Lipolysis through controlled cooling is the use of precisely controlled cooling to remove fat. The procedure is designed to kill only fat cells without harming the skin or other tissues.

Lipolysis through controlled cooling was developed through research by Dr. Dieter Manstein and Dr. R. Rox Anderson performed at the Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School. The research involved the effect of selective cooling on adipocytes and fat tissue.

UPDATED September, 2010: The cryolipolysis system discussed in this course has been cleared for non-invasive fat reduction for the flank region in the United States, and for the entire body (internationally). This system is also approved in the United States for various applications related to skin cooling during dermatologic procedures.

The process takes advantage of the fact that adipocytes respond differently to cooling than cells that do not contain significant amounts of fat. The process involves cooling adipocytes to near freezing (~12˚C), which causes crystallization of lipids but has little effect on non-lipid containing cells. Lipid crystallization triggers apoptosis and membrane rupture in adipocytes, releasing the lipids. Lipids are removed gradually through the lymphatic system, reducing tissue volume.

Fat reduction as a result of lipolysis through controlled cooling is a gradual process. Clinical results may be apparent as early as one month post-treatment, and improvement continues over the course of a few months. Additional treatments may be required for optimal effect.

Adipocytes that receive sufficient cooling are destroyed. In that sense, localized fat reduction is permanent. However, like liposuction and other methods of fat removal, fat may accumulate in remaining adipocytes in the local area or in other areas of the body. For that reason, patients should continue to eat a healthy diet and exercise for best results.

Patients should be counseled that lipolysis through controlled cooling sculpts appearance locally. It is a procedure that produces gradual change over time in local areas of fat deposit, and may require multiple procedures for optimal results. It is important for patients to know that lipolysis is not a procedure for weight loss.

Good candidates for lipolysis through controlled cooling have the following characteristics: • Localized fatty deposits in regions appropriate for body contouring (eg, anterior abdominal region, trunk, arms, legs) • Skin with good elasticity and tone • Good overall health • Realistic expectations

Poor candidates for lipolysis through controlled cooling have the following characteristics: • Morbidly obese patients • Patients without localized fat deposition • Patients with poor skin elasticity or tone • Patients with excessive scarring or skin conditions such as eczema or dermatitis in the area of intended treatment • Patients with unrealistic expectations

Contraindications for lipolysis through controlled cooling include cryoglobulinemia and paroxysmal cold hemoglobulinuria.

After treatment, patients should be counseled on the likelihood of transient redness and swelling, the possibility of transient bruising, and the possibility of transient numbness or tingling. They should also be counseled that improvement will be gradual and should become evident within a few months, although change may be visible as early as a month post-treatment. Patients should also be counseled to make an appointment for a visit approximately 2-3 months post-treatment for a follow-up evaluation.

Fat removal techniques include invasive procedures such as liposuction and non-invasive approaches using electromagnetic energy (lasers, light, RF) and ultrasound. Each technique has associated strengths, weaknesses, and risks. Cold-induced fat removal is safe, effective and non-invasive; it provides consistent, predictable results with a painless treatment.