Christopher Chung, M.D.
American Board of Plastic Surgery
Chief Medical Officer
Sono Bello

There are two main options for permanent fat reduction: Liposuction and Non-surgical fat loss (such as CoolSculpting).  CoolSculpting and liposuctioon are two very different procedures, both with advantages and disadvantages.  That being said, how do CoolSculpting and liposuction compare?

Liposuction vs. CoolSculpting

Liposuction is a surgical procedure that was developed in the 1980s. There are many different types of liposuction, depending on the source of energy used to break up the fat.  The oldest method simply depends on a suction machine to literally “suck” the fat from the body.  Since then, improved technologically advanced methods have been developed, including the use of Ultrasound (UAL), Mechanical Power (PAL), Fluid Propulsion (FAL), and Laser (LAL).  At times, several different modalities (PAL with Laser assisted) may be used to achieve the most desired outcome.  In addition, liposuction can be combined with other procedures, such as skin excision, to best meet the patient’s anatomic and aesthetic desire.

Liposuction can be performed under local anesthesia with infiltration of numbing fluid (tumescent technique), intravenous sedation or with full general anesthesia.  The choice of anesthesia is largely dependent on the expertise and preference of the surgeon, with realization that lesser anesthesia involving gentle oral sedation with local tumescence is physiologically better tolerated and preferred whenever possible.

While both modalities can achieve permanent fat reduction, liposuction is the more effective method of removing a greater amount of fat from more body areas than Coolsculpting.  Liposuction can typically remove the unwanted fat in a single session, though at times, several sessions may be needed in selected patients depending on the number of body areas that are desired.  On average, 50-70% of fatty deposit from an area can be removed in a single session of liposuction.  Postoperatively, most patients experience some mild discomfort and temporary swelling/bruising that may require some pain analgesics and supportive compression garment use.  Post-surgical complications are rare.  While the immediate reduction in unwanted fatty deposits are seen, final outcome may not be realized for 3-6 months.

In contrast, Coolsculpting is a non-invasive, non-surgical modality for permanent fat reduction that was developed in 2010.  It uses patented cooling technology to “freeze” the fat which is then eliminated by the body over time.  It does not require anesthesia and discomfort is minimal both during and after the procedure.  Unlike liposuction, Coolsculpting delivers results that are less dramatic.  In general, about 20-25% of reduction in fat thickness can be achieved in a single session, with some patients not seeing any appreciable result (14%).  Furthermore, as fewer areas can be treated in a single session, often, multiple sessions are required to achieve the desired outcome.  However, for patients who desire to avoid surgery, with small fatty deposits, or with health issues that preclude surgery, Coolsculpting can be a great option.

In summary, the advantages and disadvantages of coolsculpting vs liposuction are as follows:

Advantages of Liposuction:

• More aggressive fat reduction in a single session (50-70% reduction)
• More body areas (jowls, neck, arm, back, waist, hips, love handles, saddle bags, abdomen, thighs, knees) can be treated in a single session
• Quicker result appreciated with an immediate reduction in fatty deposits seen with the final outcome in several months
• Can be combined with other procedures, such as skin resection, for a better outcome
• Can result in some skin contraction (especially true for laser-assisted liposuction)
• More cost effective if greater fat reduction from multiple areas are desired

Disadvantages of Liposuction:

• The surgical procedure that requires acceptance of potential risks and complications (though it is minimally invasive and therefore, incidence of adverse events is low)
• Postoperative recovery of several days to a week required though most patients return to normal activity within 3-10 days

Advantages of CoolSculpting:

• Non-surgical modality
• Minimal risk of complications and no recovery period
• Great option for small fat reduction in a limited area
• Great option for patients with health conditions that may preclude surgery

Disadvantages of CoolSculpting:

• The less dramatic outcome with more modest result that is not immediate (20-25% reduction)
• Some patients (14%) do not see any result
• Typically requires multiple sessions to adequately treat an area
• Does not promote skin contraction

In conclusion, selecting CoolSculpting vs liposuction depends on what is important to a patient.  If there is a strong aversion to surgery, and less dramatic outcome is acceptable with no down time, then CoolSculpting may be the better option.  However, if a patient (of acceptable health) desires to remove as much fat as possible in a single session with a quicker result, then liposuction is the better option.  But regardless, it is always imperative to consult a reputable expert in the field of body contouring aesthetics to assist with the decision making.

Dr. Anire Okpaku:

So CoolSculpting versus laser liposuction, big big difference. CoolSculpting, they use a device which helps cool the fat cells, which hopefully will kill the fat cells. and then your body has to dispose of the fat cells later on. With liposuction, we’re actually removing the fat cells right then and there. The problem with CoolSculpting is that it’s not a very precise way of doing a procedure. Some people get some very nice results, but the average person who I’ve seen with CoolSculpting does not get great results. With laser liposuction it’s extremely precise, we know exactly where we’re removing, we can feel the difference in the tissue, we can see it right then and there, and there’s no, “uh well we gotta wait three to six months to see what happens”.  We know what’s going to be the results when we do the procedure.