Understanding cryolipolysis technology

In 1970 a group of doctors documented something odd in children who had been sucking on ice lollies. A firm red nodule would appear in the cheek a day or two later, then settle, leaving a small dent where fat under the skin had disappeared. The same effect had been noticed in women who rode horses in cold weather, on the outer thighs.

The condition was named cold panniculitis, and for three decades it stayed a curiosity. Then in 2007 two researchers at Harvard, Dieter Manstein and Rox Anderson, asked the useful question: if cold destroys fat under the skin without damaging the skin itself, could that be done deliberately and safely? They coined the term cryolipolysis for the answer.

Fat cells are more susceptible to cold injury than the tissue around them. Skin, nerve and muscle tolerate a degree of cooling that is enough to damage adipocytes, the cells that store fat, which is what makes the whole approach possible. It is a difference in threshold, and treating within that gap is the entire technique.

An applicator draws the fold of tissue in and cools it to around minus nine degrees Celsius, holding it there for the length of the session, generally forty to sixty minutes. The skin is protected throughout and the temperature is controlled rather than simply cold, which is why this is not something that can be replicated with ice at home. Attempting it is a good way to injure your skin without touching the fat underneath.

The applicators used at LMC cool the drawn fold from all the way around it rather than from two flat plates on either side, which is a newer design than the original approach and treats the fold more evenly. Two handpieces run at once, so two areas can be treated in the same session.

Nothing is removed during the session itself. The cooling triggers apoptosis in the affected fat cells, which is the biological process of programmed cell death, the orderly way a body retires a cell it no longer wants.

Within about three days an inflammatory response begins in the treated area, and immune cells arrive to break down and carry away the damaged adipocytes. Researchers examining treated tissue at two weeks found exactly this: immune cells laden with lipid, working through the area. The material is processed by the liver along the same route it handles fat from any other source.

This clearing takes weeks, which is why nobody walks out of a cryolipolysis session looking different. Visible change generally begins around the one month mark and continues developing for two to three months after treatment.

Cryolipolysis is among the better studied non-surgical contouring treatments. A systematic review pooling nineteen studies found reductions in the treated fat layer ranging from roughly 15 to 28 percent when measured by caliper, and roughly 10 to 25 percent when measured by ultrasound, assessed at around four months.

Those figures describe the fat layer in the treated fold. They are not a measure of total body fat, and they are not a weight loss figure. Someone can complete a course, see a genuine change in the shape of an area, and weigh the same afterwards.

The studies also found no meaningful effect on blood lipid levels or liver function tests, which addresses a reasonable question about where the processed fat goes. Reported side effects across the literature were mild and short lived.

Cryolipolysis treats a defined fold of tissue that an applicator can draw in. It does not work on visceral fat, the fat sitting deeper around your organs, which responds to diet and exercise rather than to any external device.

It does not tighten skin. Reducing volume under skin that has lost elasticity can leave an area looking softer rather than firmer, which is why cryolipolysis is usually paired with radio frequency or Vela Sculpture in a structured programme instead of used alone.

It is also not a weight loss treatment, and it is least effective in people who are looking for one. The candidates who do best are close to their goal weight with a specific area that has not responded.

Worth Knowing

Side effects, and one rare complication

The cells cleared after treatment are gone and do not regenerate. Adults hold a relatively stable number of fat cells, and the ones removed are not replaced.

What can happen is that the remaining fat cells in the area, and everywhere else, enlarge if your weight increases. The area will still hold proportionally less than it did, but the change you paid for becomes harder to see. Results hold well in people whose weight stays broadly stable afterwards.