Salvatore DiMercurio, M.D., a Maryland-based plastic surgeon, explains the Coolsculpting procedure and how it can freeze away fat.
Interview conducted by Ivanhoe Broadcast News in March 2017.
Any concerns of doctors not using this procedure that you are using, CoolSculpting? Have you heard any concerns from others?
Dr. DiMercurio: It’s a procedure that’s fairly safe but in any situation if it’s not used appropriately it could be dangerous.
There are some who say that only surgical intervention in the abdominal area will work. You do CoolSculpt so what is it about it that you find works for people?
Dr. DiMercurio: The CoolSculpt is not a substitute for liposuction and it’s not a substitute for tummy tuck. You have to get the appropriate patient. If you have someone who has a lot of skin laxity they’re not even a good candidate for liposuction so they’re not going to be a good candidate for CoolSculpt. CoolSculpting is sort of a modest liposuction, I think of it as maybe a twenty five percent of what liposuction would do. Where I think liposuction would give you about an eighty five percent improvement. If you’re not a candidate for liposuction you’re not a candidate for CoolSculpting. CoolSculpting is noninvasive, there is no down time, there is no anesthesia and for some people that’s the right choice. I try to choose people that would have a benefit meaning that they’re not looking for weight loss, they’re not looking for skin tightening, they’re looking for an area that’s been very difficult to get rid of. Usually the almost ideal weight patient with the pocket of fat that they can’t get rid of is the best patient. I will tell you that I do a fair amount of liposuction and I do tell my patients that are considering CoolSculpt that if they’re expecting more fat removal they’re not going to get it from CoolSculpting.
When you use the hoses and I know there’s different types and different nozzles on there, what is it actually doing during the process of CoolSculpting?
Dr. DiMercurio: The mechanical process of CoolSculpting is very simple. It essentially freezes or cools down the body temperature of the tissue that you put in to a canister. For example, this has an area where your body tissue is sucked in to. Sort of like a vacuum. If we can fill this area with some fatty tissue and some skin then the hand piece regulated by the machine will go in to a cooling mechanism. Much like a refrigerator will cool down that tissue to a certain temperature. I did some studies when I was in my surgical training where we tried to save skin and grow skin in the lab. I know that certain techniques when you cryo-preserve keep things alive. We use almost the opposite of those to make that tissue die, it crystallizes. The real trick and the real beauty of this technique and the inventors where they found a way to cool the fat but not kill the skin.
How does that happen where it attacks the fat but does not hit the skin?
Dr. DiMercurio: Both tissues have different tolerance for cold and the tolerance for skin is greater than the tolerance for fat. You find that magic amount of tissue tolerance and you protect the skin and there are certain types of protection that we put over the skin to try and minimize any injury to the skin. But fat has less tolerance so therefore over a period of time you can actually crystallize some of the fat cells and once you have crystallization most of the fat cells gradually either die or disintegrate.
Once that happens, once those fat cells crystallize how does the body eliminate that?
Dr. DiMercurio: The same way it eliminates anything in our system. Capillaries bring the fat cells or whatever is relieved from the dead lissome, goes in to the blood stream, goes to the liver and it gets processed much like you would an order of French fries.
How many people within your practice have you done this on and what’s the percentage roughly male to female?
Dr. DiMercurio: I would say that we’ve been doing this for the last ten years almost and we’ve done hundreds of patients. Ninety percent are female maybe ten percent are male although the male patients are starting to increase with time. I think that once they see their wives so they say can you do this to my hips or possibly some lower abdomen. Interestingly with men we deposit fat on the inside of our abdomen versus on the outside of the abdominal wall. Women are actually a better candidate for lower abdominal fat than men. Unfortunately, many times women have children the skin becomes more lax so that plays in to that decision.
If somebody is looking at their abdomen and you said if the skin is really relaxed they are not a good candidate. Anybody looks at themselves with an overly critical eye so what are some of the parameters on that?
Dr. DiMercurio: Well I think that the term pannus is what we use when skin actually drapes. Anyone who has a pannus is not a good candidate. Now I’ve also had patients who said, I don’t mind the pannus I just want less of a pannus, I’ll tuck it in my pants. We’ve actually done a few patients who probably weren’t the ideal candidate, some of them actually were okay with it and were comfortable with it and many of them came back to do a more formal tummy tuck or some type of tiny procedure.
How long does the procedure take when it’s actually being done?
Dr. DiMercurio: Each of these canisters need to be on the tissue for about an hour. There are some new procedures that we’re looking in to where it could be as short as forty five minutes and we keep getting different options for canisters. We now have hand pieces that work underneath the neck for those of us that have a little extra tissue here. We now have canisters and hand pieces that work on the lateral thighs which generally were not a very good place because you couldn’t get a good suction. In general I think about an hour for each area and it’s not uncommon for someone to have several areas treated in one time.
How many sessions do they have to have and does the fat come back?
Dr. DiMercurio: I recommend to most patients to think of two sessions even reapplying it to the same area six to eight weeks later. Because even though we have some good results with four to eight weeks post treatment we find that if we treat that same area again you even get better results. If they are good candidates, the skin quality is good, they have good, you know, elastic recoil you know one treatment to that area might do it but two treatments generally is better. I would say that most people would have about anywhere from four to eight treatments in one day and that’s a pretty long day. You’re here for seven to eight hours. But it’s fairly comfortable once the application is instituted you have several minutes so the area becomes numb. I know this from personal experience because I tested myself on one hip three years ago. I was expecting the cold to go away in three minutes, it took seven minutes and I was counting. But once it settled I essentially was able to read my journals and take a nap if I wanted to. I didn’t notice much of a difference for four weeks but by the fifth or sixth week I started noticing something and by eighth week I couldn’t deny that there was a difference between the two sides.
What did it look like?
Dr. DiMercurio: Just less fat. I’m not an ideal candidate because I was using it as a test. I would think a thinner patient with maybe a little more localized area would be better. But three years later it’s still different, it’s still smaller on that side.
What is the cost estimate and does insurance pick it up?
Dr. DiMercurio: Insurance does not cover this, this is a cosmetic procedure. Just to clarify cosmetic is a normal function and we won’t approve it as opposed to reconstruction where we’re actually re-creating something to create normality. There’s a misconception sometimes that people say, I have an abnormal breast or I have an abnormal pocket of tissue somewhere and removing that is cosmetic. If it’s abnormal to be there and you’re re-establishing normality, that’s reconstruction. Most of this is normal pockets of fat that we just don’t like and we just want to re-establish an improvement.
Just a price estimate of that procedure.
Dr. DiMercurio: It’s probably about thirty percent of what liposuction costs. Liposuction would range in the five to seven thousand range. This may be two to three thousand range or even lower depending on the amount of areas. A single area may be as low as seven hundred dollars. We do discount multiple areas so if you’re having five or six areas versus two. If you repeat that you have to double that price. It could be pretty costly. There are certain situations where the cost of the CoolSculpting may be pretty close to the liposuction if you are having multiple sites done. We caution patients to kind of make that comparison. You certainly would get a bit more fat removal with liposuction, well not a bit but significantly more fat removal with liposuction. But for those patients who are on the go and really just want to be able to have this procedure done and then go about their business there’s very minimal if any down time.
Is there anything else?
Dr. DiMercurio: One other item. There are always downsides to every procedure; CoolSculpt is not without any risks obviously. You can cause some nerve irritation and we’ve had a few patients who have had tingling and pain. We’ve had some patients that have had some prolonged tingling or pain. Most of the patients I’d say ninety plus percent do very well. But there are a few patients that have a lingering discomfort, some of them enough that they require some pain medication.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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