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How Does Zeltiq Work?

This completely non-invasive treatment is showing great promise as a new body contouring option.

In recent years there has been a steady push towards less and less invasive procedures for body contouring. Many patients have demonstrated that they prefer above all to avoid surgery, even if it means settling for less results than can be achieved through surgical treatments. The latest non-invasive body contouring treatment is Zeltiq and unlike some other non-invasive treatments which are often dismissed by many in the medical community, Zeltiq has the support of several prominent physicians. But how does this treatment contour the body without actually entering the body and suctioning out the fat?

Dr. Fitzpatrick Groff Zeltiq Before After
Zeltiq Results of Dr. Richard Fitzpatrick and Dr. William Groff


"This is a very very unique device because it's using cold to kill fat cells," says world renowned dermatologist Dr. Richard Fitzpatrick, one of the key developers of CO2 laser resurfacing. "Dr. [Rox] Anderson had remembered a disease that occurs in infants - fat necrosis from cold, typically from an infant whose been in a snow bank or something and they develop fat loss and it turns out that the lipids that are in fat cells have a much different freezing temperature than water so after a lot of investigation and work, that was set up to freeze the fat cells in a controlled manner without damaging the surrounding tissue. It's very controlled freezing of fat cells and then the fat cells don't rupture, there's no immediate death to the fat cells, it triggers apoptosis which is a programmed cell death so they die gradually over a period of three or four months."
Dr. Fitzpatrick Groff Zeltiq Before After
Zeltiq Results of Dr. Richard Fitzpatrick and Dr. William Groff


There is a specific process that the cell undergoes as it dies away. Dr. Fitzpatrick explains, "Initially it sets up an inflammatory reaction so if you biopsy the skin the fat cell is surrounded by an inflammatory infiltrate so there are white blood cells that move into the area and actually the area feels tender, it feels kind of like a bruise if you push on it but as that resolves, the fat cells then are just gradually reabsorbed. So they go into a programmed cellular death where that's how your body gets rid of cells that are no longer useful so the cold doesn't immediately kill the cell it goes into a stage where it dies gradually."

The treatment is completely painless and is pretty simple. As Dr. Fitpatrick describes, "We have an applicator cup... with a vacuum and it pulls the skin and fat up into the cup and there are cooling plates on both sides of the cup that drop the temperature down and that controlled drop in temperature freezes the fat cells and actually once we finish we keep them frozen for about an hour when we take the applicator cup off there's actually like a frozen stick of butter there, the skin is very firm like a little frozen brick and it is red at that point. Now it thaws over period of 5 or 10 minutes or so and then there's some redness that the skin has afterwards which is just related to increased blood flow immediately post treatment. Occasionally the patient will get a bruise much like hickey I mean so that's kind of secondary to the suction of the vacuum. If there is a bruise it will generally fade over a period of about a week or so and as I mentioned if you biopsy the skin a few days after you will see an inflammatory reaction around the fat cells and that is accompanied clinically by just some tenderness in the area."
Dr. Fitzpatrick Groff Zeltiq Before After
Zeltiq Results of Dr. Richard Fitzpatrick and Dr. William Groff


Dr. Fitzpatrick says that it is very easy to predict how the fat will be lost and that after the cells die, they are reabsorbed into the body. "You lose that layer of fat cells that's right underneath the surface of the skin. It's a very predictable process, it's good for spot reduction but right underneath the outer layer of the skin, right underneath the dermis there's a layer that will be lost that's about at the most about a half inch in thickness. That layer will be the same no matter how much fat is underneath it, you cannot make it take out more fat if there's a big thick layer. So, sometimes if you have a thick layer you may want to go back after about three of four months and retreat the same spot but in most patients the single treatment works really well."

Watch Dr. Fitzpatrick discuss the Zeltiq procedure here:



For more information on Dr. Richard Fitzpatrick, he is currently the Director of the Dermatology Division at La Jolla Cosmetic Surgery Center.