Is Heat or Cold Better for Fat Removal? CoolSculpting® vs. Heat

Craig W. Colville MD, FACS

Noninvasive fat removal is extremely popular, but it can be challenging to separate the procedures that work best from what is hype. One of the questions we hear most often is whether heat-based procedures or cold-based treatments work best.

Does CoolSculpting Actually Work?

Yes. I have used CoolSculpting for my patients from Toledo and Findlay, Ohio, for many years. It is the gold standard, in my opinion, for noninvasive fat removal. The treatment was shown to reduce fat by 25% after one treatment in clinic studies.

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:

  • Submental (under the chin)
  • Abdomen
  • Inner thigh
  • Outer thigh
  • Arms
  • Back
  • Banana roll by the hip and buttock
  • Distal (outer) thigh above the knee

Comparison: Is It Better to Freeze or Heat Fat?

With CoolSculpting, the technology used to remove or destroy the fat is cold as opposed to heat devices that usually use radiofrequency. When comparing freezing versus heating:

  • CoolSculpting delivers more consistent results.
  • Cold is more easily tolerated and heat is less tolerated.
  • CoolSculpting often requires fewer treatments than radiofrequency devices or other non-invasive treatments.

Can Heat Break Down Body Fat?

Heat-based treatments that use radiofrequency offer varying degrees of fat reduction. In general, 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. Let’s look at the effectiveness of some of the commonly available heat-based treatment options.

Exilis™: 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.

Vanquish: This is another type of radiofrequency that uses panels that surround the abdomen to heat 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. As many as 4 to 6 treatments can be necessary for Vanquish or Exilis.

TruSculpt® 3D: 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. Prior systems (truSculpt) were 3 treatments, and this 3D machine may work in 1 to 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 cool temperatures are better tolerated, offer more consistent results, and its technology has stood the test of time. There have been over 7 million treatments of CoolSculpting done since its inception. Of course, if you’re looking for more extensive fat reduction, liposuction or another surgical procedure may be a better option for you. You can learn more about your options for abdominal fat reduction in our related blog post.

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. If you’re interested in fat reduction, you can request a consultation using our online form or call us at (419) 534-6551.

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