Body
What's Better: CoolSculpting or SculpSure?
How do CoolSculpting and SculpSure differ? The episode compares cold-based and heat-based approaches to reducing localized fat, and adds truSculpt iD to the discussion. Darren M. Smith, MD, a board-certified plastic surgeon in New York City, shares his personal experience in 2020, including how treatment comfort can affect completing a protocol.
In this episode.
Episode summary
How do CoolSculpting and SculpSure differ? The episode compares cold-based and heat-based approaches to reducing localized fat, and adds truSculpt iD to the discussion. Darren M. Smith, MD, a board-certified plastic surgeon in New York City, shares his personal experience in 2020, including how treatment comfort can affect completing a protocol.
Originally published September 1, 2020. This is a historical clinical perspective, not a current head-to-head trial or a ranking of every device generation.
Key takeaways
🌡️ Cooling and heating
CoolSculpting uses controlled cooling, while the SculpSure and truSculpt approaches discussed use heat.
🎯 Fat and muscle goals
These treatments target localized fat. Dr. Smith distinguishes them from original Emsculpt, which he discusses primarily in relation to muscle tone.
📅 Historical device preference
His stated preference for CoolSculpting in this recording is based on personal experience with the devices and their tolerability.
⚖️ Liposuction comparison
He also compares noninvasive options with liposuction, which removes fat through small incisions and entails different risks and recovery.
🧩 Treatment selection
Matching the goal to the treatment is more useful than assuming every form of body contouring addresses the same concern.
Questions this episode answers
Does the recording prove that one device is best for everyone?
No. Dr. Smith explicitly presents his own clinical experience. His explanation focuses on comfort and completing the planned treatment, rather than establishing a universal result for every patient, device or applicator.
Is muscle toning the same goal as fat reduction?
No. The episode separates original Emsculpt's muscle-focused purpose from the localized fat-reduction goals of CoolSculpting, SculpSure and truSculpt iD. Anatomy and the desired change should guide the discussion.
ℹ️ Current safety context
Noninvasive body contouring is not a weight-loss treatment and is not risk-free. The FDA describes technology-specific risks, including paradoxical adipose hyperplasia after fat freezing: treated fat can enlarge instead of shrink and may require surgery. This context supplements the original discussion.
🔗 Related information
Explore current information about liposuction and the distinct, later-generation Emsculpt NEO, or schedule a consultation. Inclusion in this archival episode does not confirm current availability of every named device.
Educational information, not individualized medical advice. Benefits, risks and results vary. Show notes updated September 30, 2026.
Original show notes
Board certified NYC plastic surgeon Dr. Darren Smith helps you explore your noninvasive body contouring options.
Read the conversation.
[00:08] I'm board certified New York City plastic surgeon, Dr. Darren Smith, and this is plastic surgery before and after. Your source for the real deal about plastic surgery procedures, news about trends in aesthetic medicine, and candid sessions with industry insiders. We hope you enjoy today's episode. Liposuction versus CoolSculpting. What's better? Well, that's what we're going to address today, but I'm also going to add another competitor to the mix, and this is True Sculpt ID. There are also some newer players on the market, like Evolve. However, this is really too new for us to have significant experience with, and I don't have any personal experience with that device, so I'm going to leave it out of the conversation. However, I am going to jump in and talk about CoolSculpting and Sculpture and True Sculpt in depth.
[01:03] we'll go into why some of them may be more effective than others. So let's zoom out for a second and just describe what all of these technologies are trying to achieve. CoolSculpting, Sculpture, and True Sculpt are all examples of non-invasive body contouring technologies. Specifically, they're body contouring technologies designed to remove fat. and the term body contouring has really come into prominence over the past several years or body sculpting and this describes any procedure that is essentially designed to change the shape of the body and we have maximally invasive procedures or standard surgical procedures and these are things like tummy tucks or abdominoplasty arm lift or brachioplasty, thigh lift or thighplasty and these are operations that have true cutting. There are big excisions and tissue is directly removed and tightened and that's how we change the shape of the body for those procedures. Then there are minimally invasive body contouring procedures and the famous minimally invasive body contouring procedure that everyone talks about of course is liposuction where we're using a long thin tube called a cannula and inserting it through very small incisions to essentially suction away excess fat and achieve an improved body shape and then we move to the subject of this podcast which are non-invasive body contouring procedures and the subject here is a comparison between three of these, which is CoolSculpting, Sculptor, and True Sculpt ID, and all of these procedures have in common the goal of removing excess fat. There is another kind of non-invasive body contouring procedure that is in kind of a different category from these and that is called Emsculpt and whereas the others the other technologies aim to remove fat without surgery. Emsculpt has the goal of building muscle without surgery and it does this using HIFEM or high intensity focused electromagnetic energy to trigger supermaximal or extra strong muscle contractions.
[03:18] to the tune of 20,000 of these in a half hour. And as kind of a happy side effect of Emsculpt, we found that it does dissolve some fat, but the fat removal with Emsculpt really doesn't compare with the non-invasive fat removal that we get with some of these other devices. So again, Emsculpt is really intended to build muscle. And the focus of these other three devices that we're focusing on here is to remove... fat. So I'd like to go ahead and divide these minimally invasive fat removal procedures into two categories based on how they are. achieving fat removal. The first category is cryolipolysis, and cryolipolysis is the process by which fat cells are destroyed by exposing them to extreme cold temperatures. And the only device that fits into this category of the three that we're discussing here is CoolSculpting.
[04:18] The other two devices, the Sculpture and the True Sculpt ID, fall into the category of devices that cause fat cell destruction through heat. So essentially by either using cold in the case of CoolSculpting or heat in the case of Sculpture and True Sculpt, we are bringing fat cells to the point that they actually trigger cellular self-destruction in a process called apoptosis. So different means of arguably achieving the same results. There is some research that can demonstrate the clinical efficacy of or effectiveness of both CoolSculpting and sculpture and true sculpt. However, here I wanted to... Speak about my personal experience with these devices that I've been fortunate to work with all three with some depth and I found that CoolSculpting as far as non-invasive body contouring procedures go is Really much more effective than either sculpture or true sculpt. So the question is if we know through research both clinical meaning research conducted in patients, as well as in basic science, meaning research conducted in a laboratory setting that both heat and cold can cause fat cell death. Why are we seeing in at least my clinical experience that CoolSculpting is more effective than these heat-based modalities in achieving non-invasive body contouring?
[05:59] And I think it really comes down to a fairly straightforward observation, which is that all three of these procedures need to be performed according to a very precise protocol to achieve the desired results. More specifically, they need to be performed for a given duration of time, and the tissues need to be exposed to a very specific temperature in order to get the results that the manufacturer is promising. And CoolSculpting really does have an advantage here because while in the beginning, CoolSculpting can be a little uncomfortable as the tissues are brought down to temperature. Once we get to the extreme cold temperatures necessary to cause cryolipolysis or fat cell death due to cold temperatures, numbness sets in. The same principle that applies in everyday life applies here. If you grab an ice cube with your hand or stick your leg in the snow for an extended period of time, it's going to become numb. So while it may be painful at first, eventually you'll have no discomfort at all. So these patients that are undergoing CoolSculpting treatments, while they may have some initial discomfort, once the device gets down to the temperature at which it needs to reach to cause the death of fat cells, they're isn't generally more discomfort, so the patient can sit there pretty easily and go through the entire required treatment time at the required low temperature to achieve the desired results. On the other hand, both Sculpture and True Sculpt rely on reaching and sustaining a fairly high temperature to cause the death of fat cells and Having both performed and received each of these procedures, it has been my experience that both Sculptor and True Sculpt can be too hot and uncomfortable for the patient to sit through an entire treatment at the necessary temperatures required to achieve fat cell death due to heat. So I've mentioned in the past that I don't think non-invasive body contouring technologies really can be compared to liposuction in any meaningful way. Liposuction is just going to give you a much better customized, more reliable result than any of these non-invasive contouring modalities. But for someone who really either isn't open to having any kind of surgery or can't have surgery for medical reasons, and if they do elect to have a non-invasive body contouring procedure, for the straightforward reason that CoolSculpting essentially brings along its own anesthetic and makes you numb for the procedure, I do think that CoolSculpting is the way to go in terms of non-invasive body contouring for the purposes of fat reduction. On the other hand, if you're looking to build muscle and burn a little fat as a side effect, I would recommend that you check out Emsculpt and its Hi-Fem technology based...
[09:04] results because again this is also a completely painless procedure. It can feel a little odd and a little intense at times but again it really is without pain so you're able to get through the whole thing and complete the necessary protocol. So in that sense it's similar to CoolSculpting because you're going to be able to get through the treatment. So hopefully this clarified some of the decision making behind which non-invasive body contouring treatment to try. Thanks for listening, and don't forget to subscribe, share the show, and head over to DarenSmithMD.com for more real-world plastic surgery talk.
Sources and context.
Original Captivate episode. Original release date: 2020-09-01. The recording is the source for the transcript and episode discussion. Later context in the written summary is identified separately.
Behind the conversation.
Darren M. Smith, MD, FACS