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CoolSculpting vs SculpSure?
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CoolSculpting vs SculpSure?

Episode 39: What's Better: CoolSculpting or SculpSure?

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 truSculpt 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 SculpSure and truSculpt in depth and we'll go into why some of them may be more effective than others.

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What kinds of body contouring procedures are available?

So let's zoom out for a second and just describe what all of these technologies are trying to achieve. CoolSculpting, SculpSure, and truSculpt are all examples of noninvasive body contouring technologies, specifically they're body contract 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.

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 noninvasive body contouring procedures. And the subject here is a comparison between three of these, which are CoolSculpting, SculpSure, and truSculpt iD. And all of these procedures have, in common, the goal of removing excess fat.

Minimally Invasive Body Contouring

There is another kind of noninvasive body contouring procedure that is in a different category from these and that is called EMSculpt. And whereas 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 super maximal or extra strong muscle contractions 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 noninvasive 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.

How does minimally invasive body contouring work?

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. The other two devices, the SculpSure and the truSculpt iD fall into the category of devices that cause fat cell destruction through heat. So essentially by either using a cold in the case of CoolSculpting or heat in the case of SculpSure and truSculpt. 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 or effectiveness of both CoolSculpting and SculpSure and truSculpt. However, here I wanted to speak about my personal experience with these devices, and I've been fortunate to work with all three with some depth. And I found that CoolSculpting, as far as noninvasive body contouring and procedures go, is really much more effective than either SculpSure or truSculpt.

So the question is if we know sure 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 noninvasive body contouring?

Why is CoolSculpting more effective than SculpSure?

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 there 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 SculpSure and truSculpt 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 SculpSure and truSculpt 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.

Am I a good candidate for minimally invasive body contouring?

So, I've mentioned in the past that I don't think noninvasive 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 noninvasive 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 noninvasive 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 noninvasive body contouring for the purposes of fat reduction.

On the other hand, if you're looking to build muscle burn a little fat as a side effect, I would recommend that you check out EMSculpt and it's HIFEM technology-based 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 noninvasive body contouring treatment to try.

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  • 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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