The Cold Hard Truth About CoolSculpting®

The Cold Hard Truth About CoolSculpting®

Cold woman by a frozen river

Like the SuperBowl ads, its always interesting to see which celebrity is the latest CoolSculpting spokesperson! It looks like television personality on Bravo’s “The Real Housewives of New York City”, Sonja Morgan is in. What does this mean to you? Well, with all the marketing money Allergan® has spent across the nation, it is very likely that you have had or will have patients ask about Coolsculpting®.  Before you spend +$150,000 on a CoolSculpting® machine (including handpieces) and $10,000’s annually to use it, you need to know the Cold Hard Truth about CoolSculpting®.

This article is not about whether CoolSculpting® is an effective treatment, it absolutely works. I have had CoolSculpting® in my practice for +4 years, and we have many happy patients. This article is about the true cost of owning and operating a CoolSculpting® machine in a medical practice. Most owners are silent in their feelings about the exorbitant costs of running the machine because they want to continue to get practice marketing support (the commission sales person they provide to clinics), however, the truth needs to be told and this is my story. Please feel free to comment below, either for or against, I promise I won’t take it personally!

Is Coolsculpting® Profitable?

As many physicians have learned the hard way, investments in lasers and other expensive practice equipment often do not turn out to be as profitable as the sales representatives lead you to believe. Is CoolSculpting® any different?

Well, yes and no.  Yes, in that the procedure does work on the right patients. And no, in the fact they gloss over the real costs of owning, and more importantly, operating a CoolSculpting® machine.  One thing the reps gloss over is the cost of running a CoolSculpting® machine – the very high consumable costs will drive you crazy. In fact Allergan®  made over $148 million in consumable card sales in the first nine months of 2019! They made more money in consumable sales than in selling the actual machines.

The Equipment Purchase Is Not a One Time Event

You are used to paying Allergan® half your money when you perform a Botox® injection, well, now not only did you pay $150,000+ for a CoolSculpting® machine, you are going to need to pay Allergan® $330 per area treated. An interesting fact is when I first bought my CoolScultping® machine I was paying $125 per area, so it has increased 2.5x’s in the last 4 years!  If you didn’t already know, every time you treat a CoolSculpting® patient’s targeted body area (multiple treatments are usually required for each patient, on average 4-6 treatments per patient), you need to pay this $330 per area.  So making the equipment purchase is not a one-time event, they have now become a partner in your practice! You are now going to be paying Allergan® half your money every time you treat a CoolSculpting® patient.  When you look at other competing machines, some do not offer significant consumable costs (ie BTL’s Vanquish has a $0 consumables).

Here is a quick example of how much you will pay CoolSculpting® to treat your patients with their “Treatment to Transformation™” package they recommend you sell to patients. The package typically includes: 6 small treatments @ $330/ea + 1 large treatment at $330, which is a cost of $2,310/patient to your practice. If you see 8 patients a month, after a year, you will be writing Allergan® a check for $221,760! And it does not end there, every year after, you need to write them more checks!


10 patients a month = $221,760 in CoolSculpting® consumable costs
10 patients a month = $0.00 in BTL Vanquish consumable costs

* Both of the machines above promote 25% fat cell adiposis in their clinical research.

But the sales rep says “You will get your co-op marketing expenses reimbursed!”. Actually in the above case, if you bought your cards as you needed them, you would only receive a maximum reimbursement of $1,000/quarter ($4,000/year), so yes, if you spent $24,600 in marketing for a quarter, they are going to give you $1,000 back! (If you spend more than $25,000/quarterly, they increase it to $6,000/quarter, so they really want you to pay for 6 months of patients in advance.) Spending $221,760/year on a full-time marketing person and an advertising campaign that not only promotes CoolSculpting®, but all my procedures may be a better option to spend my money!

CoolSculpting® is not alone in requiring expensive consumables that must be purchased in advance. Cynosure’s SculpSure® and Syneron’s Velashape are both in same the boat.

Let’s begin with some education on the CoolSculpting® procedure.

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What is CoolSculpting®?

The CoolSculpting® System is a portable thermoelectric cooling and heating device that applies controlled cooling or heating to a treatment site. The device is indicated for cold-assisted lipolysis (breakdown of fat) of the submental area, thigh, abdomen, and flank, or “love handles” in individuals with a Body Mass Index (BMI) of 30 or less. The procedure is intended to change the appearance of the treatment area by delivering controlled cooling at the surface of the skin to break down fat cells that are just beneath the skin. The procedure is non-invasive and is not a treatment for obesity or weight-loss solution and does not replace traditional methods such as diet, exercise or liposuction.

In September 2009, Zeltiq® received EU CE Mark approval for their cryolipolysis device. In September 2010, the US Food and Drug Administration approved the cryolipolysis device and procedure.

How Does CoolSculpting® Work?

As with any medical equipment, you are going to see endless photos of successful procedures. I have to say with my experience offering CoolSculpting® procedures for the last 3 years, we have certainly seen many great results. However, we also have seen not so impressive results.   It is critical with this and other similar fat elimination equipment that you always take before and after photos of all your patients.  Based on how CoolSculpting® works, the patients need to wait at least 3 months before they see their final results. It is also important to take their weight and measurements.

Coolsculpting® is a procedure that is used to destroy fat cells using controlled cooling (near 4 Celsius) to gently and effectively target the fat cells underneath the skin without apparent damage to the overlying skin.  The treated fat cells are crystalized (frozen), then die and leave the body through the body’s natural elimination process, thus reshaping the body contours.  The results are long-term.

For the right patients, CoolSculpting® certainly works.  But since it is such an aggressive procedure, you are also more likely to have discomfort during and after the procedure, which will be covered in the next section.

What are the complications and side effects of CoolSculpting®?

Most patients will have a loss of feeling in the treated area. We had one patient where we used the large abdominal handpiece and they did not have any feeling in the abdomen for 6 months.  This length of time is unusual, but it can certainly happen.  Most patients will have neurogenic pain in the affected areas for between 2-6 weeks.

There have been many adverse events registered with the FDA in relation to the CoolSculpting® procedure.

  1. Patient experienced extreme pain after procedure, by day 3 had a high level of pain. The patient was not given any meds at the doctor’s office. The patient stated the procedure was a waste of money and the second treatment was not performed due to the pain.
  2. Male patient received coolmax applicator on his lower abdomen. Over a short period of time the patient noticed his abdomen was larger.  Upon his second treatment the bulge decreased but then increased again within 6 to 8 weeks. The patient required surgical intervention as the condition could not resolve on its own. (
  3. Male patient received coolmax applicator on his mid-abdomen centered on the umbilicus. Three months post-treatment the patient noticed lump and went for follow up visit to the treating office.  They said it was “tissue stiffing” in the treated area.  A CT scan diagnosed the lump as fat and the patient begun accent ultra treatments. (
  4. Patient had treatment on lower and upper abdomen, with 2 small devices in 2 separate sessions. The patient experienced intense burning in lower abdomen and sharp occasional stabbing pains and tender area to touch. Doctor’s office told patient the result was unusual.
  5. Coolsculpting treatment on male patient’s left flank became enlarged 2 months after treatment and his weight increased. Patient underwent an ultrasound and diagnosis was possible lipoma and he will be undergoing a liposuction procedure to correct condition.
  6. Clinician experienced issues with coolsculpting machine while treating patients left abdomen, skin was assessed and determined to be normal. The clinician successfully treated the right side. The patients left area was re-attempted two times and experienced two more system messages and treatment was stopped. Again the skin was assessed and determined to be normal.  Review of the device revealed no abnormalities.  On follow up appointment patient had skin discoloration on the left side and was prescribed Silvadene.  Patient continued to have issues with skin on left side with redness and the skin then peeled off.  Clinician gave the patient triple action cream, aquaphor and was also prescribed tret/kojic/hc and epicream.  The patient completed medlite laser treatments and skin was improving.
  7. Male patient received two coolsculpting treatments on the lower abdomen. Three months post treatment showed increased fat in lower abdomen.  Four month follow up visit, the area was firm and Zeltiq recommend diagnostic treating.  The patient underwent an ultrasound and the report stated “increase in volume, thickness and density of the described lower abdominal fat not associated with collections or mass. There is no eventration.”  Liposuction was recommended by a plastic surgeon.

The Aesthetic Surgery Journal also published a case report of a 29-year-old man presented with an enlarging adipose collection on his lower abdomen following cryolipolysis with CoolSculpting®. 

It was determined that “Paradoxical hyperplasia of fat following cryolipolysis occurs infrequently, usually only after multiple cycles of cryolipolysis. The condition should be identified early and treated with liposuction, not another round of cryolipolysis.”

In a recent article of The Aesthetic Surgery Journal on Paradoxical Adipose Hyperplasia and Cellular Effects After Cryolipolysis ( recommends that “Additional studies are needed to better understand the mechanism of cryolipolysis and how it affects the interstitial cells and vasculature.” This complication has been added to their patient consent forms.

What your patients can expect with a CoolSculpting® treatment?

Uneven results are quite common, and you must tell all patients that you may need to retreat some of the areas. In this study ( there were “4 initially dissatisfied patients who were re-treated” and then they were satisfied.  The study was conducted for 528 consecutive patients from January 2010 to December 2012.

The “CoolSculpting® Treatment Considerations Form” provided by Zeltiq® gives you an idea of the possible complications:

  • Excessive fat removal in the treatment area, resulting in an unwanted indentation. The indentation may be improved through corrective procedures (ie surgery)
  • Darker skin color
  • Hardness
  • Discrete nodules
  • Frostbite (local injury due to cold)
  • Hernia or worsening of existing hernia. Surgical intervention may be required to correct hernia formation. (unfortunately for us, this was added after we observed our first hernia, we have certainly seen several hernias protruding through the patients abdominal wall)

How Does CoolSculpting® (Allergan®) Make Money?

As mentioned above, not only does Allergan® make money on the one-time equipment purchase price (~$150,000), they generate an additional $5-9,000/year by providing a service warranty on the device (which is critical, our machine broke down after only 5 months of use, and needed to be replaced).  The most lucrative money they make is from the physicians themselves.

The structure at Allergan® is you have your sales rep, and then when you buy the machine you are assigned a “Practice Development Manager” to help develop your practice.  Sounds like a great idea, however there are some significant issues with this role. First and foremost, this is a commission sales role and their job is to sell you cycles so you can use your machine, in which they earn a commission.  Secondly, you can be assured that everything you tell them about how you do business will be shared with all your competitors. We have seen our website content, promotions, and ads all copied by local competitors. As well, they have certainly shared what our competitors are doing with us.  The only person who wins in this situation is the Practice Development Managers with their commission checks, certainly not your practice! We have learned, albeit the hard way, not to share anything we are doing with our rep.

Another way they make money is by requiring you to have a different type of card for each of the handpieces, which causes you to have excess cycles sitting on your shelves.  For example, I have $11,000 worth of cycles in my practice, which is $11,000 cash. I would rather spend that money on marketing my practice, rather than inventory sitting on my shelves.   If you have all the handpieces, you would need to inventory 5 different cards in your practice!  I should point out that a cycle is one patient treatment, and a card typically contains between 16-24 cycles.

How much money are we talking about?  At the time of this writing (and I have heard Zeltiq® is planning a pricing increase very soon), this is what it will cost to treat a patient (also add the mandatory FedEx shipping fee):

CoolMini/Advance – $330/each
CoolCard – $330/each
CoolCard Max – $330/each
CoolSmooth Pro – $330/each
CoolSmooth – $330/each

To make matters more complicated, the new handpieces now require $330/cycle cards.  Here Allergan® is making even more money since cards for the old handpiece will not work in the new handpieces. If the handpiece takes new cards (which they all do), you then have to wait 4 weeks after you receive your new handpiece before you can start the cycle exchange program. To help you, they will sell you more cycles (you don’t need) until you get the new replacement cycles 4 weeks later.

What does this mean to a typical practice?  A busy practice will see closer to 15-20 patients a month, and the average patient does approximately 6 treatments.  With an average cost of $330/cycle, you will need to pay Allergan® +$475,000 (+ shipping) to treat those patients. If you used a competitor that did not require consumables (cards), the cost to you would be $0.

In addition, ever since Allergan® purchased CoolSculpting® from Zeltiq®, we have seen our patients (and practice revenues) drop by 30-50% mainly due to the flood of new machines the vast number of Allergan® reps are selling. Is the market saturated with CoolSculpting machines? Absolutely!  I am certainly hearing this in every major city. Once you had 30-40 machines, now you are seeing 80-120 machines in the same area! This is good news for Allergan®, however their 4th quarter financial results showed a decrease in CoolSculpting sales of 37.6% over the previous year.

Support that Allergan® Provides

So you have just spent $475,000 in one year buying cycles so you can treat patients. What are you getting for that nearly half a million dollars? (At this level, we will assume you have reached the “Diamond” level of their Crystal Rewards program, which is now on its way out).

  • They will reimburse you up to $50,000/year for CoolSculpting® marketing (in which the requirements change every quarter, so what was approved the previous quarter will not necessarily get approved in the next).
  • You get 95% off your annual equipment warranty (this is a great benefit).
  • You have a Practice Development Manager who will continually try and sell you more cycles, and tell your competition how you made it to Diamond, and they can to!

Sorry, but I would rather take that $475,000 hire a brilliant marketing manager, create a comprehensive marketing program that covers not only CoolSculpting®, but all of the procedures I provide, like Botox®, dermal fillers, lasers, etc.

Allergan® also has a CoolSculpting® University, and for a hefty fee (+ hotel and airfare), you can send your staff to this program which is located at either their head office in Pleasanton, California or in Reston, Virginia.

The Final Truth

The intention of this blog was to give you all the facts Allergan® does not tell you before adding CoolSculpting® to your practice. I have had CoolSculpting® in my practice for +4 years, so I’m sharing my experience, in addition, I have incorporated the feedback of many owners through my role as the Executive-Director of the IAPAM.  The fact is the CoolSculpting® procedure is not a sham; it certainly works on the right patients. Hopefully, you now have some hard questions to ask your rep before you make this huge investment. Do not forget the investment is not only the machine but the onerous consumable costs that are associated with these procedures.  When you do the math, it may make more sense to buy a machine without these expensive “cycles.”

If you think I was too harsh, and you would like a more positive, advertorial style article on how great CoolSculpting® is, please check out this article, “Fat Chance Building a Better Body the Cool Way” that appeared in Prime magazine.  It’s full of quotes from CoolSculpting® and all the positives. My suggestion is to read that article as well, then you will have a much better understanding of the big picture and clearly understand the pros and cons of offering CoolSculpting® to your patients.

What Are The Benefits of CoolSculpting Training

In order to perform CoolSculpting®, specific training is essential to make sure the treatment offered is state of the art and meets standards that patients expect from their healthcare professional. Below are a few aspects that must be considered when training to perform CoolSculpting.

1. Background knowledge – It is important to know when cool sculpting can be offered to patients. In other words, a good background knowledge will arm the practitioner with the information they need to make an expert decision on whether cool sculpting is the treatment that will be of benefit to the patient.

2. Understanding equipment – The equipment used to perform cool sculpting is state of the art. The procedure is developed by Allergan®, and currently, the FDA has only approved this CoolSculpting® machine for cryolipolysis.

3. Procedural skills – The theory behind CoolSculpting® is clear – breakdown of fat cells by reducing the temperature to below freezing, while protecting the skin and other tissues. This requires a degree of skill, and training programs will aim at ensuring these skills are developed or at least introduced by the time the course is complete.

4. Risks and side effects – This is another important aspect that must be covered in training programs. Having a good knowledge of the risks and side effects means that the treating practitioners will know how to manage them in the event of them occurring.

5. Benefits – There is no doubt that patients undergo CoolSculpting® in order to experience the benefits that it offers. It is good to have a detailed knowledge of the benefits that patients can obtain from this procedure. It is essential to realize that treatments will only start to show positive effects after a few months, and repeat treatments will sometimes be needed. This aspect will need to be discussed with the patients, and therefore a good knowledge will make this process easy.

CoolSculpting® is emerging as a much sought after treatment for fat reduction. Adding it to your service will require that you undergo specific training. This way, patients can experience the most out of this safe and effective procedure.

If you are a current owner of a CoolSculpting® machine, we want to hear from you!  Please feel free to post any comments below, I’d love to hear from other owners.

Was this information useful? Let us know by rating it!

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  1. Jen

    Although this article had many well thought out points, it’s obviously lacking knowledge in several areas when it comes to CS.
    Maybe a few more points to think about:

    1.Going to a well trained provider
    2. Knowing your body and health
    3. Do you have to keep purchasing product for facials, peels, waxing, tinting, injections, etc…. yep! Purchasing cards for a CS machine is no different than the expense of purchasing other supplies for a Med Spa or any esthetic business.
    4. As an owner you want to benefit your clients while at the same time increasing your bottom line. It’s a business like any other.
    5. To make an assumption that the CS rep can sit back while their bank account gets bigger with commissions has to be the most ignorant comment. They are working just like let’s say your realtor is. Making a living, period.
    6. If you have product sitting on shelves, it’s apparent that you’re not marketing your business to bring in the right clientele.

    In short, there’s two sides to everything. So instead of reading one article and taking it as ‘Bible’, think for yourself and do what’s best for you.
    Providers look at ways you can improve sales, educate clients, and more so educate yourself on who the right candidate is.
    Clients, evaluate your health history and research your provider.

  2. ,Jenn

    second post to continue. the High intensity focused ultrasound purpose is to tighten facial skin by stimulating your own body to produce collagen where its been lost. in these areas. its much like micro needling.. it can also be used in various areas of the body Again had any one purchased ,used these machines. they are on Alibaba trade platform.. You are able to have live real time face time with their reps to see their factories.. They do produce these machines in mass quantity. so there must be something awesome about these machines given the demand or them, Thank you for any feed back from any one who had used or had experience with these machines. they could share, My heart goes out to the many Dr”s who have gone there such torment in the US market for Coolsculpting

  3. ,Jenn

    I am purchasing a Cryolipolysis machine with Ultrasound Cavatation and Laser lipo pads. along with a High intensive Focused Ultrasound machine from a large manufacturer in china. Can anyone tell me is this is much the same as the Coolsculpting? I would assume so since the Cryolipolysis has two handles one for chin and the other for body that freezes the fat cells. You need to use a membrain sheet under the suction cup that protect the skin from harm or frost bit issue. This company offers several hours of face time training session the use of the machines with their team. and manuals treatment guides video and so forth. I am intending to us this on my self at home. Has anyone used or purchased these machines from their use and what has been the out come? They are at a commercial level and not the small powerless machine for home us that do not work.

  4. John

    What are these ” consumables” and treatment cards? How does the machine have consumable or need a card to work?

  5. Cheryl Robinson

    I have permanent disfigurement on my upper and lower abdomen. Neither my provider in Champaign Illinois or Allergen Insurance has taken responsibility for my concerns. I have been completely scammed. Don’t sign up for Coolsculpting You May get a disastrous outcome!!!!

  6. jenni neal

    i didnt see the rating option But a 5 out of 5 stars on this article for sure. great job.

  7. jenni neal

    I am no Dr. just a person researching cool sculpting (Looking to get it done). Sounds like these companies / REPS who are making it impossible to be successful have been enjoying the free ride at the expense of your businesses. kickin their feet up going down hill on a bike saying weeeeeeeeeeeeeee.
    I dare say from the comments here looks like the jig is up and the reps have shot themselves in the foot. Several people looking into the investment after reading this article will be running the other direction. SO HA-HA. I think that the author who stepped up and opened up the discussion should be very satisfied with herself. Good for her she just allowed many people to share and vent the losses they have suffered, as well as saved others thinking of buying. Lastly my heart goes out to any of my fellow Americans who 1. worked so hard investing in an education in becoming a Dr. then in pursuit of their dreams to be successful opening a business/spa whatever were forced to close the doors because of this. I’m sure this is not what any of you had expected,

  8. Dr.V

    I wish I had read this article before I bought the machine. I am unable to sell it nor I am unable to use it. The PDM doesn’t come to our office anymore and I am stuck with this machine and losing money .

  9. K & C

    I am so glad that I found this article; I only wish I had found it 3 years ago when I opted to purchase the CS platform. It has been difficult to try to stay afloat since then and by far my worst business decision. It does work but the odds of being really successful with it are stacked against you. I still owe quite a bit on the platform though I was told “We would likely be able to pay it off in one year, like most practices”. You can’t make extra payments to bring down costs of the exorbitant financing fees; you are only allowed to pay the balance in full. Lesson learned and never again!

  10. Jacqueline Smith

    Chinese machines have been available on EBay since 2017 and do the same thing in experienced hands. It’s sad how companies look at the secondary market for gain. Why not just sell a good machine and service the hell out of it. Sell some gel and some other secondary things like fillers etc…build a good rapport with the clinics. Just a rip off. Anyone have any experience with the Chinese after market machine?

    • jeffadmin313

      If you buy an Chinese made machine, you will not have any medical malpractice insurance coverage, and the risks to the patient are significant, including necrosis.

  11. Amber Moncrieff

    A very similar experience here in Australia. We were once the leading clinic in the country and couldn’t make much of a net return and the situation has only become worse over time. The CoolSculpting business model just doesn’t add up which is bad for clinics and patients in the long term.

    I’ve just published my own blog on our experience:

  12. Ed

    I feel the information especially specific treatment areas and outcomes were very helpful. Is there any data on male chest fat and outcomes? I have considered this treatment but ultimately got turned off by the initial appointment being done by a technician with no consult with the actual doctor doing the procedure and would only see the doctor at the time of the procedure. I was also turned off by the costs and the fact that they wanted me to buy a package of 3 treatments when you would not know if one would work or possibly 2 and the results are months away. If there were issues with you personally like severe pain or lumps and you don’t go for the second or third treatment you were out the cash. They also wanted to use li posuction as well with the procedure which I would be totally against especially without consult with the actual doctor as this area of the body is full of nerves and a sexually sensitive area to be damaging them with tubes shoved under the skin in a rough destructive manner. All in all was not impressed with the way the procedure was presented and just heightened my distrust. I walked away.

  13. Karen

    I purchased a Coolsculpting device 2.5 years ago, and have struggled to stay open 7-8 months of the year. I may have to declare bankruptcy before I get the device payed for. If not for having to purchase treatment cards I might have a chance to stay open. 5.5 years left on my loan, not sure I we will make it. Praying for God’s continued provision.

  14. Denise Robinson

    This post is not about coolsculpting but it is about Allergen .Should we be surprised,Allergen has lied to Women , Doctors, and the FDA
    I had my implants removed October 28 2019 as they made me very sick BII (breast implant illness). This company has allowed the sale of there breast implants both saline and silicone knowing that they can cause cancer and make many of us ill . Why would they care about any business owner or Doctor it’s all about money people.

  15. Carl

    We have experienced the same extortion style tactics and lack of support.
    They drastically oversell the demand for coolsculpting and assure you that it will bring clients to your practice and then provide no marketing support.
    Their customer service is abhorrent and they will leave you for dead once they have your money.
    It’s a shame because the treatment is really great.

  16. Dr. V

    Now we all see why health care in the USA is so expensive and you can’t blame a doctor who charges exorbitant fee’s due to a company that controls what he does with patient care, and uses a device they’ve had approved by the FDA for weight loss to choke everyone.
    From companies like this, to pharmaceutical companies with $500 pills. You wonder why kids are not going into medical school. They will spend their entire career paying off there student loan, as these industries just get richer on the back of doctors and patients.

  17. Brandon Heath

    I realize this is a 3 year old article. I applaud the author. You laid out the facts a doctor will go through. But the truth is this. If we are talking about the cold hard truth – we are talking about money. You didn’t buy that machine to make your patient healthy – you bought it to make money. They are gonna lose those inches in that area. And Allergan is damn near the only company that the reps actually do actually care about anyone or anything after they sold me anything. You’re correct. You are going to have to spend money marketing and go down that rabbit hole and then your team members have to execute the sale (that’s just business) and we all agree. It does work. It’s our job to plan for that cost in excess of the consumable cost and the marketing cost to make that happen. I can’t blame zeltiq or Allergan for trying to sell their machines. It’s our job as business owners to vet that out and ask those questions before we sign. Their marketing and training is honestly the best. The cost of goods sold on each cycle is line 25-25 gross margin. It’s a product. It works. It’s been around 10 years. We bought it. It’s our job then to make it profitable. Don’t complain about their salespeople trying to make commission or the applicators being a consumable. If you didn’t know that before you bought it you had no business investing that much in a machine. Nobody has ever heard of those machines you mentioned that have no consumable cost. That was why CoolSculpting is, in my opinion, valuable for results and the practice. Nobody is going to want to do Vespa or that other laser because nobody knows what it is. I own SliMedica in San Antonio and I endorse this message.

  18. Dana Faber

    I am looking for the language that indicates a medical device vendor can no longer imply anyone (unlicensed individual) can be certified in use of such devices as this is a state specific regulatory matter.

  19. Constance

    If you own several locations and purchase 1 machine, could this machine travel to all so there’s more revenue to be made?

  20. Louis K

    Kenneth R – thank you for sharing your experience. We too are victims of the same ploy – only with SculpSure/Cynosure. “Geographical” first to market promises only to find out a month later of two other practices in our small rural market. Over saturation killed the market for all. We’ve taken the matter to our State Attorney’s office. We are holding on – we are a small private practice- but just barely. I’m not sure where it will end but all possibilities are on the table. After over 25 yrs in practice it has been devastating. Surely there is legal recourse?? More physicians should speak out. It’s good to see that this is having the effect of non-purchase from those considering such. Word to the wise – buyer beware.

  21. Shannon

    Thank you so much for being just one of only a few Dr’s willing to speak the truth! I’m 41 and gained a lot of weight after a major surgery. I was willing to spend whatever I had to just to get back to my pre-surgery weight and shape and I’m sure no one would have informed me of all of the possible complications, but I’m 100% sure they would have taken my money and promised me the world. Again thank you and God bless.

  22. Kenneth R

    We are another victim of Allergan and the CoolSculpting sinkhole. It wasn’t bad enough that they lied to us about having the local “geographical rights” to the region when they knew of one practice already active and functioning outside of the terms of their contract. It wasn’t enough that we never saw the Allergan support reps after they got their check. It wasn’t enough that we continued to pay Allergan thousands upon thousands of dollars just to be able to use the quarter million dollar machines. No, all that wasn’t enough. Bankruptcy and loss of the entire practice was, however, enough apparently. And that is how the story ends – no credit, no comfort, no facility. Score another one for Allergan.

    • Zoe Holt

      Is there a cheaper but as effective alternative?

  23. Anonymous

    Thanks for the article,quite informative.I was considering to by CS machine for my practice,so maybe not.

  24. Cooling truth

    Thank you for exposing the truth about CoolSculpting. As an electrical engineer I can tell you that the cost of making the actual device is probably no more than $3000 to produce and they want to sell it to you for $150,000? besides the hidden fees, contasntly purchasing cartigues etc etc. that’s why the cost for patients are so high to try to meet the exorbitant costs to maintain this type of device. At the end of the day for patients to spend over $3000 in a small-targeted body area to non-invasively get rid of the fat and probably get it back or not have any results, mind as well pay around the same amount of money to a board certified surgeon and get a more secure-permanent results with a tummy tuck or liposuction surgery.

    • Brenshiff

      I am a patient that had this procedure twice, was charged $10,000.00 And it didn’t work on me. The “Dr” said oh yes I can see a difference… they didn’t weigh me or measure me. Until I came back to tell them it didn’t work. The “Dr” quoted a price of $20,000.00 at first! I about passed out. Then they dropped it to $10,000.00
      So I wasted $10,000.00 on getting my fat frozen and when the nurse massaged the areas it hurt so bad. I thought I was going to pass out.
      Anyway I told the dr I wanted a refund. She said no she wouldn’t give me a refund. But she did offer to do it again for free. At that time my sister found out she had stage 4 lung cancer and my mother had to come live with me she has demitia. So the dr would call every so often wanting me to come back so she would redo for free. I couldn’t at that time helping with my sister who passed away this past May and we did get my mother in a nursing home. So I sent the dr a message I would take her up on her offer to do a redo for free. She said no, she said I’ve tried to get you in here and it’s been almost a year. So no I’m not going to do it. Actually it wasn’t the dr that told me this I got it from the receptionist in a email. So to say the least. I am not very happy. She the dr wouldn’t even take into consideration that I was helping with my sister and taking care of my mother by myself. She didn’t care about that. I couldn’t take off and leave my mother and my sister with stage 4 lung cancer. They were more important to me than getting the cool sculpting redone.
      The dr will not even talk to me. She told me she would do a redo for free never gave me a timeline to do it in. And when I’m able to come in she said I’ve tried to get you I. Here I said about my mother and sister. This was thru email too. She still said NO. She not only cheated me money, she lied and said the results are guaranteed. I asked that several times. Always the answer was yes guaranteed. I hope she never has to help a family member, and not be able to get to another place.

  25. Ana Chrynysm

    Also keep in mind – Allergan has eliminated the secondary market on machines. You cannot sell a used machine to non-“certified” practices because they cannot purchase click-count cards. Additionally, the cost to “re-certify” used equipment renders the price the same as buying a second machine new (for established practices looking to add “dual sculpting) – so certified practices will opt for a discounted new machine. Once you sign, your stuck with it.

  26. John

    Can you use with a pain pump in place as long as applicator is not over pump?
    Was told it was ok .

    • chris

      I am unsure of this. Please contact your local provider.

  27. Ppump

    Can you use cool sculpting with a pain pump in place? Was told by my dr that as long as the applicator is not over the pump, only next to it it would be fine. It’s a Medtronic pain pump.

  28. JCD

    It’s about time that physician start speaking up! This is horrible! This reps do not care, they make about 30 % + commission out this lasers. Stay away from ARTAS, same scenario as coolscupting.
    When you hear consumables do not buy the machine, you will never see the return.

    • DR RC

      Such pathetic shady practices of these companies and those reps!!The aesthetic and laser industry have slowly moved on to the consumable model so they continue to exploit the providers and have that goal of ongoing income. In fact you work for them; its just like owning seven eleven! No different! I have heard an instance (don’t know how much of its true): a provider in the east coast had his Zeltique machine remotely deactivated by Allergan as she bought it in the secondary market! How heinous!

  29. Dr. KT

    Excellent & informative review of the CS device and expected related costs. We need more honest opinions published, especially for these high-priced devices that can literally ruin profitability of a small or mid-sized practice. I have had 3 different “fat-melting”, body sculpting devices in my practice and I am finally very happy with the results (and lack of consumable costs) with the Vanquish ME and Exilis Ultra 360 machines. Fortunately, I avoided the CS device because of it’s high priced consumables as well as possible incidences of patient discomfort and/or complications.

  30. Anonymous

    Wow! Now I don’t feel so bad about paying the high ticket price for a treatment on my thighs. I am not a large woman (5’ 4” @ 112#). The fat on my inner thighs was minimal but, as I am aging (54 y/o) it was just bothering me. I had the treatment 5 weeks ago and I am already seeing results..I mean really good results. The cost was $1500.00 which is a lot of money for me. I felt as though the med Spa was advantage of their clients. After reading your article I understand why the cost is CRAZY EXPENSIVE at least for someone like me. I think I should try getting a job with the makers of the machine. Lol
    Thank you for the informative blog piece.

  31. Alicia

    Very interesting article, does anyone know where I can get good quality antifreeze gel pads from?

  32. Keith Thomae MD, FACS

    I own a CoolSculpting Unit. Worse investment in my life as a cosmetic surgeon. I agree, it does work, and does remove 25-30% of the fat. Zeltiq puts little effort into helping you succeed. Many promises—–no delivery. Tried it in two area’s. With purchasing loan interest, I lost $175,000. If anyone wants to buy my new, minimally used equipment, please contact me…….Zeltiq won’t…..
    [email protected]

  33. Bryan

    Something I did not see mentioned. If for some reason you close your office, or stop using the sculpting machine be prepared. We spent 250,000.00 on 2 machines another 60,000.00 on the latest greatest treatment heads. Had a promise from the rep to no sell any more machines in a 100 mile radius from us. 2 months later 3 machines sold within a 50 mile radius. My office manager got herself in a bit of trouble which ended the life of my Medical Spa. TRY to sell a used machine. Almost a year to finally get both machines sold. One sold for 45,000 the other for 30,000 who ever buys a used machine must pay Allergan a 30,000.00 set up fee to re-certify the machine. Hindsight I would not do it again. Nor do I recommend it to anyone else.

    • Krystal

      We are curious as to where you ultimately sold the machine ? Our practice unfortunately finds ourselves in a “similar situation”.

  34. Debbie

    Thank you so much for this article. I was seriously looking into Cool Sculpting for my new business. Before, I was looking at the Microcurrent machine from Beautiful Image. There is less drama with the Beautiful Image than this one. I’m going with Beautiful Image. It does face and body contouring. WOW!! What an eye opener. Thanks again.

    • Linda

      what about the people running the machine? Doesnt this need to be done under a Dr supervision? There are some D.O’s running an office w/ 2 satelites w. NO Physician on staff. (MD) Nobody is a trained RN or medical person, she said “we all went to college to learn hoe to use the machine” which already is a lie.

    • Anonymous

      I think your are correct and I appreciate your advice

  35. LZ

    Agree that the technology works. The author is spot on with all the added costs. I’m a year in and already having to replace parts on the machine. Also the Coolsmooth pro for outer thighs does not work. The other thing to consider is that CoolSculpting truly has high and low months. Typically the winter months and late summer months there is a nationwide dip in cycles performed. At least in my practice I cannot count on consistent revenue, sometimes not even enough to make the payment on the machine. The cost of owning the machine is certainly much higher than I expected and wish I would have read this blog before I purchased.

    • Ivonne

      Running a startup clinic out of one of Canada’s largest cities I inquired with Cool Sculpt directly on the costs. I was so excited about it when I learned of it.
      But after a minute discussion with sales and doing some quick math I couldn’t make the numbers work. I don’t see how this is profitable but for creating another possible entry funnel for my clients.

  36. Anna Woodburn

    Is cool sculpting a good solution for reducing the size of fat left on the outside of the abdominal wall after a ventral hernia repair?

  37. Anonymous

    Do NOT invest any money into this business. As an owner, I can tell you it is not worth it. Allergen makes money . We have never had any customers come in through their ads. In fact, they are indirectly directing customers away from our office as we are a Coolsculpting only practice. Their brilliant distinction program lists Coolsculpting practiced as long as they also offer Botox. They are not partners in this in any way. Even the reps couldn’t disagree. The new applicator does not in any way lead to a better result. It was a great moneymaker for allergen as it forced existing practices to ‘upgrade’.

    • Coolscupting Poverty

      I’ve been an owner for 4 years and cannot dispute anything written in the article “The Cold Hard Truth about Coolsculpting” or the responses listed here. It has been a long painful journey for with with Zeltiq/Allergan. Partnership is a laugh. Owners pay Allergan for the pleasure of having a Coolsculpting device in their practice. Allergan’s profits are over $100,000 each year for an average practice (running 18-20 cycles per month) yet the owner only collects between $35,000 to $40,000 per year in net revenue. The liability insurance, warranty, disposables, staff salaries and clinic rent make it a very time-consuming and expensive business model for a practice.

      Most practices loose a significant amount of their potential Coolsculpting revenue from lost cycle recovery. This is labor-intensive and Allergan has made it almost impossible to track lost cycles. They will only replace cycles on a quarterly basis.

      Treatment outcomes are very dependent on the skill level of the practitioner. For owners to make money, they typically delegate to the lowest level employee–and unless they are doing Coolsculpting full time, their “skills” will not produce optimal outcomes.

      Allergan’s clear goal with Coolsculpting device sales is to mimic their Botox model: One on every corner and at least 2 in every clinic. They sell machines so close geographically that the pagers from one practice set off the pagers in another practice. No matter how much I beleive in the science of Coolsculpting, I would never invest in the business model of “disposables”.

      The overwhelming greed of Allergan will ruin the entire business model in a few short years.

      Buyer be ware! Before investing in Coolsculpting, talk with an owner who truly knows their business.

  38. Rae

    Excellent, informative article. Thank You!
    Laser lipo!

    I’d say because of your experience with the product, your information is the most accurate then a mere CoolSculpting provider.

  39. ERICA

    Thank you for this fair and honest article. I was considering CS for my new practice. Now, I have decided to put a pause on it at least for now. Your information has armed me with great questions to pose to Zeltiq or any of these providers. Thanks again!

  40. Deborah Kessler Hudak, MD, MHA

    Your article is spot on, EXCEPT the disposable cool cards are even MORE EXPENSIVE now that Allergan (the aesthetic industry’s greediest player) bought Zeltiq.
    Furthermore, they play unfair games. I have a second CoolSculpting machine at a satellite office, and two of the seldom-used handpieces (CoolMini and the flat plate for outer thighs) can only be used on one of my two machines…because the company rigged the software in a way that would force me to buy another set of these hand pieces for the other machine!!

  41. Le Yen

    Great article! I was considering getting the machine for my medical spa. I’m not going to now.

    • Mike

      My experience with aesthetic equipment was the costliest ($400,000 loss) and worse experience of my professional life. Aesthetic equipment salespeople are the “used car” and “aluminum siding” sales people of the medical industry. Before purchasing ANY aesthetic equipment, ask one simple question: “HOW MUCH AM I WILLING TO LOSE?”

  42. Dolores C McClarty

    Very interesting article. What are your experiences in the area of double chin. The loose skin in the neck area? The success and side effects . I am not interested in botox.

  43. Jay

    Great information! Thank you!!

    Do you have any information/opinions on the Cutera TruSculpt 3D?

  44. STEVE ST.JOHN 816-820-9596


    • Anonymous

      the cards that say 1 are the cards that Zeltique sends out to practices when they have a lost cycle or tech problem. when i have had a few pop offs, i call the company, and they send a replacement cycle/cyles depending on how many you report. so if i lost one cycle, card will say 1 on it, or 3 etc. perhaps they sent one to him by accident.

  45. Ann Linhares

    This is great to read ,
    I have appointment with a rep for next Thursday .
    What other company’s should I consider?
    I will be printing this let’s see what she has to say !

    • Dawn seldon-matthews

      Hi Ann

      Interested to see if you managed to seek alternative machine that didn’t have the high price tag of a c s machine or indeed running costs ?


      zimmer machine ( Zlipo) should be considered

    • Ron

      Hi Ann
      Did you find another machine that does the same job? The price tag that I was quoted for the machine and cycles actually in much higher that this article stated…..

  46. John

    In regards to the “cards”- what are they? What is the “cycle exchange program” and how does that work?

    • iapam999

      No, there is no cycle exchange program. You need to purchase plastic “cards” that plug into the CoolSculpting machine in order for you to use it. Each “card” has a certain number of cycles on it (i.e. you may pay $5,000 for a card that has 10 cycles on it). If a card has 10 cycles, you may use it for 10 treatments, once the cycles on the card have been used, you toss the card in the garbage and order more!

      • Shannon

        Oh heck no! If you buy the machine you should have full use and not have to pay someone else to use it! What a rip off! Why cant you just buy a machine outright??

      • Anonymous

        This is rediculous, nobody should buy these machines and see how cheap they get then!

      • Dr RC

        What a rip off!!

  47. Jean McKoy

    This blog was very informative as I have been doing my research on CS to add to my practice. Thank you so much for sharing because after reading the naked truth I’ve decided NOT to buy this machine.

    Jean McKoy

  48. Practice manager

    Wow! This is truly an eye opener for me and so glad to have come across your article. This helps me quite a bit as I was considering buying this equipment for our practice due to the hype of cool sculpting. I didn’t even realize or factor in the consumables the company is selling is so pricey. I was only concerned with the cost of the machine and didn’t even know/and factor in the high priced consumables, warranty and marketing fees. My doctor was smart all along when I stressed to him years ago to purchase this equipment and he said traditional liposuction is best for optimal results. At the time and even before reading this article I had no idea the plan behind this machine is like the printer market. Meaning, buy a printer for a steal of a deal but the cartridges are so expensive to use the printer. I’m so grateful I came across your article as I too believe that, though this technology may work, I agree that the money given to the company to operate the laser and advertising (240k) can be and IS well spent on an aggressive marketing company instead. Thank you for posting your true experience and I wish to see more doctors come out to state their experience as well. The equipment company is the true winner of this deal is as I see it. I am no longer interested in buying this equipment.

  49. Susanne McCarthy MD

    I feel that all these aesthetic things -lasers/ fat melters all end up making more revenue for the companies selling them with minimal benefit to patients that they make claims of doing. Then the monthly maintenance fees! Bunch of nonsense. I own Cynosure lasers and they do some benefit, their B & A pictures are really carefully picked and they don’t give you much training on these machines and every person you speak to in customer support gives you a different story on how to approach treatments. I think the B & A pictures that Cynosure has circulating at their talks about Sculpture are really very disappointing and will not convince me to get this machine at all. Then the reps of each company (Coolscupting Zeltique vs Sculpture Cynosure vs. Smart Lipo Cynosure) run down the reputation of the other companies selling the competitor product-don’t know what to believe. And they give you so little info to go on before your purchase. I remember Cynosure came to me with a very high pressure sales pitch to buy a Smart Lipo machine at a very low cost-right before the Sculpture was release. Trying to move machines, not concerned about is this product right for your practice. You have to remember do what is best for you ask about hidden costs and watch the sales reps squirm!

  50. Manzo Hodge

    I have 4 CS units and your artical is spot on. I experienced the the increased fat in my abdomen as well. We have had a horrible experience with Coolsculpting our first rep was a good rep but complained from day one how CS was over working her and quit in the first 30 days of our practice being open. Our new Rep arrived at our grand opening along with the regional director who could not stay during our event because of his busy schedule. Our brand new very green rep could not help us nor help drive traffic to our business and it took 5 months to get on the practice locator, in 12 months we have not seen one lead from Coolsculpting, they have been self generating . We have two of our machines Collecting dust in a room due to the low volume of patients. Our rep is constantly asking us to purchase more cycle cards when we have $60,000 in cool smooth cards that we can’t even use because majority of people don’t qualify for outer thigh. Our investment has been $500.000 with CS worst investments I’ve ever made

    • Jill

      I have been considering this for outer thigh. What are the qualifying criteria? I’m approx 10 lbs overweight and it’s all in the “bottom” area. Very lean up top. Thanks

      • liliana

        Hi Jill,

        For most accurate information please consult your CoolSculpting provider.

      • Dant71

        Are you sure this is a bad thing please send pic to verify.. just kidding! 10# on bottom may not be so unaesthetic though.

    • Dan

      Why would you buy 4 machines at once? Absolutely ridiculous.

      Why would you buy $60,000 in cards at once? Absolutely ridiculous.

      It is pretty obvious why you are out 500K.


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