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Liposuction vs CoolSculpting™

Before and after photos of a three quarter's view of the torso of a woman who had liposuction of abdomen & love handles

Before and after photos of a woman who had liposuction of abdomen & love handles

Bulges that restrict one’s wardrobe can make a person self-conscious, and Spanx only does so much. Large shirts can hide bellies and gathered skirts can cover wide hips, but when clothing no longer camouflages those fleshy prominences, liposuction can sound appealing. But so does CoolSculpting™. They both sound great, so which one is better?

The short answer is they’re both effective. Some people are candidates for both and will get good results either way, and others will find one or the other will best suit their needs.


Let’s start with liposuction. First, let’s wade through the proliferation of names. The terms “liposculpture,” “lipoplasty,” “suction-assisted fat removal,” and simply “lipo,” all mean the same thing: liposuction.

After a rocky start in France in the 1920s, when a model developed gangrene of the leg, liposuction gained popularity in the 1980s with the development of  specialized equipment and new techniques. Hollow metal tubes (“cannulas”) attached to plastic tubing were plugged into a suction machine.

How Liposuction Is Done

Liposuction is based on the principle of negative pressure. If you’ve ever used a straw to suck up the tapioca balls in bubble tea, you have an idea of how liposuction works.

Small incisions (around an eighth of an inch) allow access to the bulge of fat. Fluid infused into the area loosens the fat to encourage smoother contours. Local anesthetic can be added to the fluid unless the case is done under general anesthesia.

After the surgeon inserts the cannula into one of the incisions, the suction is turned on, vacuuming lobules of fat from the body into a plastic canister. The doctor moves the cannula throughout the fatty bulge to tailor and sculpt.

How successful is liposuction in reducing unwanted bulges? According to the most recent statistics from the American Society for Aesthetic Plastic Surgery (ASAPS), liposuction is the most popular cosmetic procedure in America.

Before & After Photos of the back of the thighs of a woman who had liposuction of the inner and outer thighs

Before and after photos of a woman who had liposuction of the inner and outer thighs


The noninvasive CoolSculpting™, made by ZELTIQ Aesthetics, Inc., came on the scene much more recently. After receiving FDA approval in 2010, its fat freezing (“cryolypolysis”) treatments have taken off. In fact, Deloite recently named ZELTIQ the #1 fastest growing medical device company, which the company attributes to the phenomenal success of CoolSculpting™.

Two Harvard dermatologists came up with the idea of freezing the fat after reading a report of teething toddlers given popsicles for pain relief. Their cheek fat had frozen, leaving them with dimples. Subsequent research confirmed selective freezing eliminated fat cells, resulting in 20 to 25% reduction of treated fatty bulges.

Unlike liposuction, the noninvasive CoolSculpting™ was associated with no down time or pain, with rare exceptions.

How CoolSculpting™ Is Done

A skin-protecting transparent gel pad is placed until it adheres to the area to be treated. Then an applicator head is placed over the pre-marked area, and the bulge is vacuumed inside the applicator cup. The cup contains two cooling panels opposite each other, so the fatty bulge is sandwiched between them.

As the temperature drops, the area becomes numb. The sensation is like walking outside in the cold when your hands become numb. The controlled cooling freezes the fat cells within the bulge without harming skin, muscle, or nerves. After an hour of cooling, the application cup is removed, and the practitioner massages the frozen fat to break up as many fat cells as possible. The fat cells are slowly eliminated over two to four months.

Before & after profile views of a woman who had CoolSculpting™ of the abdomen

Before and after views of a woman who had CoolSculpting™ of the abdomen

Liposuction vs CoolSculpting™

Liposuction wouldn’t be the most popular cosmetic procedure if it didn’t have advantages over CoolSculpting™. Here’s why so many people still opt for surgery:

  • More aggressive and complete fat reduction
  • Better contouring since the cannula can move around an area, whereas CoolSculpting™ is limited to what can be vacuumed into the applicator cup.
  • More immediate results
  • Can be combined with skin tightening technologies that deliver heat energy deep to the skin, including laser (SmartLipo™) and ultrasound (Vaser™)
  • Can be done simultaneously with other surgical procedures, such as a tummy tuck

    Three quarters view of before & after photos of a woman who had liposuction of the love handles at the same time as a tummy tuck

    Before and after photos of a woman who had liposuction of the love handles at the same time as a tummy tuck

But CoolSculpting™ wouldn’t be ranked number one in medical device growth if it didn’t also have advantages. Here’s what they are:

  • Noninvasive
  • No or minimal down time
  • Fewer risks (though not risk-free)
  • Can be less expensive, depending on the amount done
  • Best option for those who can’t have or don’t want surgery

    Before and After Views of the back of a woman after having CoolSculpting™ of the Love Handles

    Before and after views of a woman who had CoolSculpting™ of the love handles

Liposuction also has disadvantages, though, and anyone considering which option to choose should be aware of them:

  • Surgical risks, albeit low when performed judiciously by a board-certified plastic surgeon or dermatologist under safe conditions
  • Downtime of a few days with some activity restrictions for 3 to 6 weeks
  • Surface irregularities

CoolSculpting also has disadvantages:

  • Less dramatic results compared with liposuction
  • Surface irregularities
  • Rare risks of pain or paradoxical increase in fat
  • Treatable sites are limited by whether the available CoolSculpting™ applicator head fits.
  • Areas of concern must be pinchable, since taut skin can’t be sucked into the applicator head.

Neither procedure is a substitute for weight loss. Should a patient gain weight after the procedure, the treated contours will fill out as the remaining fat cells expand. Bulges associated with loose skin can sag even more with fat reduction, whether by liposuction, by CoolSculpting™, or by natural weight loss. Loose belly skin is better treated with a tummy tuck, and loose arm skin with a brachioplasty. A doctor with your best interests in mind will steer you toward the right procedure.

If you’re a candidate for both procedures, prioritize your desires. If you want a more dramatic result, choose liposuction. If you want no downtime, choose CoolSculpting™. To help you decide, look at your doctor’s before-and-after photos, whether you’re considering liposuction or CoolSculpting™.

Whatever option you choose, having reasonable expectations goes hand in hand with satisfaction with the results. Neither procedure is magical, but, hey, they’re both number one. That must mean they’ve made a lot of patients very happy.

Dr. Heather Furnas

About Dr. Heather Furnas

Inspired by watching her plastic surgeon father operate in African bush hospitals, Dr. Heather Furnas followed in his footsteps, training at Stanford and serving on the Harvard clinical faculty. She and her husband, Dr. Paco Canales, practice together in Santa Rosa, California, where they raised their two children. (To learn more about their practice, visit She believes an informed patient is more likely to be a happy patient and is committed to providing that education. If you have any suggestions for topics you'd like to learn more about, she would love to hear from you!

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One Response to Liposuction vs CoolSculpting™

  1. Wendy says:

    Incredible results and a great article by Dr. Heather Furnas!!

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