Coolsculpting Vs. TruSculpt: A comparison

by Jennifer Stieber, NP

WhaT's the difference?

Although Coolsculpting (also known as cryolipolysis or "fat-freezing") and truSculpt may share similar names, they differ quite a bit in their mechanism of action and associated side effects:

  Coolsculpting truSculpt iD
First clinical study 2008 2010
Mechanism of action of destroying fat Cells containing a large proportion of fat are more prone to cell-death when exposed to cold than are water-containing cells. 15 minutes of thermal exposure at 43–45 degrees Celsius will result in fat cell-death
Permanent fat removal? Yes Yes
Time for one treatment 2-4 hours 30 min-75 minutes
Nausea Occasionally None reported
Pain Common Uncommon
Swelling Moderate None to mild
Weeks of swelling 0 weeks - 3 weeks 0 days - 4 days
Short-term side effects swelling, pain, redness small nodules, redness
Long-term adverse effects

neuropathic pain, delayed-onset pain, paradoxical adipose hyperplasia* (overgrowth of fat)

Estimated rate of adverse effects 1 in 100 patients Not applicable
Effectiveness Greater than 20% fat reduction Greater than 20% fat reduction
Cost  $2250 and up for abdomen $2000 and up for abdomen

*Read below for information on paradoxical hyperplasia/overgrowth of fat


Although both modalities are effective at permanent fat removal, cryolipolysis does have more reported permanent side effects, as is reported widely in the literature. The most troublesome side effect of which is paradoxical hyperplasia, in which case the fat-frozen area becomes larger rather than smaller in the weeks after the procedure, leaving a painless, enlarged mass of fat beneath the skin.


Yes, SLK has witnessed both delayed neuropathic (nerve) pain and paradoxical adipose hyperplasia (unwanted fat growth) after Coolsculpting. SLK providers have not witnessed any permanent side effects of this nature following truSculpt iD.

What is Paradoxical Adipose Hyperplasia?

Paradoxical adipose hyperplasia (PAH) is a condition in which case a fat-frozen area increases in size, rather than decreases in the weeks after the procedure, leaving an enlarged pocket of fat beneath the skin. This side effect is more common in men than in women and is thought to occur due to "natural selection" of more resilient fat cells during the fat-freezing process. PAH typically appears 5-6 months after the initial procedure. The frequency of this phenomenon has caught the attention of plastic surgeons in recent years:

"In the recent article, “Paradoxical Adipose Hypertrophy
(PAH) After Cryolipolysis” by Strouzma et al, the incidence
of PAH is estimated to be approximately 1/100 based on
their reporting on 4 cases in 398 patients. The authors state that this incidence is still most likely under-reported, and our experience with this technique is completely in agreement with this impression. We started performing CoolSculpting in 2014, and the enthusiasm we generated with this technique quickly generated about 150 patients over an 18-month period. During that short time, we experienced 2 patients with fulminant PAH. By personal recollection, at least 10 other patients had what we considered unchanged or even worsened “girth,” which in retrospect may represent a new classification of PAH considered to be mild to moderate... The fact that we experienced (unpublished) 2 cases out of approximately 150 treated patients in my solo practice alone speaks volumes about the under-reporting and likely true incidence of PAH."

- Dr. James Vogel in the Aesthetic Surgery Journal, 2018

paradoxical adipose hyperplasia coolsculpting vs trusculpt

From left to right: pre-treatment, 2 months after, and 5 months after Coolsculpting. A visible fat pocket is developing in the 3rd column of photos. Credit: James Vogel, MD FACS 2018.

How to avoid Paradoxical Adipose HyperPlasia:

Although there is no known way to predict who will experience paradoxical hyperplasia, if you are male, you should be aware that you may possibly be at higher risk. All patients receiving cryolipolysis should also be aware that there is a 1% incidence, meaning 1 in every 100 patients could face PAH:

ARTICLE: Complication of 'fat freezing' procedure may be more common than thought

how to get rid of paradoxical adipose hyperplasia?

  • If you believe you have experienced PAH, the first thing you should do is tell your original provider who performed the treatment so they can properly document the side effect in your medical record, and also connect you to resources who may be able to help you. Do not be shy - most providers will want to know if their patients experience any negative side effects after a treatment.
  • For assistance with, or to report adverse or negative side effects following Coolsculpting, please call the Allergan Drug Safety line at 1-800-678-1605. Your provider may choose to reach out to the hotline on your behalf.
  • Once you have properly reported any unwanted side effects, known treatment options for paradoxical adipose hyperplasia include liposuction or abdominoplasty ("tummy tuck").


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