Does CoolSculpting Actually Work?

It's complicated.

Skincare supplements, cellulite creams, a deal on comedy club tickets in Times Square—most things in life that sound too good to be true usually are. And if you, like me, have been burned one too many times by false promises, you’ve likely become somewhat of a skeptic who trusts nothing and no one.


So when CoolSculpting, a non-invasive, fat-freezing treatment, became the topic of conversation after the FDA cleared it in 2010, you can guess how I felt about it. But here we are, 10 years later, and people are still talking about the procedure, so I decided maybe I should put my naysaying aside and finally find out once and for all: Does CoolSculpting work? Below, board-certified dermatologist Paul Jarrod Frank, MD, answers my many fat-freezing questions. Keep reading to find out what to know before trying CoolSculpting, or in my case, before writing it off completely.


Does CoolSculpting actually work?

Well, that depends on what you mean by “work.” Will it sculpt your body and replace a healthy diet and regular exercise? Definitely not. Will it make you lose weight? Nope, it won’t work like that either. However, it will work to reduce small amounts of fat in stubborn areas. “It does actually work—there is science behind it,” Frank explains. “If you reduce the temperature of fat to a certain degree, cells go into what’s called apoptosis, which means they kill themselves, and your body digests the by-products of that. The magic of it is you’re cooling down the skin to a temperature where it hurts the fat, but it doesn’t hurt the skin, and that’s why it works so well.”


The real problem is it doesn’t work for everybody. “The patient it works best for is someone with pinchable, plump fat, but small amounts is what’s important,” Frank says. “Someone who has 3 pounds of pinchable fat to remove in an area rather than 10 pounds. It’s for that patient who’s maximized diet and exercise, has pinchable fat in areas that are resistant—a love handle, an inner or outer thigh, a little on the lower belly.” And despite the name, it’s very difficult to actually sculpt with CoolSculpting, and it works much better for spot treating.


Does CoolSculpting tighten loose skin?

Well, kind of but not really. Frank says, theoretically speaking, there is a natural contraction that occurs when you remove fat with any treatment, but there’s nothing particular about the CoolSculpting technology that causes skin tightening. “There are some competing technologies like SculpSure, which have a heat-based laser that the technology itself can, hypothetically, tighten the skin in addition to removing fat, but CoolSculpting does not have that,” Frank adds.


What are the negative effects of CoolSculpting?

If you’ve done your online digging, you might have heard that one downside of CoolSculpting is the possibility of uneven fat removal, and for the first time, maybe ever, the internet is right. This is one of the biggest risks of relying on a technology rather than on the human hand,” Frank says. Also, he adds that if the handpiece is not placed appropriately, there can be ridging or an area of drop-off that shows the shape of the handpiece where the fat was removed.


The other big rumor swirling around the internet is that your fat can actually come back. And while it’s possible, Frank says generally in all fat removal technologies, including liposuction, the results should last if you remain weight-stable. Another side effect that’s rare (but it can happen, so I’m gonna tell you about it) is what’s called lipohypertrophy, which is where there is a rebound of the fat growth, and it actually grows instead of shrinking.


“These are all side effects that can occur, and they’re ones I’ve seen,” Frank says. “A lot of it has to do with the manner in which the treatment is given. There is skill to applying the handpiece. You have to make sure you don’t do the same area within a three month period, and the whole treatment has to be planned out appropriately by someone who’s skilled at doing it.” Because there are risks like the above mentioned, and precautions that must be taken, please promise me you’ll see a licensed healthcare provider to perform the treatment. Cool? Cool.


Does freezing fat hurt?

In the world of procedures, it’s not the most painful, but Frank says it’s not totally without discomfort, either. You know that feeling when you come inside from the cold and sit in front of a fire, and you get that aching pain until your numb hands warm up again? Yeah, it’s like that. A CoolSculpting session used to take an hour to treat each section, but Frank says they’ve decreased the treatment times to half an hour, so whatever pain you experience during the process is at least short-lived. Also, since the process requires pulling, tugging, and pinching the skin, you could experience slight bruising and soreness.


How long does it take for CoolSculpting to work?

If you were hoping to walk out of your appointment looking all sculpted and chiseled, I'm sorry to disappoint you again. How noticeable your results are depends on the number of treatments you get, but either way, the effects aren’t immediate. On average, you could start noticing changes in one to three months, but it could take six months for the full results—definitely something to consider when timing the appointments.