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Updated and added to a number of sections. Additional information included patent information, patient reviews, mention of CoolSculpting, and added medical references, where needed.
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{{Use dmy dates|date=September 2016}}
{{medref|date=January 2015}}
{{Infobox medical intervention
{{Infobox medical intervention
| name = Cryolipolysis
| name = Cryolipolysis
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'''Cryolipolysis''' is a medical treatment used to destroy [[fat cell]]s by freezing. The functional principle is the controlled application of [[Heat transfer|cooling]], within the temperature range of +5 to −5&nbsp;°C, for the non-invasive, localized reduction of [[fat]] deposits, in order to reshape the contours of the body. The degree of exposure to cooling causes the [[apoptosis]] (cell death) of [[subcutaneous fat]] tissue, without damage to the overlying [[skin]].<ref name=eoncaieopn>{{cite journal |title=Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on Peripheral Nerves. |authors=Coleman, S, Sachdeva, K, Egbert, B, Preciado, J, Allison, J |journal=Aesthetic Plastic Surgery |date=July 2009 |volume=33 |pages=482-488 }}</ref>
'''Cryolipolysis''' is a medical treatment used to destroy [[fat cell]]s by freezing. The functional principle is the controlled application of [[Heat transfer|cooling]], within the temperature range of +5 to −5&nbsp;°C, for the non-invasive, localized reduction of [[fat]] deposits, in order to reshape the [[Body contouring|contours]] of the body. The degree of exposure to cooling causes the [[apoptosis]] (cell death) of [[subcutaneous fat]] tissue, without damage to the overlying [[skin]].<ref name=eoncaieopn>{{cite journal |title=Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on Peripheral Nerves. |authors=Coleman, S, Sachdeva, K, Egbert, B, Preciado, J, Allison, J |journal=Aesthetic Plastic Surgery |date=July 2009 |volume=33 |pages=482-488 }}</ref> Clinical research suggests this technology exploits the premise that [[adipocytes]] are more susceptible to cooling than other skin cells.<ref name=krueger>{{cite journal |title=Cryolipolysis for noninvasive body contouring: clinical efficacy and patient satisfaction |authors=Krueger,N, Mai,S, Luebberding,S, and Sadick, N |journal=Clinical, Cosmetic, and Investigational Dermatology |date=2014 |volume=7 |pages=201-205 }}</ref> Precise application of cold temperatures triggers the death of [[adipocytes]] that are subsequently engulfed and digested by [[macrophages]]. No changes in [[subcutaneous fat]] are noticeable immediately after treatment.


As a medical procedure, cryolipolysis is a nonsurgical alternative to [[liposuction]].<ref name=pmid25061326/> Etymologically, the term ''cryolipolysis'' (freezing of fat) is a [[portmanteau]] word derived from the conflation of ''cryogenic'' and ''lipolysis''.{{Citation needed|date=July 2014}} In Europe, specific-design cryolipolysis machines are used in aesthetic clinics and spas; the brands of machine include CoolSculpting.<ref name=pmid25061326>{{cite journal |title=Cryolipolysis for Noninvasive Body contouring: Clinical Efficacy and Patient Satisfaction. |authors=Krueger N, Mai SV, Luebberding S, Sadick NS |journal=Clinical Cosmetic Investigational Dermatology |date=26 June 2014 |volume=7 |pages=201–5 |doi=10.2147/CCID.S44371 |pmid=25061326 |pmc=4079633 }}</ref>
As a medical procedure, cryolipolysis is a nonsurgical alternative to [[liposuction]].<ref name=pmid25061326/> Etymologically, the term ''cryolipolysis'' (freezing of fat) is a [[portmanteau]] word derived from the conflation of ''cryogenic'' and ''lipolysis''.{{Citation needed|date=July 2014}} In Europe, specific-design cryolipolysis machines are used in aesthetic clinics and spas; the brands of machine include CoolSculpting.<ref name=pmid25061326>{{cite journal |title=Cryolipolysis for Noninvasive Body contouring: Clinical Efficacy and Patient Satisfaction. |authors=Krueger N, Mai SV, Luebberding S, Sadick NS |journal=Clinical Cosmetic Investigational Dermatology |date=26 June 2014 |volume=7 |pages=201–5 |doi=10.2147/CCID.S44371 |pmid=25061326 |pmc=4079633 }}</ref>

==Patent information==
ZELTIQ (acquired by [[Allergan]] in 2017)<ref>{{cite web|title=Allergan Successfully Completes ZELTIQ® Aesthetics Acquisition|url=https://www.prnewswire.com/news-releases/allergan-successfully-completes-zeltiq-aesthetics-acquisition-300447962.html|website=PR Newswire|publisher=PR Newswire|accessdate=2 January 2018}}</ref> is the exclusive licensee of cryolipolysis, which is marketed worldwide as [http://www.coolsculpting.com CoolSculpting]. A CoolSculpting treatment is performed by applying an applicator in connection with a device for the treatment of subcutaneous, fat-rich cells using cold. The applicator inventions are also patented by ZELTIQ.<ref>{{cite web|title=Device for cryolipolysis|url=https://www.google.com/patents/US20150080769|website=Google Patents|publisher=Google|accessdate=2 January 2018}}</ref>


==Evidence==
==Evidence==
Cryolipolysis is used for removing certain areas of body fat that are just under the skin to contour a person.<ref name=pmid26017594>{{Cite journal | last1 = Ingargiola | first1 = MJ. | last2 = Motakef | first2 = S. | last3 = Chung | first3 = MT. | last4 = Vasconez | first4 = HC. | last5 = Sasaki | first5 = GH. | title = Cryolipolysis for fat reduction and body contouring: safety and efficacy of current treatment paradigms | journal = Plastic and Reconstructive Surgery | volume = 135 | issue = 6 | pages = 1581–90 |date=June 2015 | doi = 10.1097/PRS.0000000000001236 | PMID = 26017594 | pmc=4444424}}</ref> Evidence supports its effectiveness at three to four months.<ref>{{Cite journal | last1 = Derrick | first1 = CD | last2 = Shridharani | first2 = SM | last3 = Broyles | first3 = JM | title = The Safety and Efficacy of Cryolipolysis: A Systematic Review of Available Literature. | journal = Aesthetic Surgery Journal | volume = 35| issue = | pages = 830–6|date=June 2015 | doi = 10.1093/asj/sjv039 | PMID = 26038367 }}</ref>
Cryolipolysis is used for removing certain areas of body fat that are just under the skin to contour a person.<ref name=pmid26017594>{{Cite journal | last1 = Ingargiola | first1 = MJ. | last2 = Motakef | first2 = S. | last3 = Chung | first3 = MT. | last4 = Vasconez | first4 = HC. | last5 = Sasaki | first5 = GH. | title = Cryolipolysis for fat reduction and body contouring: safety and efficacy of current treatment paradigms | journal = Plastic and Reconstructive Surgery | volume = 135 | issue = 6 | pages = 1581–90 |date=June 2015 | doi = 10.1097/PRS.0000000000001236 | PMID = 26017594 | pmc=4444424}}</ref> Evidence supports its effectiveness at three to four months.<ref>{{Cite journal | last1 = Derrick | first1 = CD | last2 = Shridharani | first2 = SM | last3 = Broyles | first3 = JM | title = The Safety and Efficacy of Cryolipolysis: A Systematic Review of Available Literature. | journal = Aesthetic Surgery Journal | volume = 35| issue = | pages = 830–6|date=June 2015 | doi = 10.1093/asj/sjv039 | PMID = 26038367 }}</ref>


It appears primarily applicable to limited discrete fat bulges.<ref name=nelson>{{cite journal |last1= Nelson |first1= AA |last2= Wasserman |first2= D |last3= Avram |first3= MM |title= Cryolipolysis for reduction of excess adipose tissue |journal= Seminars in Cutaneous Medicine and Surgery |pmid= 20123423 |year= 2009 |volume= 28 |issue= 4 |pages= 244–9 |doi= 10.1016/j.sder.2009.11.004}}</ref> According to a 2015 review it shows promise with the average fat reduction, measured by calipers of about 20 percent.<ref name=pmid26017594/> With the small number of people treated, clinical data remain scarce, thus it is not known how long the treatment effect will last, or when and if later treatments would be necessary to maintain the result.
It appears primarily applicable to limited discrete fat bulges.<ref name=nelson>{{cite journal |last1= Nelson |first1= AA |last2= Wasserman |first2= D |last3= Avram |first3= MM |title= Cryolipolysis for reduction of excess adipose tissue |journal= Seminars in Cutaneous Medicine and Surgery |pmid= 20123423 |year= 2009 |volume= 28 |issue= 4 |pages= 244–9 |doi= 10.1016/j.sder.2009.11.004}}</ref> According to a 2015 review it shows promise with the average fat reduction, measured by calipers of about 20 percent.<ref name=pmid26017594/> With the small number of people treated, clinical data remain scarce, thus it is not known how long the treatment effect will last, or when and if later treatments would be necessary to maintain the result.


==Side effects==
==Side effects==
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===Cost and treatment time===
===Cost and treatment time===
Typical cost per treatment area varies depending on location. Price in the US ranges from $750 to $1500,<ref>{{cite web|title=Can you freeze your fat away?|url=https://www.statnews.com/2015/12/24/freeze-fat-weight-loss/|accessdate=25 August 2016|date=24 December 2015}}</ref> with UK prices about £750 per area to be treated.<ref>{{cite web|title=CoolSculpting is only cold-based treatment cleared by US FDA for fat loss|url=http://www.ibtimes.com.au/coolsculpting-only-cold-based-treatment-cleared-us-fda-fat-loss-1509445|accessdate=25 August 2016|date=21 March 2016}}</ref> Treatment time for general use/application is 45–60 minutes per site. Some cryolipolysis devices have a pair of applicators that can be used simultaneously reducing the overall treatment time when treating corresponding areas such as the sides of the stomach, back of legs, and flanks.
Typical cost per treatment area varies depending on location and treatment plan. Price in the US typically ranges from $2,000 to $4,000, depending on how many areas are treated,<ref>{{cite web|title=How much does CoolSculpting cost?|url=http://blog.coolsculpting.com/how-much-does-coolsculpting-cost|accessdate=2 January 2018}}</ref> with UK prices about £750 per area to be treated.<ref>{{cite web|title=CoolSculpting is only cold-based treatment cleared by US FDA for fat loss|url=http://www.ibtimes.com.au/coolsculpting-only-cold-based-treatment-cleared-us-fda-fat-loss-1509445|accessdate=25 August 2016|date=21 March 2016}}</ref> The latest technology of CoolSculpting can treat a patient in 35-60 minutes, some patients have more than one treatment during the same office visit. Treatment times can also vary if a participating physician's office has more than one cryolipolysis device, allowing a patient to have multiple areas treated at once.

===CoolSculpting reviews===
During a 2013 assessment to investigate the clinical outcomes of cryolipolysis, it was determined that the procedure was well-tolerated, with 89% of respondents reporting a positive perception of treatment duration and 96% reporting minimal to tolerable discomfort. Survey results demonstrated 73% patient satisfaction and that 82% of patients would recommend the cryolipolysis procedure to a friend.<ref name=Dierickx >{{cite journal |title=Safety, Tolerance, and Patient Satisfaction With Noninvasive Cryolipolysis |authors=Christine C. Dierickx MD, Jean-Michel Mazer MD, Mila Sand MD, Sylvie Koenig MD, Valerie Arigon MD |journal=Dermatologic Surgery |date=2 May 2013 |doi=10.1111/dsu.12238 }}</ref>

There are thousands of CoolSculpting reviews across the web from real patients, which can be found on [https://www.realself.com/coolsculpting-by-zeltiq realself.com], [https://www.facebook.com/CoolSculpting/reviews Facebook], and [https://www.realpatientratings.com/coolsculpting realpatientratings.com]. The reviews vary in patient satisfaction with RealSelf, as of January 2018, saying 81% of all reviewers would say the treatment was worth it.


===Regulatory approval===
===Regulatory approval===
In September 2000, Zeltiq received EU CE Mark approval for their cryolipolysis device.<ref>{{cite web|title=ZELTIQ Announces European CE Mark Approval for Non-Invasive Fat Layer Reduction Using Cryolipolysis|url=http://investor.coolsculpting.com/releasedetail.cfm?releaseid=604599}}</ref> In September 2010, the US [[Food and Drug Administration]] approved the cryolipolysis device and procedure.<ref name=pmid25061326 />
In September 2000, ZELTIQ received EU CE Mark approval for their cryolipolysis device.<ref>{{cite web|title=ZELTIQ Announces European CE Mark Approval for Non-Invasive Fat Layer Reduction Using Cryolipolysis|url=http://investor.coolsculpting.com/releasedetail.cfm?releaseid=604599}}</ref> In September 2010, the US [[Food and Drug Administration]] approved the cryolipolysis device and procedure.<ref name=pmid25061326 />


==References==
==References==

Revision as of 00:09, 3 January 2018

Cryolipolysis

Cryolipolysis is a medical treatment used to destroy fat cells by freezing. The functional principle is the controlled application of cooling, within the temperature range of +5 to −5 °C, for the non-invasive, localized reduction of fat deposits, in order to reshape the contours of the body. The degree of exposure to cooling causes the apoptosis (cell death) of subcutaneous fat tissue, without damage to the overlying skin.[1] Clinical research suggests this technology exploits the premise that adipocytes are more susceptible to cooling than other skin cells.[2] Precise application of cold temperatures triggers the death of adipocytes that are subsequently engulfed and digested by macrophages. No changes in subcutaneous fat are noticeable immediately after treatment.

As a medical procedure, cryolipolysis is a nonsurgical alternative to liposuction.[3] Etymologically, the term cryolipolysis (freezing of fat) is a portmanteau word derived from the conflation of cryogenic and lipolysis.[citation needed] In Europe, specific-design cryolipolysis machines are used in aesthetic clinics and spas; the brands of machine include CoolSculpting.[3]

Patent information

ZELTIQ (acquired by Allergan in 2017)[4] is the exclusive licensee of cryolipolysis, which is marketed worldwide as CoolSculpting. A CoolSculpting treatment is performed by applying an applicator in connection with a device for the treatment of subcutaneous, fat-rich cells using cold. The applicator inventions are also patented by ZELTIQ.[5]

Evidence

Cryolipolysis is used for removing certain areas of body fat that are just under the skin to contour a person.[6] Evidence supports its effectiveness at three to four months.[7]

It appears primarily applicable to limited discrete fat bulges.[8] According to a 2015 review it shows promise with the average fat reduction, measured by calipers of about 20 percent.[6] With the small number of people treated, clinical data remain scarce, thus it is not known how long the treatment effect will last, or when and if later treatments would be necessary to maintain the result.

Side effects

Side effect data are based on a limited experience. Transient local redness, bruising and numbness of the skin are common side effects of the treatment and are expected to subside.[8] Typically sensory deficits will subside within a month. The effect on peripheral nerves was investigated and failed to show permanent detrimental results.[9] No serious long-lasting side effects were encountered during follow-up time of six months.

Research on mechanism

Lipolysis procedures attempt to "dissolve" fat cells by nonsurgical means. A number of methods have been attempted, including the use of laser, ultrasound, and radio frequency current.[3] Popsicle panniculitis is a dermatologic condition that shows that exposure to low temperatures can selectively damage subcutaneous fat while leaving skin intact.[6][10] Based on the premise that fat cells are more easily damaged by cooling than skin cells, cryolipolysis was developed to apply low temperatures to tissue via thermal conduction. In order to avoid frostbite, a specific temperature level and exposure are determined, such as 60 minutes at −5 °C (23 °F).[11]

Initial studies to establish cryolipolysis methods were performed on pigs.[12][13] While the process is not fully understood, it appears that fatty tissue that is cooled below body temperature, but above freezing, undergoes localized cell death followed by a local inflammatory response called local panniculitis[12] that gradually over the course of several months results in a reduction of the fatty tissue layer.[9] When exposed to cold, the body's usual response is to restrict circulation to keep the core of the body at the correct temperature.

Society and culture

Cost and treatment time

Typical cost per treatment area varies depending on location and treatment plan. Price in the US typically ranges from $2,000 to $4,000, depending on how many areas are treated,[14] with UK prices about £750 per area to be treated.[15] The latest technology of CoolSculpting can treat a patient in 35-60 minutes, some patients have more than one treatment during the same office visit. Treatment times can also vary if a participating physician's office has more than one cryolipolysis device, allowing a patient to have multiple areas treated at once.

CoolSculpting reviews

During a 2013 assessment to investigate the clinical outcomes of cryolipolysis, it was determined that the procedure was well-tolerated, with 89% of respondents reporting a positive perception of treatment duration and 96% reporting minimal to tolerable discomfort. Survey results demonstrated 73% patient satisfaction and that 82% of patients would recommend the cryolipolysis procedure to a friend.[16]

There are thousands of CoolSculpting reviews across the web from real patients, which can be found on realself.com, Facebook, and realpatientratings.com. The reviews vary in patient satisfaction with RealSelf, as of January 2018, saying 81% of all reviewers would say the treatment was worth it.

Regulatory approval

In September 2000, ZELTIQ received EU CE Mark approval for their cryolipolysis device.[17] In September 2010, the US Food and Drug Administration approved the cryolipolysis device and procedure.[3]

References

  1. ^ "Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on Peripheral Nerves". Aesthetic Plastic Surgery. 33: 482–488. July 2009. {{cite journal}}: Unknown parameter |authors= ignored (help)
  2. ^ "Cryolipolysis for noninvasive body contouring: clinical efficacy and patient satisfaction". Clinical, Cosmetic, and Investigational Dermatology. 7: 201–205. 2014. {{cite journal}}: Unknown parameter |authors= ignored (help)
  3. ^ a b c d "Cryolipolysis for Noninvasive Body contouring: Clinical Efficacy and Patient Satisfaction". Clinical Cosmetic Investigational Dermatology. 7: 201–5. 26 June 2014. doi:10.2147/CCID.S44371. PMC 4079633. PMID 25061326. {{cite journal}}: Unknown parameter |authors= ignored (help)CS1 maint: unflagged free DOI (link)
  4. ^ "Allergan Successfully Completes ZELTIQ® Aesthetics Acquisition". PR Newswire. PR Newswire. Retrieved 2 January 2018.
  5. ^ "Device for cryolipolysis". Google Patents. Google. Retrieved 2 January 2018.
  6. ^ a b c Ingargiola, MJ.; Motakef, S.; Chung, MT.; Vasconez, HC.; Sasaki, GH. (June 2015). "Cryolipolysis for fat reduction and body contouring: safety and efficacy of current treatment paradigms". Plastic and Reconstructive Surgery. 135 (6): 1581–90. doi:10.1097/PRS.0000000000001236. PMC 4444424. PMID 26017594.
  7. ^ Derrick, CD; Shridharani, SM; Broyles, JM (June 2015). "The Safety and Efficacy of Cryolipolysis: A Systematic Review of Available Literature". Aesthetic Surgery Journal. 35: 830–6. doi:10.1093/asj/sjv039. PMID 26038367.
  8. ^ a b Nelson, AA; Wasserman, D; Avram, MM (2009). "Cryolipolysis for reduction of excess adipose tissue". Seminars in Cutaneous Medicine and Surgery. 28 (4): 244–9. doi:10.1016/j.sder.2009.11.004. PMID 20123423.
  9. ^ a b Coleman, SR; Sachdeva, K; Egbert, BM; Preciado, J; Allison, J (2009). "Clinical efficacy of noninvasive cryolipolysis and its effects on peripheral nerves" (PDF). Aesthetic Plastic Surgery. 33 (4): 482–8. doi:10.1007/s00266-008-9286-8. PMID 19296153. {{cite journal}}: Unknown parameter |displayauthors= ignored (|display-authors= suggested) (help)
  10. ^ Avram, MM; Harry, RS (2009). "Cryolipolysis for subcutaneous fat layer reduction". Lasers in Surgery and Medicine. 41 (10): 703–8. doi:10.1002/lsm.20864. PMID 20014262.
  11. ^ "Effects of Cryolipolysis on Abdominal Adiposity". Case Reports in Dermatological Medicine. 2016. doi:10.1155/2016/6052194. {{cite journal}}: Unknown parameter |authors= ignored (help)CS1 maint: unflagged free DOI (link)
  12. ^ a b Manstein, D; Laubach, H; Watanabe, K; Farinelli, W; Zurakowski, D; Anderson, RR (2008). "Selective cryolysis: A novel method of non-invasive fat removal". Lasers in Surgery and Medicine. 40 (9): 595–604. doi:10.1002/lsm.20719. PMID 18951424. {{cite journal}}: Unknown parameter |displayauthors= ignored (|display-authors= suggested) (help)
  13. ^ Zelickson, B; Egbert, BM; Preciado, J; Allison, J; Springer, K; Rhoades, RW; Manstein, D (2009). "Cryolipolysis for noninvasive fat cell destruction: Initial results from a pig model". Dermatologic Surgery. 35 (10): 1462–70. doi:10.1111/j.1524-4725.2009.01259.x. PMID 19614940. {{cite journal}}: Unknown parameter |displayauthors= ignored (|display-authors= suggested) (help)
  14. ^ "How much does CoolSculpting cost?". Retrieved 2 January 2018.
  15. ^ "CoolSculpting is only cold-based treatment cleared by US FDA for fat loss". 21 March 2016. Retrieved 25 August 2016.
  16. ^ "Safety, Tolerance, and Patient Satisfaction With Noninvasive Cryolipolysis". Dermatologic Surgery. 2 May 2013. doi:10.1111/dsu.12238. {{cite journal}}: Unknown parameter |authors= ignored (help)
  17. ^ "ZELTIQ Announces European CE Mark Approval for Non-Invasive Fat Layer Reduction Using Cryolipolysis".
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