How to Choose between Liposuction and CoolSculpting™?

How to Choose between Liposuction and CoolSculpting™?
Before and after liposuction of the abdomen and love handles

Spanx, tunics, and jackets can camouflage small bulges, but when clothing no longer hides those fleshy prominences, liposuction sounds appealing. But so does CoolSculpting™. They both sound great, so which one is better?

The short answer is they’re both effective for people who are good candidates. But for some, one option is better than the other.


Let’s start with liposuction. The terms liposculpture, lipoplasty, suction-assisted fat removal, and simply lipo all mean the same thing: liposuction.
Although liposuction was introduced in France in the 1920s, it wasn’t until the 1980s that the procedure took off. Finally a surgeon could remove fat without a knife by using a small metal tube, called a cannula, and suction.


Liposuction is based on the principle of negative pressure. If you’ve ever used a straw to suck up the tapioca balls in bubble tea, you have an idea of how liposuction works.

Small incisions (around an eighth of an inch) allow access to a fatty bulge. First the surgeon puts IV fluid into the area to loosen the fat and to encourage smoother contours. Local anesthetic can be added to numb the area.

After enough fluid is injected, the surgeon inserts a cannula and turns on the suction. Small, round, yellow lobules travel down the plastic tubing from the body into a plastic canister. The surgeon tailors and sculpts by moving the cannula throughout the fatty bulge from different incision sites. Progress is monitored by looking, feeling, pinching, and measuring the amount of fat removed.

How successful is liposuction in reducing unwanted bulges? According to the most recent statistics from the American Society for Aesthetic Plastic Surgery (ASAPS), liposuction is the most popular cosmetic procedure in America.


CoolSculpting™ is a noninvasive fat –reduction technology developed by ZELTIQ Aesthetics, Inc. After receiving FDA approval in 2010, its fat freezing (“cryolypolysis”) treatments have taken off like a rocket…so much so that Deloitte recently named ZELTIQ the #1 fastest growing medical device company.

Freezing fat was the brainchild of two Harvard dermatologists. Intrigued by a report of teething toddlers who had developed cheek dimples after sucking on pain-relieving popsicles, the doctors investigated. Their research confirmed that selective freezing of adipose (fat) cells reduced fatty bulges by 20 to 25%. Patients typically need 1-3 treatments on the same area to get noticeable results. Those findings lead to CoolSculpting™.


The practitioner makes marks on the area to be treated for precise placement of the device. Then a transparent gel pad is placed to protect the skin, and the applicator head is put into position. Now it’s time to turn on the vacuum. Once the bulge is sucked into a cup, two cooling panels numb the area like bare fingers on a cold, wintery day.

The controlled cooling freezes the fat cells without harming the skin, muscle, or nerves. After an hour, the practitioner removes the application cup and massages the frozen mound to break up even more fat cells.


Liposuction wouldn’t be the most popular cosmetic procedure if it didn’t have advantages over Coolsculpting™, such as:

  • more aggressive and complete fat reduction
  • better contouring
  • more immediate results
  • the possibility of combining heat-energy skin tightening technologies
  • the possibility of simultaneous surgical procedures

But CoolSculpting™ wouldn’t be ranked number one in medical device growth if it didn’t also have advantages, including:

  • a noninvasive technology
  • no or minimal down time
  • fewer risks (though not risk-free)
  • treatment at a lower price, depending on the amount done
  • a treatment option for those who can’t have or don’t want surgery


Anyone considering liposuction needs to consider:

  • the possible surgical risks
  • the downtime of a few days with some activity restrictions for 3 to 6 weeks
  • the potential for surface irregularities

CoolSculpting™ also has disadvantages, including:

  • less dramatic results compared with liposuction
  • surface irregularities
  • rare risks of pain or paradoxical increase in fat
  • treatable body part areas is limited by fit of application head
  • bulges must be pinchable to fit into cup

News flash: the procedure is neither a substitute for weight loss nor does it protect against weight gain. Should a patient consume more calories than expended, the remaining fat cells will expand.

Both procedures also have limits if the patient has loose skin, since a deflated bulge can end up hanging. The patient with relaxed belly skin is better treated with a tummy tuck and the person with hanging arm skin should consider an arm lift. If you have loose skin, seek a board-certified plastic surgeon who can offer you all possible alternatives in case the best choice is neither liposuction nor CoolSculpting™.

Neither liposuction nor CoolSculpting™ is magical, but, hey, they're both number one. That must mean they've made a lot of patients very happy.

About the Author

Heather J. Furnas MD
Heather J. Furnas MD
4625 Quigg DrSanta RosaCA95409US

Heather J. Furnas MD

4625 Quigg Drive, Santa Rosa, CA, 95409, US

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