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What is the Deal with CoolSculpting?

The treatment of double chins has gotten a lot of publicity lately with several minimally invasive, namely Kybella and now CoolSculpting. I first want to say that I am a fan of all new technology and if there is an easier, safer and more effective means to achieve a result I am all for it. Having said that, the majority of the “new” technology that presents is minor in terms of making a big difference. Once in a while we experience a paradigm shift where the game is truly changed. Botox, liposuction, lasers and injectable fillers are good examples. Many times, however, the technology touted as being new and better really is not. If you watch TV shows about cosmetic surgery, there is some new miracle treatment every week and a year later many have fallen by the wayside.

So…..what is the deal with CoolSculpting? I get asked this question a lot and last night, I saw a TV piece that Honey BooBoo’s mom had the procedure for her double chin.

The good news about CoolSculpting is that it does work to a certain extent, just as Kybella does. Both of these technologies will reduce some fat under the chin. That is the good news. The bad news is that the average person that is interested in this type of treatment is frequently not a candidate. These minimally invasive procedures, whether you freeze, heat, vibrate or dissolve the fat are only effective on younger patients with isolated fat deposits and little or no excess neck skin. This definition really reduces the true and effective population for these procedures. If a patient has fat and skin excess, and you remove the fat (regardless of the technique) you are left with even more excess skin and a worse result. So, if the ideal patient is someone with isolated fat under the chin and little or no skin excess, who exactly is this? For the most part the ideal patient is young with minimal fat. Older patients (over 45) are likely to have a component of skin excess and patients in their 50’s are rarely candidates in my opinion.

RULE # 1- Patients with excess neck skin need a facelift.

There is really no getting around this. Every day I see patients with excess neck and jowl skin and they have wasted money or numerous “miracle procedures” that were supposed to tighten their neck. Most of the nonsurgical fat treatments simply do not and cannot address skin excess. So, many patients want to avoid a facelift and end up having several years of other treatments that actually cost more than a facelift and they finally return to have a facelift.

ky yes

Figure 1. These are good candidates for nonsurgical double chin treatment (or facial liposuction).

ky no

Figure 2. This is a poor patient for nonsurgical treatment and the result will be disappointing without facelift.

kybella figure 6

Figure 3. This patient was treated with liposuction and chin implant only.

kybella figure 9

Figure 4. This patient was treated with face and neck lift which is the ultimate solution for excess neck fat and skin.

RULE # 2- If it sounds too good to be true, it probably is.

I see numerous company photos of fat reduction techniques that are impressive, but they don’t tell the entire story. Was it an exceptional case? Does that represent the typical treatment for everyone? Did the patient have the fat melting procedure and also go on a big diet and exercise regimen? Lots of variables here! If you are considering having any new nonsurgical procedure, ask the doctor to show you 20 cases of before and after pictures that are 6 months to a year after the procedure. If they can’t show you that, then you should be cautious.

Finally, just because something is new does not mean it is better. None of the nonsurgical fat melting procedures can produce as effective of a result as simple liposuction. I can perform submental (under the chin) liposuction in 10 minutes with local anesthesia and get an immediate result with about a week of recovery. I understand that some folks simply don’t want surgery and for this population, the minimally invasive procedures may be a good thing. It will take longer, require multiple treatments and won’t offer the comprehensive result that liposuction will. For instance, with conventional facial liposuction, the surgeon can lipo the double chin, neck, jowls, cheeks, etc. This is not possible at this point with most nonsurgical treatments or injectables.

CoolSculpting is a good product from a good company and I have numerous friends that market or use it and it works well for spot treatments on selected patients. It will not be effective for patients with a lot of face and neck fat and is by no means a treatment for obesity. It is an alternative and not a replacement for conventional surgical procedures.

As technology and science progress, hopefully nonsurgical treatments will make surgery a thing of the past. Currently we are light years away but the new technologies are nonetheless interesting. Make sure you are the proper candidate and investigate before investing thousands of dollars into a procedure that may have limited results. You can also say the same thing about surgery. Educated and informed cosmetic consumers get the best results as they take the time to research the proper treatments.

For more information about cosmetic facial surgery visit

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia



Office Address

Joe Niamtu III, DMD
11319 Polo Place
Midlothian, VA 23113

Office Hours

Monday - Friday
8:00am - 5:00pm

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