For nearly all patients, choosing between CoolSculpting (Allergan) or liposuction for fat removal comes down to a personal preference, according to Maria Atkins, D.O., owner and medical director of the Cosmetic Enhancement Center of New England in Portland, Maine.
“In general, I do not convey my own preferences to patients as to which of the two modalities is a better choice for them,” Dr. Atkins tells The Aesthetic Channel. “The decision should be patient-driven, based on the patient’s desire for quick results or not being worried about downtime or avoiding an invasive procedure or not having any risk of scarring.”
Dr. Atkins notes that even large patients can achieve good results with the noninvasive CoolSculpting. “They may not attain weight loss, but that is the same as with liposuction,” she says. “Regardless, patients can end up with dramatic reduction in fat with either CoolSculpting or liposuction. But there is a significant difference in downtime and recovery.”
Lipo vs CoolSculpting
With CoolSculpting, each individual treatment session will reduce the amount of fat in a particular area by about 20%, according to Dr. Atkins, with the first session targeting between 1 and 10 areas. “Patients who undergo more circumferential treatment all in one visit will achieve a much better result,” she says.
Patients return two months later for the same pattern of treatment. In total, there are two or three sessions with CoolSculpting, spaced two months apart.
In contrast, liposuction provides much more dramatic results in a single treatment. “Sometimes there is an 80% to 90% improvement, depending on how much fat the patient has to begin with,” Dr. Atkins states. “The results are also instant.”
However, during the first three days of recovery with liposuction, there will be some drainage, and bruising can last up to three weeks. “There are also tiny scars where the cannulas entered the body,” Dr. Atkins says. “Patients do not feel their treated areas are completely tenderless and healed until six to eight weeks. But most patients can return to work within one week, depending how much fat is actually removed during a visit.”
Although CoolSculpting is completely noninvasive, the procedure does cause slight numbness on the surface of the skin for a few weeks afterward and perhaps a little pins-and-needles sensation for about a week. “Especially with the newer handpieces, there is no bruising,” Dr. Atkins says. “After the procedure, patients can immediately go to the gym or work.”
In the past, when CoolSculpting first became available, “it was slightly more uncomfortable because the handpieces were a lot more ‘pinchy’,” says Dr. Atkins, who has been offering the treatment since 2010. “Now, very rarely is there discomfort.”
Similarly, by administering local anesthesia for low-volume liposuction, “the patient does not really feel anything,” Dr. Atkins says.
For the same results, the patient cost for CoolSculpting is about 20% more than for liposuction, according to Dr. Atkins, due to the need for multiple CoolSculpting treatment sessions.
A Question of Patient Selection
Despite several advantages of CoolSculpting over liposuction, patients with an abdominal hernia who seek treatment in that area are not candidates for CoolSculpting, Conversely, liposuction can be difficult for patients who have had abdominal surgery because the cannulas do not pass through the skin as easily.
“Obviously, patients need to be in good general overall health to qualify for surgery like liposuction, but health status is not a consideration for CoolSculpting,” says Dr. Atkins, who notes that the vast majority of her patients are candidates for either procedure. “A small percentage of people are simply too unrealistic in their expectations and too heavy to undergo either treatment.”
Most patients come to Dr. Atkin’s office for CoolSculpting, largely because it is noninvasive. “Still, liposuction will continue to be popular for people who need a large amount of fat volume removed,” she says, pointing out that candidates with lax skin and overhang may also need a tummy tuck. “Liposuction is also ideal for women with excessive scarring post-pregnancy who want to get rid of that scarring.”