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What is the Difference Between Liposuction and Coolsculpting?

What is the Difference Between Liposuction and Coolsculpting?


Episode 10: What is the Difference Between Liposuction and Coolsculpting?

Today, we're going to discuss the differences between liposuction and CoolSculpting. To organize that discussion, we're going to focus on several key topics. We'll address: who is a good candidate for each procedure, what kind of results you can expect with each procedure, how long will it take to see the result of each procedure, what recovery is like and downtime, what is the cost comparison between liposuction and CoolSculpting, what are possible complications with liposuction and CoolSculpting, and as a bonus, we'll discuss what our favorite noninvasive body contouring procedure is.

Who is a good candidate for liposuction and who is a good candidate for CoolSculpting?

So let's begin with a discussion of who is a good candidate for liposuction, and who is a good candidate for CoolSculpting. The ideal candidate for liposuction is someone who is at their goal weight, and would like to improve the contour of specific areas of their body. Remember that liposuction is not a weight change procedure, but instead, it's a shape change procedure. So liposuction is not for people that are looking to lose weight, it's for people that are already at, or near their goal weight, and are looking to improve the shape of their body.

On the other hand, CoolSculpting is really best for people who are in good shape, and are looking to improve the contour of very specific areas. Specifically, someone who has a defined bulge of fat, for example, in their abdomen or their love handles, or their arms, or their legs.

To be a little more specific, with liposuction, you can treat someone whose abdomen is a little larger than they'd like it to be and get a nice result. With CoolSculpting, you're not going to get phenomenal results on a global treatment of the abdomen, whereas you might see nice results if you're treating a very specific bulge of fat on the abdomen.


What kind of results can you expect to see with CoolSculpting? What kind of results can you expect to see with liposuction?

In terms of the kinds of results you can expect to see with each procedure, this really comes down to the nature of the procedures themselves. With liposuction, you are getting a custom tailored approach to body contouring, where an expert body contouring surgeon can remove the bulk of excess fat from the target area, and very nicely feather that area into surrounding areas, so there is a very nice natural change in your body contour. On the other hand, with CoolSculpting, you're essentially putting an automated device onto a bulge of fat and setting it to preset parameters, and hoping that the result that's achieved is compatible with the outcome that you're looking for. There is no room for customization or personalization with CoolSculpting.

To dive a little deeper, CoolSculpting works by placing applicators over specific treatment areas. So there's no feathering or extending a treatment area to cover a body part in a natural way. Instead, all you can really do is line up applicators to treat different segments of a body area. And you're essentially hoping that by lining up applicators in the right pattern, you'll achieve a nice, natural result. Whereas with liposuction, because the treatment is performed by a human who is an expert in performing body contouring, you can achieve a nice, natural result and you're not left essentially at the whims of an automated process.

So in terms of how this translates into the kind of results you can expect with liposuction versus the kinds of results you can expect with CoolSculpting, with liposuction, you can generally expect a more natural overall reduction of fatty volume in the treatment area, whereas with CoolSculpting, you can expect a reduction of fat in extremely targeted specific areas that fit into the applicator without any real room for feathering between those applicators.

How much of an improvement can you expect to see with each procedure?

The other important consideration is the magnitude of change that you can expect to see with each of these procedures. And in summary, you can see a much greater result with liposuction in one session than you can see with CoolSculpting really in a series of sessions. To be a bit more precise, what we like to tell our patients is that with liposuction, you can expect to remove approximately 75% of fat in the treatment area in just one session. With CoolSculpting, on the other hand, you really expect on average to remove about 22% of the fat in the treatment area with each session. And since the volume of the fat in the treatment area decreases on average by 22% with each treatment, the amount of fat that you can remove each time decreases, because now you're just removing 22% on average of the remaining fat, not of the original volume. And we'll come back to this concept when we talk about the price comparison between liposuction and CoolSculpting.

Let's jump to the amount of time that it takes to see results with liposuction versus CoolSculpting. With liposuction, after your procedure is performed, what we generally advise patients is that after about two to three weeks, they'll start to see a nice change in their appearance. But it does take about three months to see the absolute final result as swelling subsides and tissue contracts to reveal their new improved body contour. With CoolSculpting, on the other hand, the process is really a bit slower, and we find that while you will often see the final result at about three months, there really often aren't any early gains to be seen.

What is recovery like with liposuction? What is recovery like with CoolSculpting?

In terms of the recovery to be expected with liposuction versus CoolSculpting, we actually find that the recovery from liposuction is often a lot more comfortable than the recovery after CoolSculpting. While it's true that liposuction is a surgical procedure, it's really minimally invasive in the sense that there are several three to four millimeter incisions made, and they are well hidden, and they heal very nicely, and are ultimately very difficult to see.

CoolSculpting is a noninvasive procedure. However, after CoolSculpting, there is the potential for significant discomfort, both from pain of the cryolipolysis process itself (that's the process by which CoolSculpting kills fat cells) and also due to nerve changes after CoolSculpting. The extreme cold temperatures of CoolSculpting can irritate nerves, and this can lead to numbness, or the term we use is paresthesia, and this kind of pain can be very uncomfortable. And for men that are having CoolSculpting of their double chins, this numbness can make it difficult or even impossible to safely shave.

With liposuction, on the other hand, what we're finding with most of our patients is that they're not that uncomfortable at all, and they report feeling soreness or achiness that's comparable to what they would feel after a hard workout.

How much does liposuction cost? How much does CoolSculpting cost?
So now let's turn our attention to a cost comparison between liposuction and CoolSculpting. You will find pretty wildly variable costs in liposuction from provider to provider, and this varies with geography and the experience and popularity of the provider. But in general, in our experience, what we've seen is that the cost of one round of liposuction, which remember, will on average, get rid of about 75% of fat in the treatment area in a nicely customized way, is almost an equivalent cost to the cost of three rounds of CoolSculpting, which really is not customizable. And by most accounts, won't lead to as high quality results as a custom liposuction procedure.

So, all in all, the cost is probably comparable between the liposuction procedure and the number of CoolSculpting procedures that one would require to reduce an amount of fat that's even close to comparable to the amount of fat that you'd be removing with the liposuction. And the result that you're getting with the liposuction will be truly customized and contoured to your shape. Whereas with the CoolSculpting, you're relying on a machine to do the job.

What is safer: liposuction or CoolSculpting?

Next, we should look at the possible complications with each procedure. And it's important to realize that liposuction is a true surgical procedure and CoolSculpting is a noninvasive body contouring procedure. So while that may sound intimidating in terms of liposuction, extensive data shows that it really is extremely safe when performed by an expert surgeon who's following proper protocol. And really, the most common complications that we see with liposuction, and these really are seen fairly uncommonly, would be things like infection, which is generally managed very easily with antibiotics, a bleeding problem, which we may need to address by going to the operating room to address the bleeding, or minor contour abnormalities that we may need to address down the line with fat grafting or other similar procedures. So this is all to say that liposuction, while it is a surgical procedure is very safe when performed by a board certified plastic surgeon and achieves truly excellent customized results.

At the same time, we do have to remember that liposuction is a surgical procedure, and all surgical procedures do have risk. And this is why it's important to seek out an expert surgeon and discuss the risks and benefits of the procedure to see what the best option for you is in your unique case.

Now, CoolSculpting could be the right choice for some individuals, if they are absolutely opposed to having surgery. But the results that can be achieved with CoolSculpting really should not be thought of as comparable in any way with the results that you can achieve with liposuction. And the possible complications that could be seen with CoolSculpting are not negligible. Now, there are some very rare complications with CoolSculpting, like actual loss of tissue due to the extreme cold temperatures, but there are some more common complications that can be quite difficult to deal with. There are things like hyperpigmentation of the skin, that can require various treatment modalities to correct. There is an entity called paradoxical hyperplasia, which is where CoolSculpting actually causes fat to grow instead of shrink. And this is not a very well understood process, and it often requires liposuction for correction. And there's also significant potential for unevenness or contour deformity with CoolSculpting that would often require either fat grafting or liposuction to correct.

Should you have liposuction or CoolSculpting?

To summarize my opinion on liposuction versus CoolSculpting, liposuction is really the choice for the person that wants the best possible result, they're okay with a surgical procedure, and they'd like to see that result as rapidly as possible. And CoolSculpting is the procedure of choice for someone who is willing to compromise on the quality of the result and the amount of time it takes to see that result, or who is absolutely opposed to having any kind of surgical procedure.

What is Emsculpt?

At the beginning of this episode, we promised that we would talk about our favorite kind of noninvasive body contouring, and that is Emsculpt. And Emsculpt is a really cool noninvasive body contouring treatment that is the first of its kind to focus on actually building muscle in addition to reducing fat. And Emsculpt is FDA cleared to treat almost any area of the body, but the most common areas, especially in our practice, are the abdomen and the glutes. And what Emsculpt does is it uses HIFEM, or highly focused electromagnetic energy to stimulate the muscle group being treated to perform supramaximal contractions. These are contractions that are far more powerful than what you could ever achieve in the gym or during a workout on your own.

Emsculpt, for example, in a 30 minute treatment section of the abdomen, actually does the equivalent of 20,000 crunches, and in a 30 minute treatment session of the glutes is the equivalent of 20,000 squats. So really, for those who are fit and want to see awesome muscle definition, and also the reduction of the fat overlying their muscles, so they could start to see some really nice results, Emsculpt is a really cool thing to think about, and it's done in the course of four treatments over two weeks, and it can take about four to six weeks to see maximum results since the muscle has to build just like it would after a workout.

In addition to being a really nice, powerful aesthetic treatment, people are reporting tremendous improvements in their workouts as well, since they're getting a great improvement in their core strength or the strength of other muscle groups that helps them work those areas more efficiently and more efficaciously in the future. So Emsculpt is a totally noninvasive treatment that takes about 30 minutes, and it really does build muscle very effectively, and people are super happy with it.

Can you combine liposuction with Emsculpt?
We've also started introducing Emsculpt in combination with liposuction. So once we've really gotten rid of excess fat in the treatment area, we then come back with Emsculpt and work on defining the underlying muscles, and we could really come up with some beautiful results.


  • Darren M. Smith MD
  • Darren M. Smith MD
  • Darren M. Smith MD
  • Darren M. Smith MD

All photos are of models except before and after images.

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