More than 100 doctors nationwide have CoolSculpting machines. The company continues studies for safety and effectiveness so it can win FDA approval for thighs, upper arms, buttocks, men's breasts and backs, said Kristine Tatsutani, chief technology officer for Zeltiq, based in Pleasanton, Calif.
"It's really about body sculpting and not about massive weight loss," she said. "It's about taking away an unwanted bulge."
So far, the company has followed hundreds of patients treated with CoolSculpting machines for up to four months, so there is no longer-term information on safety and effectiveness. None had a serious adverse reaction in the time studied, Tatsutani said.
But long-term consequences are what concerns Susan Fried, an obesity researcher at Boston University.
She said some evidence indicates that removing or harming fat cells leads to fat deposits in more dangerous places — say, around organs in the abdomen. That kind of fat increases the risk of heart disease and diabetes.
That issue could also present itself with liposuction or with laser treatments, she said. Cold laser treatments burst fat cells and let fat flow out, potentially causing clots. And heat lasers emulsify fat and can cause burns, she and other doctors say.
She advocated for more old-fashioned methods of body sculpting.
"I think there is danger in all 'fat removal technologies,'" Fried said. "Diet and exercise is the much better approach — boring but known positive effects on health."
And a lot is possible with the right program, said Scott Thompson, a personal trainer at the Maryland Athletic Club in Timonium.
He said those who adhere to a regimen can see results, he said. A good program involves proper diet, regular exercise including weights and aerobic activity, and good sleeping habits. It also takes commitment, Thompson said.
"If they listen to you and really take your advice and own it, then yes, they'll get some results," he said. "It's not magic. People don't put on weight in a month or two, and they're not taking it off in that short of time either. They have to stick with it."
Eating right and exercising are still important for those seeking the aid of technology, say Schuster and Dr. Patrick J. Byrne, a Johns Hopkins University plastic surgeon. They say they turn away those with unrealistic expectations from a procedure and those unwilling to properly care for themselves afterward.
Byrne does not offer CoolSculpting but is considering adopting the technology, after rejecting others that he deemed unsafe or ineffective. Those heat lasers, for example, offer much more room for error than techniques involving cold, he said.
In general, consumers need to ensure that their doctors are properly trained in any procedure, said Byrne, director of facial plastic and reconstructive surgery at Hopkins and an associate professor.
Byrne said a tummy tuck, or abdominoplasty, which removes excess fat and skin, is the most invasive and has the highest chance of complication. It calls for a large incision under general anesthesia and significant recovery. Liposuction requires puncture holes but also sedation, and comes with the potential for infections, fat clots in blood vessels, nerve damage and punctured organs, according to the Centers for Disease Control and Prevention.
Because CoolSculpting is non-invasive, the potential for complications is lower, Byrne said.
Still, only some will be satisfied with the limited fat reduction it offers. They may be those frustrated by their lack of progress in the gym, which he says is sometimes a lack of commitment but is often a result of genetics. Some people just can't get the shape they want without technology, he said.
"Until now there's only been diet and exercise and invasive procedures," he said. "Now there is a third option. It could be a wonderful option for some people."
Losing the extra inches
•Freezes fat cells non-surgically
•About $1,300 for a belly treatment
•Reduces fat by about 20 percent
•Surgically sucks out fat deposits
•Removes most of the bulk in an area
•Surgically removes the most excess fat and skin
•About $7,500 and up
•The most dramatic reduction in body size
•Modest to dramatic reductions
•Varies in cost; involves time and sweat equity
•Varies in outcome
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