Cleared by the FDA last year, the Zeltiq device for cryolipolysis is quickly gaining popularity with the public and with physicians. Using intense cooling to destroy fat cells, the technique is relatively painless and associated with no significant side effects. “The key thing for successful cryolipolysis is really patient selection and patient expectations,” says Brian Zelickson, MD, Adjunct Associate Professor of Dermatology at University of Minnesota Medical School and director of Zel Skin and Laser Specialists in Edina, MN. The procedure is intended for treatment of discreet fat deposits or bulges that are unresponsive to diet and exercise. “We want to make sure the patient has the best body shape that is most amenable to the Zeltiq procedure,” Dr. Zelickson explains. “We're basically using it as a contouring device for slimming down and improving bulges, primarily the love handles, abdomen, back fat, and some areas that may be amenable to that type of treatment.” Because of its intended use, the manufacturer calls the technique CoolSculpting.

The novel device can be applied successfully to multiple anatomic sites in a single patient, and serial application can provide a circumferential treatment, Dr. Zelickson says. He describes his approach below.

How do you perform circumferential fat reduction of the lower abdomen?
When thinking about targeted fat reduction in small anatomic areas, the love handles or the abdomen frequently come to mind. But in his practice, Dr. Zelickson noticed that a significant proportion of patients were suited to treatment of the entire lower abdomen, including both flanks and the stomach. So, he began offering circumferential treatment of the entire lower abdomen with application of Zeltiq to each flank and the stomach.

Application time for each target area is typically about an hour, so the total required treatment time is about three hours. That's a long time for most patients to sit through a treatment, so the procedures are usually divided into two treatment sessions, spaced a few days to a week a part. This time span is close enough that all treatment areas will show a similar response rate at subsequent time points. This also means that the order of treatment (whether it be both love handles at the first visit and the stomach at the second, the stomach and one handle at the first visit, etc.) will not alter results.

Wider abdomens may require more than one hour for treatment, in order to effectively treat the entire stomach. However, Dr. Zelickson notes, the availability of three applicator shapes, including the new large eZ App 8 applicator, has enhanced the operator's ability to rapidly treat larger areas.

All patients treated with Zeltiq are re-assessed in about two months and the need for additional treatment is determined. Studies and clinical experience confirm a cumulative effect from subsequent applications, Dr. Zelickson says.

What challenges face operators?
Success with Zeltiq, Dr. Zelickson reiterates, depends on patient selection and expectation building. “The physician that's doing the procedure really does need to spend the time to understand the procedure and understand who really is the best candidate for it,” he says. Knowing which patients are best suited to treatment, “is a pretty easy learning curve, but it's an important one,” he notes. Operators and patients must recognize that the device does not treat skin laxity.

To ensure success, physicians should be actively involved in patient treatment and not simply delegate patient selection and treatment to staff. In his practice, Dr. Zelickson evaluates all patients and maps out a treatment protocol. Nursing staff then apply the device according to his directions.

It is not necessary that staff remain with patients throughout the application time. Patients can use a beeper to call staff if they have any concerns or require assistance during treatment. Dr. Zelickson's treatment rooms are equipped with a DVD player and wi-fi service to occupy patients during treatment.

Other considerations to optimize outcomes include the use of good photo-documentation. Also, he says to cleanse the treatment area thoroughly prior to device application; patient-applied products (body oils, lotions) could interfere with device function.

— To see Dr. Zelickson perform a treatment, visit DermTube.com