Dr. Gerrish is a Top Doc on RealSelf.com. Here are some of his CoolSculpting common questions and answers.


CoolSculpting Elite offers a number of improvements over CoolSculpting Legacy, including the following:


Improved Applicators

CoolSculpting Elite applicators are no longer U-shaped but C-shaped, and come in 7 different shapes and sizes. This new and improved design better fits the body’s natural curves. CoolSculpting Elite’s advanced applicators make treatments more comfortable and more efficient.

Enhanced Fat Removal

Thanks to improved contact between the applicator and the skin’s surface, cooling is faster and results are improved. CoolSculpting Elite removes 20-25% fat in a single treatment, versus its predecessor which removed 18-20% fat at each visit.

Faster Results In Fewer Treatments

CoolSculpting Elite makes contact with the body in a more efficient manner, as Elite applicators cover up to 18% more skin surface than CoolSculpting Legacy. This means larger treatment areas can be targeted in less time (shorter treatment sessions). Not only that, but each device has the ability to use two applicators at the same time (commonly referred as Dual Sculpting). Each CoolSculpting Elite machine can address two different treatment areas at the same time. This shortens appointment times considerably, since multiple areas can be treated at one.

Enhanced Comfort

Improvements to the CoolSculpting machine itself means treatment is quieter and more precise. CoolSculpting may feel like mild pinching or pulling until the area is numbed. Superior freezing technology reduces discomfort by freezing the treatment area faster. Not only does this reduce physical discomfort but allows for sessions to feel more relaxing.

The result of 10 years of research and design improvements, CoolSculpting Elite provides a better overall experience and results that are visible sooner.


5 Ways New CoolSculpting Elite Is Better Than Ever

CoolSculpting has been the leader in fat freezing body contouring treatments. With over 8 million procedures preformed worldwide.  The makers of CoolSculpting have taken their extensive 10 year proven track record and improved the entire procedure.

  1. Eliminates up to 20-25% of treated fat cells. For good.  CoolSculpting ELITE removes more than 20-25% of unwanted fat – an improvement on the classic model, and the best fat-freeze stats out there!
  2. 18% More Coverage It’s true:  CoolSculpting Elite covers 18% more skin surface, targeting more fat cells in the same treatment time. You get more body surface coverage at no addition cost.
  3. Dynamic Duo.  The new CoolSculpting Elite is always a DualSculpting session. Whereas the old model had only one lonely applicator, ELITE has two.
  4. Eliminates up to 20-25% of treated fat cells. For good.  CoolSculpting ELITE is the culmination of 10 years of CoolSculpting research, development, and widespread use. The device is now sleeker, more compact, and offers superior freezing technology.
  5. 9 Treatment Areas  The one and ONLY treatment FDA-cleared to eliminate stubborn fat in 9 different areas of the body including under the chin and jawline areas, thighs, abdomen and flanks, along with bra fat, back fat, underneath the buttocks, and upper arms.
    You wouldn’t buy an old iPhone, so don’t compromise on your fat freezing treatments! Get CoolSculpting Elite at Gerrish MedEsthetics Vienna, VA and Scottsdale, AZ

Over the last 20 to 30 years the history of non-invasive cosmetic procedures has been very tumultuous. There have been a number of technologies that have disappointed both physicians and patients in delivering the results they have promoted. A conservative and very critical physician will approach new technology with skepticism until proven otherwise. Since CoolSculpting’s commercial launch in the fall of 2009, over 4 million treatments have been performed to date worldwide. Many physicians are now adopting Coolsculpting based on its proven track record of delivering consistent and reliable results.

As to where the fat goes, there are two main pathways. The first is your body could utilize or “burn” the stored energy of the fat during your daily activities or exercise. In this case, the fat is metabolized to H2O and CO2. The water is eliminated in the urine and the carbon dioxide is expelled when you breathe/exhale. The second process is through your body’s natural mechanism of removing damaged or unhealthy cells. Through a sophisticated process, the fat cell is removed via the lymphatics, liver, and bowel movements.

Lastly, the fat cells are permanently removed. Your body contour should remain stable as long as your weight remains consistent. The remaining or untreated fat cells in the treated area will be able to expand or increase in size if you were to gain weight but should not be more than if the area was not treated.

What kind of applicator is best suited for my abdominal area – how many cycles?

Unfortunately to get an accurate treatment plan you should have an in-person consultation with an experienced CoolSculpting provider. Most practices offer complimentary consultations along with discussing realistic expectations and a detailed fee quote.

This Q was submitted to Dr. Gerrish but initially treated in another clinic

Redness and hotness are normal in the short-term following CoolSculpting.  It is also normal to experience transient numbness, bruising, soreness, and mild warmth in the treated area. It is however unusual to experience redness and hotness at the 2-week mark. I have seen patients with a post-treatment course similar to yours as a result of mild panniculitis (an inflammatory process of the fat layer) following CoolSculpting. I recommend a follow-up with the treating physician for an accurate diagnosis.

The instances of paradoxical adipose hyperplasia (PAH) is very rare. The new Advantage applicators have reduced the instances of PAH even further. At this point, the etiology of PAH is unknown and there is currently no evidence that diet and/or exercise would influence the instances of PAH. Diet and exercise will however complement your CoolSculpting results and offer the best possible overall outcome.


Hello – I went to Ideal Image for a consultation for CoolSculpting. I’m 5’5 and 145 pounds. To do upper and lower abdomen she gave me a quote with 8 applicators – I’m assuming she quoted me with the smaller applicators – each being 35 minutes and all in one sitting. I haven’t seen any reviews with this many applicators – does this seem right?


Unfortunately, without an in-person examination, it is very difficult to assess the number of cycles you would need to completely treat your upper and lower abdomen. However, I can say that multiple cycles in one appointment are completely safe. For the best results, it is recommended to follow the Treatment to Transformation protocol. The Treatment to Transformation protocol dictates that the entire cosmetic area (i.e. stomach, love handles, back, etc) be treated fully to obtain the best body contouring response. Blood work looking at cholesterol, liver function, triglycerides, etc were analyzed and found to be stable in the studies used to obtain CoolSculpting’s FDA clearance.


How do I know if my therapist is qualified in CoolSculpting?


One of the very unique opportunities for medical offices that offer CoolSculpting is the ability to send their staff to a CoolSculpting Training Center, also known as CoolSculpting University (CSU). Currently, there are two training centers in the United States (Virginia & California). As the East Coast Medical Director of the Virginia CSU, the comprehensive programs teach medical professionals from around the world the latest techniques and best CoolSculpting practices through the 3-day intensive training program. In addition to CSU training. I would also recommend you feel comfortable with the treatment plan that will address your body contouring concerns.

NOTE: Dr. Gerrish is the Medical Director of CoolSculpting University. To date, Dr. Gerrish has trained over 5,000 medical professionals on how to get the best patient results.


CoolSculpting on inner and outer thighs. One side feels normal, the other side is tender. Does that mean it didn’t work?

My outer right thigh is swollen and much more tender yet numb than any other part of my thighs. I have slight tenderness on the left inner thigh. The treatments were done to the right inner and left outer and then switched to the opposite sides 5 days ago. Is it possible only one side worked? Is it possible that the tender swollen side is Paradoxical hyperplasia that people speak of? I’m a little concerned. I’ve been massaging the area and drinking tons of water as directed. Please advise.



It is very common to experience varying degrees of numbness and tenderness in CoolSculpted areas. The good news is that there is no correlation between post-treatment tenderness and the effectiveness in fat reduction. Paradoxical Hyperplasia (PAH) is a very rare occurrence (1 in 25,000 with the new Advantage applicators) and is typically not seen until about 4 months after treatment. Additionally, there appears to be no correlation between the amount of bruising, tenderness, or numbness and the development of PAH. Massaging the area is an important aspect of the treatment immediately after removing the applicator. Continued massage days after the treatment will not offer additional benefit and may actually increase the tenderness you are experiencing.


I measure every week with no change today is my 6th week —at least the soreness has lessened some–still same “belly”-due for the second procedure on August 16th if I can handle pain–what should I get for after –rub on cream???? should I have it done again on 16th-past 6 weeks have been awful–HELP



With CoolSculpting you may begin to see an initial response around the 6th week. On average, it will take 12 to 16 weeks to see the final result. With you being at 6 weeks, I would not expect to see any significant changes yet. You still have another 6 to 10 weeks of improvement. While soreness can be present several weeks after the treatment, it is unusual to persist into the 6th week. I would recommend you follow up with your CoolSculpting provider to discuss your ongoing discomfort and to possibly push your second treatment further into the future until the area has fully recovered


I went for a Coolsculpting consult for my saddlebags at a new medical spa. The doc said the procedure will take two hours long: one hour for each side. I saw the applicator and it is not the one that uses suction. From what I’ve been reading, the process should take 2 hours on each side=4 hours total. Can someone clarify, please?



The outer thigh or saddlebag area can not be treated with the traditional suction applicators. There are two generations of applicators currently available to physicians that can treat the outer thigh, the CoolSmooth, and the CoolSmooth Pro. The CoolSmooth has a treatment time of 2 hours (4 hours in total) and the CoolSmooth Pro is 75 minutes (2 1/2 hours in total). Both applicators will have similar efficacy. Keep in mind that practice with two machines may be able to halve the treatment time by DualSculpting (using both machines at the same time).


Would it be helpful to wear a compression hose following to alleviate swelling?


The post-treatment course has changed significantly since the release of the new Cool Advantage applicators. The amount of swelling, bruising, and post-treatment discomfort has been dramatically reduced. From a medical standpoint, compression following CoolSculpting is not necessary. With that being said, some patients have reported that compression garments do help with the soreness they may experience during the first week after CoolSculpting. I always advise patients to try compression if they do experience some post-treatment soreness and assess if it offers some relief.


So I was curious I have the basics of where CoolSculpting is done on the lower body. However is it possible to do the front sides of the legs and beside the knees? I wanted to have slimming done on my lower half however I’d prefer not to go invasive if possible.


Over the last several years CoolSculpting has expanded its FDA clearances to include areas on the legs, specifically the inner thigh, the outer thigh, the ‘banana roll’ – the bulge just below the buttocks, and above the knee. For all of these areas, a careful evaluation must be performed to assure the bulge is amenable to treatment and the applicator geometry. To date, there is not an applicator for treating the front side of the leg other than just above the knee.


I had coolsculpting on my stomach but the technician only very briefly rubbed the area. I have read that massaging is very important to the coolsculpting results. Will I still see a good difference in the treated area even without the massage?


The most up-to-date protocol we teach at CSU is to perform a 2-minute manual massage after removing the treatment applicator. CoolSculpting will cause fat reduction with or without the massage, however, it has been shown that the manual massage will further increase the fat cell destruction, i.e. results when done properly. An experienced CoolSculpting provider may limit the massage or forgo it completely if the goal is to ‘feather in’ a bulge that purposefully needs less fat reduction. A discussion with the treating practitioner may help you in understanding your treatment


How cold do you have to freeze the fat with a cool Machine for it to really freeze those cells like -10 below? And will it ” burn” the skin being that cold?


The temperatures used in Coolsculpting have been rigorously evaluated to maximize fat reduction while maintaining a substantial safety margin. Continual temperature monitoring is utilized during the treatment to assure safety. During the treatment, the skin reaches about -11 degrees Celsius with the superficial fat getting to about -8 or -9 degrees Celsius and the deeper fat reaching approximately 0 to +4 degrees Celsius. The temperature of the fat is the critical aspect of CoolSculpting to achieve cryolipolysis or fat cell destruction. The special CoolSculpting wipes used on the treatment area lowers the freezing point of the skin and allows the skin to withstand the colder temperatures


I had CoolSculpting done to my outer thighs yesterday. By the time I got back home, I was hardly sore and now there is only a dull ache. No itching, tingling, numbness, and not that much or no swelling (non that I can notice). Did I just get lucky or is my body too resistant to the treatment/ the treatment isn’t working?  I went to a very professional well-reviewed and certified office to get this done.


The applicator used for treating the outer thighs has a drastically different post-treatment course than the traditional CoolSculpting suction applicators. In general, the outer thighs have less swelling and rarely bruise. Itching and tingling, if you are to experience it, usually happens several days after the treatment. You should expect to see the beginning of your results in 4 to 8 weeks.


Does Coolsculpting get rid of or change the number of fat cells on your body?


As adults, the total number of fat cells is fixed and we are not able to create new fat cells unless we become morbidly obese. With CoolSculpting the treated fats cells are destroyed permanently. Since CoolSculpting has reduced the number of fat cells and we are not able to create new ones, the total number of fat cells in the body will be permanently reduced.


CoolSculpting: Would getting rid of extra water weight before a session help freeze more fat cells?


Altering your body’s water balance prior to CoolSculpting will not influence your final results. The cooling profile from the treatment is delivered and monitored accurately so each patient gets safe and consistent results.


may I know Zimmer Cryolipolysis is a CoolSculpting treatment but just using a different machine? how was the result for Zimmer? Does any surgeon recommend Zimmer compare with Zeltiq? because the prices are very different and my biggest concern is the EFFICIENCY and result. I plan to go for lower abdomen treatment. please advise me as I’m a bit confused now.



The Zimmer Corporation manufactures a medical-grade cooling device that assists in both skin cooling and pain control for dermatological procedures. The Zimmer does not have the ability to create any changes and/or reductions in the fat layer. CoolSculpting on the other hand uses cryolipolysis to cause fat cell death resulting in non-invasive body contouring. In regards to the most efficient and successful non-invasive body contouring treatment, it is my feeling that CoolSculpting is the current gold standard.


I had coolsculpting 4 weeks ago nearly on my upper and lower stomach but I still haven’t seen results? Also, I want to get in on the roll of fat just under my bra line but would this be classed as upper stomach?


It is absolutely normal and to be expected that at the 4-week mark you do not see much or any results from the CoolSculpting treatment. On average, patients will see the start of the results at 6 weeks. By 8 weeks patients typically see 50% of the results and by 12 to 16 weeks the full response is obtained.

The upper abdomen bulge just under the breast can be treated with Coolsculpting as long as the geometry of the applicator and the bulge match. An examination by an experienced Coolsculpting provider can qualify if the area is appropriate for treatment.





Gerrish MedEsthetics is ready to design the ideal treatment plan so you love, love, love what you see!!