Cool Vs. Heat: What Works Best For Noninvasive Fat Removal?

Craig W. Colville MD, FACS

Noninvasive fat removal: what technologies exist, what works, what is hype.

First of all, I want to talk about CoolSculpting which has been on the market almost 10 years. I have 8 years of use and experience with the device. CoolSculpting is the gold standard, in my opinion, for noninvasive fat removal. CoolSculpting represents 70% of the noninvasive fat removal market and is the technology that all others market against. It is FDA cleared for treatment of 8 specific areas. These aren’t FDA clearances for technology that is shared by multiple companies, but these are specific FDA clearances for CoolSculpting. The FDA cleared areas include the submental or under the chin, abdomen, inner thigh, outer thigh, arms, back, banana roll by the hip and buttock, and distal thigh above the knee. CoolSculpting delivers more consistent results and the technology used to remove fat or destroy the fat is cold as opposed to heat (radiofrequency). Cold is easily tolerated and heat is less tolerated. CoolSculpting often requires fewer treatments than radiofrequency devices or other non-invasive treatments.

All the rest of the devices on the market for fat reduction that are non-invasive involve radiofrequency. Devices such as Exilis use radiofrequency and a motion technique to achieve a particular temperature and maintain it for three minutes. When the heat is applied directly, without motion, it is not tolerated well by patients and has resulted in burns. Motion is used so the elevated temperature is more tolerable, but effectiveness is then variable since it is harder to maintain an even peak temperature when the machine handle is moving. Radiofrequency procedures are more technique dependent, the more you move the device the harder it is to reach and maintain the elevated temperature needed for some result. This creates more variability in results. Vanquish is another type of radiofrequency that uses panels that surround the abdomen and again it heats the fat. So you still have the situation of trying to maintain an elevated temperature versus the discomfort of the temperature versus trying to get your result. Four to six treatments can be necessary for Vanquish or Exilis.

TruSculpt 3D is a new version of truSculpt and also uses radiofrequency(heat). The original truSculpt device was a generation one machine using one megahertz of power and now it uses about two megahertz. Motion is required so that the temperature is tolerable, again creating more variability in results. Prior systems (truSculpt) were 3 treatments and this 3D machine may work in 1-2 treatments. TruSculpt 3D has no FDA clearance for “fat destruction”.

I struggle with radiofrequency claims of heating the fat layer (thick or thin) and creating a uniform result. Radiofrequency devices have no FDA clearance for skin tightening but “off label” they are marketed for the concept of heat creating collagen and therefore getting skin tightening. There has been no external radiofrequency device to date that actually has an FDA clearance for this skin tightening claim. TruSculpt has some cellulite improvement but this is temporary. Also for truSculpt 3D the FDA clearance for circumferential contouring is actually a clearance for temporary contouring.

In summary, I still like CoolSculpting as the cool is better tolerated with more consistent results and this technology has stood the test of time. There have been over 7 million treatments of CoolSculpting done since its inception.

I hope you find this information to be beneficial. I continue to look for and evaluate technology as it comes to the market place so that I can continue to offer the best, safest, and most effective treatments.

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