Nonsurgical fat reduction:
Kybella and Coolsculpting

The holidays are over and the new year is here. If you’re like me, you’ve had a bit too much turkey, stuffing, and pie in the last few weeks. Fortunately, this is the golden age of minimally invasive plastic surgery and nonsurgical treatments. There are two newly available nonsurgical options for reducing fat: Kybella® and CoolSculpting®. They both have a lot of hype surrounding them. So let’s explore how they work, how effective they are, and how to choose the right option for you.


The underlying concept is “cryolipolysis”. Basically, the idea is that tissues don’t like being cold. If they are cold for long enough, cells will die – think frostbite. Fortunately, fat cells are more sensitive to cold than skin. CoolSculpting takes advantage of this difference and selectively kills fat cells without hurting the skin. The device uses a vacuum seal to gently pull skin and fat into it. It cools down the tissues to a temperature where the skin is unharmed, but the fat cells freeze. The treatment lasts for around 1-2 hours – while you read or watch TV. The results aren’t immediate – the injured fat cells are removed by the body over weeks to months. Most patients need multiple treatments to reduce fat by about 25% or so in the treated areas. Overall, CoolSculpting will give you a mild improvement, not major fat reduction.


Kybella is an injectable chemical – deoxycholic acid. Deoxycholic acid is basically an emulsifier or a detergent. Just like your dish soap helps dissolve grease from a baking pan, Kybella dissolves cells. It has to be carefully injected into fat cells below skin (and not the skin itself, or the nerves). Kybella is injected in a precise grid pattern, to ensure that fat cells are uniformly dissolved. You will generally need 3 to 6 treatments at least a month apart to see an adequate result. The injections themselves are not particularly painful, but you will have some swelling, inflammation, and redness in the weeks after the treatment as the fat cells dissolve. Currently Kybella is approved by the FDA only for submental fat – that is, for a double chin.

Kybella vs. CoolSculpting

CoolSculpting was first approved in 2010, while Kybella was only cleared by the FDA in 2015. As a result, CoolSculpting has approval for multiple areas – abdomen, flank, thighs, bra line, back, upper arm, and the double chin. Kybella is only FDA approved for fat in the double chin. There are other differences too:

  • Each CoolSculpting treatment requires an hour or two, while the Kybella injections require around 5 minutes to perform
  • Kybella requires injections, but CoolSculpting is completely noninvasive
  • Kybella and CoolSculpting costs are similar for small areas like a double chin (around $1500 per treatment). But for larger areas (flanks, abdomen, etc.) CoolSculpting is likely to be cheaper
  • Kybella does have some risks, like swelling, redness, numbness, and hair loss in the beard area in men. CoolSculpting can result in some swelling, and occasionally prolonged numbness. There is also a rare risk of increased fat formation – called paradoxical adipose hyperplasia.

Other nonsurgical options

CoolSculpting and Kybella are only the newest nonsurgical treatments available. Other options exist as well – for example, Ulthera®, Venus Freeze™, and ThermiRF®. All of these options rely on introducing energy into the skin and fat with the goal of destroying fat cells. Ulthera uses ultrasound waves while Venus Freeze and ThermiRF use radio waves. ThermiRF requires thin probes to be inserted under the skin to heat the tissues from the inside out.

How do these options compare with surgery?

The surgical treatment of choice for fat reduction is liposuction. More extensive surgeries can re-position fat and remove excess skin (e.g. abdominoplasty, thigh lift, or face lift). Surgery will almost always have a bigger bang for your buck than nonsurgical treatments. If liposuction is a direct flight from New York to LA, Kybella and CoolSculpting are a road trip – multiple pit stops along the way, and you only make it as far as Chicago. To put it another way – liposuction gets you the best possible result in a single procedure. But it might cost a bit more and has some inconveniences associated with it. The nonsurgical options will generally require multiple treatments and won’t have as good an outcome as liposuction, but they are non-invasive, and cheaper.


Not every option is right for every patient. It’s important to have an in-person evaluation with a plastic surgeon. This will help you to articulate your goals, and your surgeon can help you determine which of these many options are likely to work for you. Hopefully the information here will help you to understand the different risks and benefits of these options and choose among them.

If you would like to learn more or for an in-person consultation, schedule your consultation or give us a call.