Non-surgical fat removal: heat it or freeze it?

One of the “Holy Grail” topics in plastic surgery is the non-surgical removal of fat: in other words, no incisions, no anesthesia, and no instruments being inserted under the skin.  This rules out regular liposuction, laser liposuction, tummy tucks and all the traditional methods.
Recently, there are several FDA-approved methods that have taken America by storm.  One uses focused beams of high-energy ultrasonic energy to zap the fat.  Think of using a magnifying glass to focus the sun’s rays on a piece of paper.  The focused light energy heats up the paper – and you know what happens next!  Liposonix uses a similar concept, except it substitutes high intensity ultrasonic energy for light energy.  Once that fat cells have been liquified, they are gradually absorbed by natural processes over the next few months.  The science on this is good – it does work effectively.  However, it can be quite painful, especially when the more effective higher energy settings are used.  So, this means either doing multiple, lower energy passes for each treatment – which takes much longer… or sedating the patient, so they can get through the treatment in a reasonable state of comfort.  I had this done to me, when I was “demoing” the machine – and even on a medium setting, without any pain meds on board, it felt like hot needles jabbing me in the side.  So, if we get this machine, we’ll be offering pre-medication to our patients!
The other leading contender to melt fat uses cooling.  It turns out that, if you cool skin to just the right temperature, that there’s a temperature zone where the fat freezes, but the skin doesn’t.  This kills some of the subcutaneous fat cells, but the skin remains normal and healthy.  This is the secret of the “Coolsculpting” machine made by Zeltiq.  The treatment uses a suction device to draw a fold of abdominal or flank skin in between two cooling plates, and chills it for about an hour.  Most patients tolerate this pretty well, without any sedation.  Over the next two or three months, the body eliminates the fat cells that were damaged by the freezing process.  Currently, the Coolsculpting machine is approved for treatments on the abdomen and flanks.  They are working on getting approval for other areas.  One of our staff members tried it – and was pleasantly surprised by the whole experience.
These technologies are both perfect for the person that wants an improvement, but doesn’t have time in their schedule for surgery, or is afraid of anesthesia, or just wants a minor contouring effect.  Liposuction or tummy tuck surgery still has far more dramatic shaping results than either of these machines, by far.
As with any technology, there are always pros and cons.  I’d summarize it this way:
Liposonix                                     Coolsculpting
method:                          focused ultrasound                       cooling

required thickness:           at least one inch of fat                   no minimum
repeat treatments OK?      if there’s > 1″ fat                          yes, no problem
pain:                                often needs medication                 typically doesn’t need medication
cost of machine:               high                                              high
FDA approved:                  yes                                              yes
time to see results:            2-3 months                                   2-3 months
scientifically proven?          yes                                              yes
as dramatic as lipo?           no way!                                        no way!
We’re in the process of choosing one of these machines to bring to our patients, before the end of this year.  Which one would you prefer?