Pause for 2-3 months between cryolipolysis treatments

LAS VEGAS – It’s probably best to treat one area during an initial cryolipolysis session and wait "2-3 months to see what clinical benefits you have" before the next treatment, according to Dr. Mathew Avram.

"If patients are going to get another treatment, I want them to be happy with the first one," he said. Cryolipolysis is expensive, and "there are definitely patients who do not respond."

Also, "you’ll get down a little deeper to cells that weren’t reached" during the first treatment if inflammation and dead fat cells are given a chance to dissipate before the next treatment. "If you wait 2 or 3 months, I think you’ll get a better end-result," said Dr. Avram, director of the Dermatology Laser and Cosmetic Center at Massachusetts General Hospital in Boston.

Most patients can expect a small but noticeable difference with the procedure. "It’s not a home run," but it’s helpful for areas "that you can’t really get rid of with diet and exercise," he said at the SDEF Las Vegas Dermatology Seminar.

The study that earned cryolipolysis (CoolSculpting – Zeltiq Aesthetics Inc.) Food and Drug Administration clearance found that one session decreased love-handle fat layer thickness by 22.7% in 32 patients. One side was treated in each patient, with the other side used as a control. Results were assessed by high-resolution ultrasound and histology at 4 months.

"Most people come in for a little bit of protrusion in the lower abdomen. Two to three months later, they’ll see a small but noticeable decrease," said Dr. Avram, who’s also treated gynecomastia, the upper back, and other areas over the past 3 years.

But "this does not compare to liposuction. This is a much more modest amount of fat removal," he said.

CoolSculpting takes about 1-3 hours and does not require close supervision once the cooling device is placed. The procedure is thought to crystalize lipids in subcutaneous fat cells at near-freezing temperatures, causing their death without damaging the skin. Fat "feels like slush underneath the skin" after treatment, and patients can expect some redness, numbness, and bruising where the device was applied.

Overall, it’s "typically very mild – not a very painful treatment." Postprocedure massage may improve clinical results [although] "there are no hard data to show that," Dr. Avram said.

The areas that respond best are "grabbable areas of fat" because the cooling applicator is not contoured to curved areas like the buttocks, though Zeltiq is working to address the problem, he said.

"The posterior upper arms don’t do as well either. Typically both laxity and fat are involved, and sometimes you can get a little problem with the nerve root there," he said.

The procedure does not change skin pigmentation, but rarely patients can experience significant pain 3-7 days following treatment that resolves with no sequelae. Even more rarely, there can be a paradoxical fat increase in the treated area 3-5 months later, Dr. Avram said.

Cold-air urticaria, cryoglobulinemia, and hernia are all contraindications.

SDEF and this news organization are owned by Frontline Medical Communications. Dr. Avram is on the scientific advisory board of Zeltiq and is a paid consultant to the company.

LAS VEGAS – It’s probably best to treat one area during an initial cryolipolysis session and wait "2-3 months to see what clinical benefits you have" before the next treatment, according to Dr. Mathew Avram.

"If patients are going to get another treatment, I want them to be happy with the first one," he said. Cryolipolysis is expensive, and "there are definitely patients who do not respond."

Also, "you’ll get down a little deeper to cells that weren’t reached" during the first treatment if inflammation and dead fat cells are given a chance to dissipate before the next treatment. "If you wait 2 or 3 months, I think you’ll get a better end-result," said Dr. Avram, director of the Dermatology Laser and Cosmetic Center at Massachusetts General Hospital in Boston.

Most patients can expect a small but noticeable difference with the procedure. "It’s not a home run," but it’s helpful for areas "that you can’t really get rid of with diet and exercise," he said at the SDEF Las Vegas Dermatology Seminar.

The study that earned cryolipolysis (CoolSculpting – Zeltiq Aesthetics Inc.) Food and Drug Administration clearance found that one session decreased love-handle fat layer thickness by 22.7% in 32 patients. One side was treated in each patient, with the other side used as a control. Results were assessed by high-resolution ultrasound and histology at 4 months.

"Most people come in for a little bit of protrusion in the lower abdomen. Two to three months later, they’ll see a small but noticeable decrease," said Dr. Avram, who’s also treated gynecomastia, the upper back, and other areas over the past 3 years.

But "this does not compare to liposuction. This is a much more modest amount of fat removal," he said.

CoolSculpting takes about 1-3 hours and does not require close supervision once the cooling device is placed. The procedure is thought to crystalize lipids in subcutaneous fat cells at near-freezing temperatures, causing their death without damaging the skin. Fat "feels like slush underneath the skin" after treatment, and patients can expect some redness, numbness, and bruising where the device was applied.

Overall, it’s "typically very mild – not a very painful treatment." Postprocedure massage may improve clinical results [although] "there are no hard data to show that," Dr. Avram said.

The areas that respond best are "grabbable areas of fat" because the cooling applicator is not contoured to curved areas like the buttocks, though Zeltiq is working to address the problem, he said.

"The posterior upper arms don’t do as well either. Typically both laxity and fat are involved, and sometimes you can get a little problem with the nerve root there," he said.

The procedure does not change skin pigmentation, but rarely patients can experience significant pain 3-7 days following treatment that resolves with no sequelae. Even more rarely, there can be a paradoxical fat increase in the treated area 3-5 months later, Dr. Avram said.

Cold-air urticaria, cryoglobulinemia, and hernia are all contraindications.

SDEF and this news organization are owned by Frontline Medical Communications. Dr. Avram is on the scientific advisory board of Zeltiq and is a paid consultant to the company.

LAS VEGAS – It’s probably best to treat one area during an initial cryolipolysis session and wait "2-3 months to see what clinical benefits you have" before the next treatment, according to Dr. Mathew Avram.

"If patients are going to get another treatment, I want them to be happy with the first one," he said. Cryolipolysis is expensive, and "there are definitely patients who do not respond."

Also, "you’ll get down a little deeper to cells that weren’t reached" during the first treatment if inflammation and dead fat cells are given a chance to dissipate before the next treatment. "If you wait 2 or 3 months, I think you’ll get a better end-result," said Dr. Avram, director of the Dermatology Laser and Cosmetic Center at Massachusetts General Hospital in Boston.

Most patients can expect a small but noticeable difference with the procedure. "It’s not a home run," but it’s helpful for areas "that you can’t really get rid of with diet and exercise," he said at the SDEF Las Vegas Dermatology Seminar.

The study that earned cryolipolysis (CoolSculpting – Zeltiq Aesthetics Inc.) Food and Drug Administration clearance found that one session decreased love-handle fat layer thickness by 22.7% in 32 patients. One side was treated in each patient, with the other side used as a control. Results were assessed by high-resolution ultrasound and histology at 4 months.

"Most people come in for a little bit of protrusion in the lower abdomen. Two to three months later, they’ll see a small but noticeable decrease," said Dr. Avram, who’s also treated gynecomastia, the upper back, and other areas over the past 3 years.

But "this does not compare to liposuction. This is a much more modest amount of fat removal," he said.

CoolSculpting takes about 1-3 hours and does not require close supervision once the cooling device is placed. The procedure is thought to crystalize lipids in subcutaneous fat cells at near-freezing temperatures, causing their death without damaging the skin. Fat "feels like slush underneath the skin" after treatment, and patients can expect some redness, numbness, and bruising where the device was applied.

Overall, it’s "typically very mild – not a very painful treatment." Postprocedure massage may improve clinical results [although] "there are no hard data to show that," Dr. Avram said.

The areas that respond best are "grabbable areas of fat" because the cooling applicator is not contoured to curved areas like the buttocks, though Zeltiq is working to address the problem, he said.

"The posterior upper arms don’t do as well either. Typically both laxity and fat are involved, and sometimes you can get a little problem with the nerve root there," he said.

The procedure does not change skin pigmentation, but rarely patients can experience significant pain 3-7 days following treatment that resolves with no sequelae. Even more rarely, there can be a paradoxical fat increase in the treated area 3-5 months later, Dr. Avram said.

Cold-air urticaria, cryoglobulinemia, and hernia are all contraindications.

SDEF and this news organization are owned by Frontline Medical Communications. Dr. Avram is on the scientific advisory board of Zeltiq and is a paid consultant to the company.