinemia, paroxysmal cold hemoglobinuria, cold agglutinin disease.
- Relative contraindication: Cold intolerance and Raynaud’s disease.
It is important to establish realistic expectations for patients who will benefit from cryolipolysis and discuss the results attainable with this modality compared to surgical interventions.

Create a treatment plan with the patient explaining that although there are recommended numbers of treatment cycles, the total number of treatments to obtain results may vary with each patient (Table 90.1).

**Table 90.1** Typical numbers of treatments per site
Treatment site	Number of treatments Per site
Flanks	1 to 3
Abdomen	1 to 3
Inner thigh	1 to 2
Outer thigh	1 to 2
Submental area	1 to 2
Upper arm	1 to 2

Identify areas with pinchable fat and nonpinchable fat as this will dictate what applicators should be used (Table 90.2).

**Table 90.2** Applicators, contours, and treatment sites
Applicators	Contours	Treatment areas
CoolMini^TM	N/A	Submental Submandibular Bra fat
Cool Advantage Petite^TM	CoolFit^TM CoolCore^TM CoolCurve^TM	Upper arms Flanks Abdomen Thighs
Cool Advantage^TM	CoolFit^TM CoolCore^TM Cool Curve^TM	Upper arms Flanks Abdomen Thighs
Cool Advantage Plus^TM	CoolCore^TM CoolCurve^TM	Flanks Abdomen Thighs
Cool Smooth^TM	N/A	Lateral thighs Upper abdomen

Mark the patient using the templates for the applicators which will be used. The templates will also help determine which applicators and corresponding contour attachments should be used depending on the convexity of the lipodystrophic area being treated.
The risks and benefits of the procedure should be discussed with the patients and they should also be aware of paradoxical hyperplasia, which may occur 2 to 5 months after treatment and requires surgical excision.