Coolsculpting Side Effects – Introduction
Cryolipolysis, also named coolsculpting, is a non-surgical procedure involving the application of local cold temperatures to the skin and subcutaneous tissues. Cold is believed to induce apoptosis (programmed cell death) of fat cells, also called adipocytes.
After that, cells that participate in inflammatory processes clean the dead adipocytes for a period of weeks.
Any procedure performed could carry its risks. We all have a notion that there are adverse effects to drugs, surgeries, phlebotomies, x-rays, etc., but we all may have undergone such procedures for a specific purpose. This clearly shows that we, as individuals, have to make decisions about our health-related issues.
Therefore, knowing the risks of what we are exposed to in the context of the benefits or values to be achieved is relevant.
This article will explain the adverse reactions associated with coolsculpting, their frequencies, mechanisms, and severity, to help physicians and patients understand the benefit-to-risk relationship of their particular contexts.
Benefits and descriptions of the procedure can be found in related articles on this blog.
Milder Side Effects of Coolsculpting
Let us start by defining the different side effects associated with cryolipolysis and depicting how frequent they are and how they are produced.
According to two systematic reviews, coolsculpting side effects are generally mild: (1, 2)
Erythema, a red skin discoloration, is the most common coolsculpting side effect, accounting for almost 100% of cases. (1) Erythema is most likely produced by vasodilation, a process in which several blood vessels expand to augment the amount of heat delivered to the zone.
Swelling, another common side effect of coolsculpting, accounts for a similar percentage of erythema, probably produced by the same mechanisms. (1)
Pain, accounting for approximately 26-96% of the cases, may be produced by stimulating pain nerve fibers in the skin. (1) They stop conducting stimuli after several minutes because cold temperatures diminish the activity of excitable tissues. Therefore, most of the time, the pain is mild to moderate in intensity and decreases from minutes to days.
Numbness is described in 28% of the cases explored by this study. (1) The mechanism by which numbness develops is similar to that of pain. There are multiple nerve fibers in our skin, not just those that conduce pain stimuli, but also pressure, position in space (proprioception), and vibration.
Because the latter three are myelinated fibers, they take a longer time to stop conducting. Therefore, the sensation experienced is that of poor sensation or numbness.
Bruising can occur in patients with capillary fragility and has been reported in 9.5-21% of cases. (1)
Hypersensitivity to tactile stimuli appears in about 3% of the cases. (1) This feature likely occurs due to the weakness that nerve fibers experience after exposure to cold. As neural transmission resumes, even mild stimuli that do not typically produce pain can elicit it.
Moderate to Severe Coolsculpting Side Effects
Unfrequent but more severe effects were described in the last decade. Bearing in the context that coolsculpting is a non-invasive method for fat reduction, these side effects are considered moderate to severe due to the failure to achieve the cosmetic goal or even the worsening of the affected site. Fortunately, these are very infrequent, and scientists are studying ways to avoid them.
Paradoxical Adipose Hyperplasia (PAH) occurs in about 0.05-0.39% of cases and is associated with male sex and European ethnic origin. (3) Although very unfrequent, this side effect could augment the fat tissue in the site initially treated.
The underlying mechanism of PAH is hypothesized as a response to mechanical stress by connective tissue surrounding adipocytes. (4) This tissue then stimulates nearby adipose tissue to grow instead of undergoing apoptosis, producing a mass of adipocytes 3-6 months after the procedure.
Frostbite lesions are those produced by the excess cold to a tissue. This side effect has been recently described in case reports and is associated with defective use of devices, poor training by providers, or at-home procedures with no professional overlook. (5) If severe, frostbite lesions could produce skin necrosis, requiring prompt medical attention to diminish the amount of necrotic tissue involved and prevent complications such as local infections.
How to Deal With Side Effects of Coolsculpting?
The first and most crucial point is to know that they are possible. Second, discussing them and one’s risk for side effects with a practitioner helps make an informed decision.
Once the procedure has been undergone, constant communication about results and side effects with practitioners is helpful for the patient to receive guidance and for the practitioner to receive feedback and monitor the patient.
Mild coolsculpting side effects usually resolve in 1-3 weeks and are managed with analgesics and topical measurements.
Paradoxical Adipose Hyperplasia usually requires a surgical procedure called liposuction to repair the defective adipose tissue.
Frostbite lesions need urgent care because there could be tissue that is not entirely dead, and physicians take measurements to attempt to recover it. Also, dead tissue could be a site for infection, a scenario that may worsen the cosmetic results and increase the probability of morbidity in affected subjects.
Generally speaking, coolsculpting is a safe, non-surgical procedure for adipose tissue reduction. It is well-tolerated among people who have contraindications to undergo surgery. The procedure’s risks and benefits should be thoroughly reviewed between the patient and the practitioner to decide whether to undergo cryolipolysis. Information and education about coolsculpting side effects are beneficial for understanding the best treatment option for each individual.
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1. Ingargiola MJ, Motakef S, Chung MT, Vasconez HC, Sasaki GH. Cryolipolysis for fat reduction and body contouring: safety and efficacy of current treatment paradigms. Plast Reconstr Surg. 2015 Jun;135(6):1581-1590. doi: 10.1097/PRS.0000000000001236. PMID: 26017594; PMCID: PMC4444424.
2. Hedayati B, Juhász M, Chu S, Mesinkovska NA. Adverse events associated with cryolipolysis: a systematic review of the literature. Dermatologic Surgery. 2020 Oct 1;46:S8-13.
3. Keaney TC, Naga LI. Men at risk for paradoxical adipose hyperplasia after cryolipolysis. Journal of Cosmetic Dermatology. 2016 Dec;15(4):575-7.
4. Nikolis A, Enright KM. A multicenter evaluation of paradoxical adipose hyperplasia following cryolipolysis for fat reduction and body contouring: a review of 8658 cycles in 2114 patients. Aesthetic Surgery Journal. 2021 Aug;41(8):932-41.
5. Benoit C, Modarressi A. Severe frostbite complication after cryolipolysis: A case report. JPRAS open. 2020 Sep 1;25:46-51.