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Coolsculpting Update 2017 – Faster, More Comfortable, Better Results

Coolsculpting’s original FDA approval was in 2009 and it was initially cleared to cool skin prior to dermal procedures. It was later in 2010 that the FDA approved Coolsculpting for fat reduction in the flanks (love handles). Over the next several years, the procedure has been approved for abdomen, thighs – both inner and outer with various sized handpieces to treat every body type.

What’s new is that there are 2 new indications for Coolsculpting treatment. The submental fat (double chin) can now be treated with the Cool Mini handpiece. Depending on the needs of the patient, one or two applications are needed. Treatment times are 45 minutes. There is no downtime as is customary with all Coolsculpting procedures. A 2nd treatment is needed in some patients who need larger corrections. Another exciting area of recently approved treatment is the underarm area. This is where the new Cool Petite handpiece is used. Loose skin is not going to improve but that annoying “bat wing” can be reduced with these treatments.

In 2016, there was a significant change to the handpieces used for treatment called the CoolAdvantage Handpieces. (Not all practices have upgraded to these, so patients must inquire). The difference is that these handpieces are more shallow – the amount of suction witl therefore be less. The cooling plate is continuous rather than just the sides. The area treated is now more uniformly cooled than with the prior handpieces. These changes result in:

More comfortable treatments
Treatment times of 35 minutes vs the usual 60 minutes
Faster onset of results – as little as 3 weeks
Less bruising and post procedure pain

Soon after Coolsculpting’s approval it had been noted that manual massage post treatment led to improved results. About a couple years ago it was found that using the Zimmer Z Wave in place of the massage yielded even better results. It was found that adding the Z Wave increased the treatment efficacy by 68-100%. The Z Wave uses Acoustic Pulsed Technology, which sends shock waves through the skin and fat. It is a painless 5-10 minute procedure. These shock waves further injure the fat cells leading to a better result. After the Coolsculpting treatment, there are fat cells which are killed, some unaffected, and some which are “on the fence” as to whether they will survive or die. The Z Wave pushes some of these “undecided” cells over the brink. Z Wave has also been shown to lead to less post procedure discomfort.

“If one is good, two is better”. In some practices, a second Coolsculpting machine has been purchased. This allows for “DualSculpting”, treating 2 areas simultaneously. Treatment times are then cut in half using this technique.

Comparing the DualSculpting to treatments 1 year ago, two areas can now be treated in about one quarter of the time when adding the benefits of the CoolAdvantage Handpieces.

The Aesthetic Clinique has been one of the pioneers in Coolsculpting treatments. Its first machine was obtained in 2009, being one of the first 25 in the country, even before the formal FDA approval for fat reduction. All the latest handpieces are available including the CoolAdvantage, Cool Mini, and Cool Petite. The Zimmer Z Wave is a complementary service added to all Coolsculpting treatments. A second machine has just been purchased, so DualSculpting is now available at The Aesthetic Clinique.

Recent advances have made Coolsculpting significantly faster, more comfortable, and more effective. It is a great noninvasive procedure for reducing unwanted fat without downtime.

Maximizing Coolsculpting Results with CoolAdvantage and Zimmer Z Wave

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Coolsculpting has established itself as the worlds #1 noninvasive fat reduction treatment. It has over 3 million treatments worldwide and has been found to be a safe, well tolerated, and reliable procedure. It was FDA approved to cool skin to allow for anesthesia in 2009 and later in 2010, it was given the permanent fat reduction approval.

Coolsculpting treatments involve attaching a handpiece to the area of desired fat removal. There are various sizes of handpieces to assist in reaching all the different areas of the body where there is excessive fat. Most of these handpieces use a suction to pull/draw the tissue and fat into the handpiece, so a requirement (except for the outer thigh where a flat handpiece is used) is that there is “pinchable” fat. These handpieces gradually cool the area treated to the optimal temperature where the fat is killed but the surrounding tissues (skin, blood vessels, nerves) are kept safe. The attachment duration has been 1 hour until recently. It has been proven that about 25% of the fat treated will be removed during this process. It has also been shown that massaging the area treated immediately after handpiece removal improved the outcomes too. There was more fat loss and less post procedure discomfort.

There was a study last year that showed the Zimmer Z Wave treatment, done in place of the massage, lead to a 65-100% improvement in outcomes. In large volume practices, including Dr. Weiner’s office, this is now routinely performed on all Coolsculpting patients immediately when the handpieces are removed. The Z Wave uses radio pulsed technology that send shock waves through the tissues. When these waves bump against newly frozen fat cells, the already compromised cell is further damaged. This increases the amount of fat cell death from the Coolsculpting treatment. Another way to explain how it works is that with Coolsculpting, there are cells that are killed, cells that aren’t, and cells that are undecided. The Z Wave pushes some of these undecided cells to the point that they will die.

A recent advancement in the handpiece technology has been developed. This is the found in the CoolAdvantage and CoolMini handpiece. The changes consist of a more uniform cooling of the area treated. Older handpieces had cooling elements only on the sides of the handpiece cup but the newer has cooling throughout. What does this do to change the treatments? It lowers the treatment time from 1 hour to 35 minutes (45 min with the CoolMini). The newer handpieces have less depth, so more fibrous, less flexible skin areas can now be treated. This also translate into a much more comfortable treatment because there is less pulling in of the tissues. It has been found that post treatment discomfort is also less. There are reports that these handpieces are more effective because there are no longer fat pockets that might not get to the critical temperature need for death.

With the addition of CoolAdvantage technology and the Zimmer Z Wave, Coolsculpting treatment times are almost cut in half, treatments are more comfortable (during and after), and most importantly, the procedure is significantly more efficacious. When researching providers, make sure they use these new technologies.

Vanquish ME Vs Coolsculpting for Fat Reduction

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Coolsculpting ushered in the era of non invasive fat reduction in 2009. Who would ever have believed that a one hour procedure could remove fat permanently, without incisions? Coolsculpting can produce reliable fat loss of approximately 20-25% with no downtime and minimal risk. It is clearly the market leader with over 2 million treatments. For a long time, Coolsculpting stood without competition, but over the past couple years, formidable competition has been developed. The differences between Coolsculpting and Vanquish ME will be elaborated below. (Dr. Weiner has experience with both technologies, adopting the Coolsculpting in 2009 and the Vanquish in 2014.)

Research has found that a fat cell’s survival is sensitive to both heat and cold. Coolsculpting takes advantage of cooling the fat tissue to a temperature that is safe for all other structures such as nerves, muscles, and skin. After the Coolsculpting treatment, the fat cells gradually die in a process called apoptosis over the next 6-8 weeks. Subsequent treatments in the same areas yield even better results.

Vanquish ME uses radiofrequency technology to heat up the fat tissue to a point where the fat cells undergo apoptosis as well. The more treatments an individual has, the better the outcomes will be.

From a cursory perspective, it appears that these technologies are interchangeable, but that is definitely not the case. These are where they differ:

One of the major differences between these 2 technologies is that Coolsculpting requires pinchable fat that can be suctioned into the handpiece. This is a major downside to this technology because patients that have fat that can’t be drawn into the handpiece, can’t be treated. On the other hand, Vanquish ME can treat all patients. This includes the moderate to severe obese patient, who is not a candidate for the Coolsculpting. It can also treat the very fit patient who has just a small bit of fat that doesn’t go away with exercise but is not enough to place in a Coolsculpting handpiece.

The treatment area of Vanquish ME is significantly larger than with a Coolsculpting application. This is important because there have been cases of Coolsculpting treatments leading to demarcations between the treated areas. Correction of this problem is difficult, and might require liposuction. This has not been found to occur with Vanquish ME due to the large treatment areas, multiple sessions, and feathering that occurs on the edges of the area treated.

Coolsculpting has been advocated for patients with BMI’s (body mass index) below 30. This limits the procedure to those patients which are mildly overweight. On the other hand, Vanquish ME can be performed on all body types. The problem with treating the higher BMI patient’s with Coolsculpting is that they are at higher risk to have the indentations and demarcations then the lower BMI patients.

Radiofrequency has long been used to help tighten skin. The heat causes collagen stimulation and remodeling. An advantage of the Vanquish ME over Coolsculpting is it’s ability to cause some skin contraction.

Potential side effects of Coolsculpting have been shown to be numbness, bruising, prolonged pain, and paradoxical fat enlargement. The potential side effects from Vanquish has only been superficial skin burns, but that risk has been minimized with changes in the administration of the treatments.

The areas treatable with the technologies are:

Abdomen and Flanks: Coolsculpting needs at least 4 different applications to treat abdomen and flanks (4 hours). This can be performed in one treatment with the Vanquish ME, but will require 4-6 visits (about 4-5 hours).
Inner and Outer Thighs: Coolsculpting 2 different applications each leg vs Vanquish ME’s one each leg but 4-6 treatments
Chin, Gynecomastia, Bra Fat: Only treatable with Coolsculpting
Arms (“batwings”): Treatable with both technologies

Zimmer’s Z Wave has been shown to increase the fat destruction after use of both the Vanquish ME and Coolsculpting. Studies have shown an average increase of about 68% fat loss (up to 100%) when the Z Wave is used. The Z Wave is a painless 5 minute procedure that is performed at the conclusion of the treatment. Technically, the Z Wave is described as “Radial Pulse Therapy (RPT)”, which causes a shock wave to go thru the fat. It pushes fat cells that are “undecided” as to whether they are going to survive the fat destroying treatment over the edge, leading to a more effective treatment.

Both Vanquish ME and Coolsculpting have proven technologies that treat unwanted fat permanently using noninvasive techniques. Coolsculpting can be used to treat some areas that Vanquish can not. Coolsculpting has more side effects, albeit usually minor. The clear winner for the larger patient is the Vanquish ME for its ability to treat larger surface areas without the risk of lines of demarcation or indentations. Patients with loose skin will be better served with the Vanquish ME.

Coolsculpting Update 2017 – Faster, More Comfortable, Better Results

Maximizing Coolsculpting Results with CoolAdvantage and Zimmer Z Wave

Vanquish ME Vs Coolsculpting for Fat Reduction

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