Cryolipolysis vs liposuction: Understanding the difference

Lifestyle changes are the number one way to lose weight, but many people may need a little extra help contouring and shaping stubborn areas of their figure. That's where contouring procedures like liposuction and cryolipolysis (CoolSculpting) come into play. These are not weight loss solutions; they are body contouring solutions. Lifestyle changes can take you 90 percent of the way to your goal, but these procedures can help you cross the finish line by helping you achieve the shape you desire.

Both options can help you sculpt your body, but they are completely different procedures that contour the body in different ways. Understanding the difference between these procedures can help you find the option that best addresses your needs and delivers the aesthetic you are looking for.

What is body contouring?

You can lose weight by combining diet, exercise and new tools like GLP-1 medications. However, you can't control where you lose that fat. You can do everything right and still wonder why you have a little tummy pouch left, or thighs that don't quite fit your ideal.

"In general, we have three different ways of reducing fat," said Kristy Hamilton, MD. "The first, of course, is lifestyle-based, which can be modulated with pharmaceuticals like the GLP-1s. Second is direct removal of fat, also known as liposuction. The fat is in the liposuction canister at the end of the case, and it is permanently removed, leaving a contoured appearance behind. The third category is nonsurgical devices, which include cryolipolysis."

The overall goal of these fat reduction methods is the same, but how they reach that goal is unique. Understanding the difference and carefully considering overall contouring goals can help patients choose the procedure that offers the best chance at the result they want to achieve.

"Cryolipolysis and liposuction are different procedures, and although the terms may be interchangeable by some, the reality is that they are quite different," said Josef Hadeed, MD, FACS.

Liposuction is a surgical procedure that helps remove localized pockets of fat. A plastic surgeon makes small incisions in the treatment area and inserts a hollow cannula, or tube. Fat deposits are suctioned out of the body, removing the fat and sculpting the body. The abdomen and thighs are popular locations for liposuction treatment because of resistant fat deposits in these areas. However, liposuction can also contour the back, upper arms, hips or "love handle" and other body regions.

While liposuction requires incisions, cryolipolysis offers a nonsurgical alternative.

"Cryolipolysis is a noninvasive procedure that uses controlled cooling to target and destroy fat cells," said Dr. Hadeed. "The process involves applying a device to the skin that cools fat cells to a temperature that triggers their death, which the body then removes over a period of time."

The cold damages fat cells in a targeted area of the body. Fat cells are more susceptible to cold than other cells, like skin cells. A plastic surgeon can freeze or otherwise damage fat cells using a specialized device. This procedure triggers an inflammatory response, and the body responds by eliminating those injured or damaged fat cells over time.

Other sculpting procedures can also fall into the nonsurgical fat reduction category.

"Devices like radiofrequency microneedling (Morpheus8 Burst) and injectables like Kybella (deoxycholic acid) also fall into this category," said Dr. Hamilton. "What is true of all these nonsurgical treatments is that the fat is damaged, whether by heat, cold, being denatured with exposure to acid, etc. The body must then clear these damaged fat cells."

Understanding the benefits and drawbacks

The benefit of cryolipolysis and other sculpting procedures is that they are nonsurgical and minimally invasive. Unlike liposuction, patients do not require sedation or anesthesia to undergo treatment. These procedures may also benefit specific patients looking to address other issues.

"Body treatments like Morpheus8 Burst, for example, also have added benefits such as improving collagen production in the skin as well as skin quality in general, which may be appealing to patients who have mild laxity after weight loss or pregnancy," said Dr. Hamilton.

However, these procedures may not always deliver the results that patients are looking for in a contouring procedure.

"That is where we see some of the variability in terms of efficacy and results," said Dr. Hamilton. "Some patients will clear more fat than others; some of these devices are more effective than others."

She also pointed to a rare side effect that can increase fat, instead of decreasing it.

"For cryolipolysis, in particular, there is a rare but real type of complication possible called PAH, paradoxical adipose hyperplasia," said Dr. Hamilton. "This condition is where, instead of reducing fat in the areas, the body actually responds to the treatment by producing more fat cells, yielding a firm area of increased fat where the treatment handpiece was applied."

Varying body shapes and the vacuum-based nature of the device may cause variable results for some patients. Many devices come with fixed-sized applicators, which may not perfectly contour to all body shapes. Sometimes, suction and freezing can also be inconsistent.

"Many patients have reported uneven results after cryolipolysis," said Dr. Hadeed.

There is a reason liposuction remains the gold standard of contouring and fat reduction – it works! According to statistics from the 2024 ASPS Procedural Statistics Report, liposuction remains the most popular plastic surgery procedure. Consistently at the top of the pack, liposuction delivers results.

"Liposuction will always provide the more dramatic option in terms of fat removal and is 'better' in that sense," said Dr. Hamilton. "You can create beautiful contours and sculpt the body and take out significant volumes."

You may have a tough choice to make if you want to avoid surgery but still want more dramatic results.

"While liposuction is invasive, the benefits are that more fat can be removed, and the body can be shaped or contoured to a more desired result," said Dr. Hadeed.

However, Dr. Hamilton understands that the obvious downside of the surgical procedure is the recovery period, and patients should be prepared to wear compression garments and perform lymphatic massages faithfully.

Making the choice that makes sense

Which procedure can help you accomplish your body contouring goals? The answer depends.

"Patients need to consider their goals," said Dr. Hamilton. "If they are looking for a five-liter change in volume, they will be sorely disappointed by nonsurgical options. If they are seeking a small change for a stubborn area and downtime is a concern, then they may be very pleased with a nonsurgical option, particularly if it is a focused area. The key is to speak to a board-certified plastic surgeon who understands the treatment options and can guide the patient."

One of the issues she sees with cryolipolysis is that patients are sometimes "oversold" the results that a nonsurgical option can deliver, so they can be disappointed with the overall sculpting outcome. This may be especially true in med spa-type scenarios.

Discussing your aesthetic goals with an ASPS Member Surgeon who can appropriately assess the treatment options and help you make a choice that makes sense for you.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.