Liposuction is the more effective of the two at reducing local fat: authors of a randomized split-body trial wrote that cryolipolysis has fewer side effects than liposuction, but its effectiveness at reducing local fat tissue is also lower[1]. Cryolipolysis, the fat-freezing treatment also known by the name CoolSculpting, uses targeted cold to make fat cells die off while sparing the surrounding tissue[2][3]. In a systematic review of 19 cryolipolysis studies, average fat reduction ranged from 14.67 percent to 28.5 percent by caliper and from 10.3 percent to 25.5 percent by ultrasound[4].
This article was researched and written with AI assistance from peer-reviewed sources, and automatically fact-checked against those sources. It has not been reviewed by a physician. It is educational, not medical advice. Please consult a board-certified surgeon about your situation. How we write.
Liposuction reduces local fat more effectively than cryolipolysis, according to the authors of a randomized split-body trial, while cryolipolysis causes fewer side effects[1]. A systematic review still called cryolipolysis a compelling alternative to liposuction and other, more invasive methods, with significant fat reduction when used for localized fat deposits[4].
The same systematic review described liposuction as a more invasive method with an increased risk of complications[4].
Reported cryolipolysis results differ from study to study[4]. In a randomized split-body trial of 25 people who had one cryolipolysis session on the lower abdomen, ultrasound showed a mean fat reduction of 14.1% after 12 weeks on the sides that were not heated afterwards[1].
In a multicenter study of a cryolipolysis device using three-dimensional cooling, abdominal fat reduction compared with baseline was 28.45% at 12 weeks and 31.13% at 16 weeks among the 24 participants who completed the study[5]. In a study of multiple simultaneous torso treatments in 35 participants, the mean reduction in fat layer thickness was 0.33 cm[6].
On the inner thighs, cryolipolysis produced a fat thickness reduction of 2.8 mm and a circumference reduction of 0.9 cm at 16 weeks in 42 patients who completed follow-up[7]. For fat under the chin, a meta-analysis of eight pre-post studies involving 206 patients found a pooled mean reduction in submental fat thickness of 2.78 mm[8].
One single-center retrospective study of 287 patients and 1118 procedures reported a fold thickness reduction of 69.91%, measured by plicometry[9]. That figure is well above the average caliper reductions of 14.67 percent to 28.5 percent reported in the systematic review[9][4].
Cryolipolysis works gradually: a review reported histology evidence of a gradual thinning of the fat layer over a period of two to four months[10]. In a dual-applicator study, a majority of physician reviewers and participants noted visible improvements at 4 weeks after the initial treatment[11].
For cryolipolysis, a systematic review found it unclear whether multiple treatments in the same body area enhance the effect[4]. Two studies measured results after a single session, including a trial on the lower abdomen and a study of the arms, the area under the chin and the male chest[1][12].
Other cryolipolysis protocols used repeat sessions: in a torso study, participants received a mean of 20.8 treatment cycles over 2 treatment sessions[6]. A study of fat under the chin used two treatments with an interval of 10 weeks[13]. In the inner thigh study, each single-cycle treatment lasted 60 minutes, followed by 2 minutes of manual massage[7].
A review presented cryolipolysis as an alternative to liposuction that offers fat reduction without the need for a lengthy recovery period or major surgery[2]. Ask your surgeon how many sessions or procedures your own goals would likely involve, and what recovery from each option would look like for you. You can read more about the limits of nonsurgical liposuction.
Most reported cryolipolysis side effects were mild and short-term, such as redness (erythema), swelling and pain[4]. In a large retrospective study covering 287 patients and 1118 procedures, few side effects were reported, including posttreatment pain (1.70%) and one case of paradoxical adipose hyperplasia (0.09%)[9].
In a split-body trial, swelling, redness and reduced skin sensation (hypesthesia) remained on unheated sides, while heating the area afterwards made them fade almost completely[1]. However, heating also lowered the fat reduction after 12 weeks to 9.6%, compared with 14.1% on the unheated sides[1].
In a torso study, most adverse device effects were mild with no serious events, and mean maximum pain scores were 2.6 and 4.1 out of 10 during the first and second treatment sessions[6]. In a study of fat under the chin using colder temperatures, side effects were mild and resolved within 10 weeks, except for one case of hyperpigmentation (skin darkening) that resolved on its own within 6 months after the last treatment[13].
Beyond paradoxical adipose hyperplasia, a case series described other underreported cryolipolysis side effects, including contour irregularities, skin and soft tissue atrophy, and asymmetries[14].
Paradoxical adipose hyperplasia is a rare complication of cryolipolysis in which fat cells unexpectedly overgrow in the treated area, and its incidence appears to be higher than manufacturer reports[15]. The report that first described the complication involved a man in his 40s whose abdomen gradually enlarged starting three months after a single cryolipolysis cycle, with an incidence estimated at that time at 0.0051%[16].
A meta-analysis of 28 studies encompassing 13,078 patients estimated a pooled incidence of paradoxical adipose hyperplasia of 0.22%, or 1 in 455 patients, based on low-certainty evidence[15]. The same meta-analysis noted that only 4 studies reported follow-up of 16 weeks or longer, and that differences in risk between the sexes were not statistically significant[15].
A multicenter evaluation at 8 Canadian medical centers found paradoxical adipose hyperplasia incidence rates between 0.05% and 0.39% of treatment cycles, slightly higher than the manufacturer's quoted rate of 0.025% (1 per 4000 cycles)[3]. In that Canadian evaluation, incidence rates at all sites fell by over 75% with newer device models, and 76.9% of cases were associated with older models[3]. Of the Canadian patients who developed the complication, 55% were male[3].
Smaller single-center reports give different numbers: one academic center calculated a paradoxical adipose hyperplasia incidence of 0.67%, based on four patients[17]. A chart review at another practice identified 11 cases, in eight men and three women, all of Hispanic background[18]. A review of cryolipolysis for fat under the chin found no reports of paradoxical adipose hyperplasia following treatment with that device at the time[19].
In two published series, 7 of 11 patients and all 4 patients with paradoxical adipose hyperplasia were treated surgically[18][17]. No evidence of paradoxical adipose hyperplasia resolving on its own has been described[18][16]. In one single-center series, seven patients were treated surgically, six with liposuction alone and one with liposuction and abdominoplasty (a tummy tuck), and three of the liposuction patients required a secondary procedure[18].
The authors of that series advised delaying treatment until the affected area has softened, which normally occurs 6 to 9 months after the initial cryolipolysis procedure, and named power-assisted liposuction as their preferred method[18]. At an academic center, all four patients with the complication underwent liposuction, abdominoplasty or both, and none showed signs of recurrence[17].
Because paradoxical adipose hyperplasia appears as fatty enlargement of the treated area months after cryolipolysis, contact the clinician who treated you or a board-certified surgeon if a treated area starts to grow[17].
Cryolipolysis studies generally reported high satisfaction, but a literature review raised concerns about the rigor and commercial bias of many cryolipolysis reports[11][7][13][20]. In a multicountry study, 83.3% (80 of 96) of evaluable participants were satisfied or very satisfied with their midsection results 12 weeks after the final treatment[11].
In the inner thigh study, 93% of patients were satisfied with the procedure, 84% noticed visible fat reduction and 89% would recommend it to a friend[7]. In a study of fat under the chin, 12 of 15 subjects (80%) were satisfied or very satisfied with the treatment[13].
Satisfaction and visible change do not always line up: in the split-body trial, overall satisfaction was 9.2 of 10 points, even though only 44% of participants subjectively recognized fat loss[1]. A review of 32 cryolipolysis reports found that most lacked rigorous scientific methodology, with concerns about the validity of photographic documentation, conflicts of interest and commercial bias[20].
Among people who had surgery to repair a cryolipolysis complication, satisfaction was high: all patients whose paradoxical adipose hyperplasia was treated surgically, mostly with liposuction alone, were very satisfied with their final appearance[18].
Cryolipolysis is aimed at localized fat deposits, where a systematic review found it produces significant fat reduction[4]. In a Brazilian study of the arms, the area under the chin and the male chest, body mass index was the only factor significantly related to results, and the authors concluded that obese subjects did not benefit[12].
In a randomized trial of obese adolescents aged 13 to 16, cryolipolysis plus diet improved waist-hip ratio and subcutaneous fat more than laser lipolysis plus diet or diet alone, but body mass index and body weight did not differ significantly between the groups[21]. None of the groups in that adolescent trial showed an effect on visceral fat[21].
A review concluded that further research is needed to determine the categories of patients in whom cryolipolysis gives the most favorable outcomes[20]. The trade-off described by the split-body trial authors is that liposuction reduces local fat more effectively, while cryolipolysis causes fewer side effects[1].
Consider asking a board-certified surgeon to examine the area and talk through which option, if either, fits your goals. Our guides on whether you are a liposuction candidate and liposuction versus non-surgical treatments may help you prepare.
These questions can help you compare liposuction and cryolipolysis with a board-certified surgeon:
Authors of a randomized split-body trial wrote that cryolipolysis has fewer side effects than liposuction, but its effectiveness at reducing local fat tissue is also lower[1].
Rarely, a complication called paradoxical adipose hyperplasia makes fat cells overgrow in the treated area; a meta-analysis estimated a pooled incidence of 0.22%, or 1 in 455 patients, based on low-certainty evidence[15]. In one series, surgically treated cases were corrected with liposuction alone or with liposuction and abdominoplasty[18].
A review reported a gradual thinning of the fat layer over a period of two to four months[10]. In one study, a majority of physician reviewers and participants noted visible improvements 4 weeks after the initial treatment[11].
In a Brazilian study of the arms, the area under the chin and the male chest, body mass index was the only factor significantly related to results, and the authors concluded that obese subjects did not benefit[12]. Consider discussing your weight and goals with a board-certified surgeon.
A meta-analysis of eight pre-post studies involving 206 patients found a pooled mean reduction in submental fat thickness of 2.78 mm, with minimal, transient side effects[8].