Freeze That Fat with CoolSculpting

Speaker 1 (00:07):
You're listening to The La Jolla Cosmetic Podcast.

Monique Ramsey (00:14):
Welcome, everyone to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey. Today, I want to welcome back to our podcast, Anh Bridgewater. Hi, Anh.

Anh Bridgewater (00:24):
Hi, there.

Monique Ramsey (00:26):
You just came back from having a baby. How does it feel to be back at work?

Anh Bridgewater (00:31):
Yeah, it's actually really nice to be back, just because we're only dealing with non-talking babies, changing diapers, burping them, spit-up everywhere. It's really nice to actually have some human interaction, adult interaction for that matter, so it feels really good to be back.

Monique Ramsey (00:47):
Everybody's so excited that you're back. I want to tell everybody the big news, where you're going to be working, which is our new location in Carlsbad. So you're going to be up at the Carlsbad location once it's open?

Anh Bridgewater (01:02):
Yep, I'll be there. I'll be there full-time. I look forward to seeing all of our patients there. We are really, really excited about this new location.

Monique Ramsey (01:12):
Yeah. Today we're going to talk about CoolSculpting. It's a super popular treatment. It's been around a really long time. It's very safe and effective. But there's some myths about it, some misconceptions about it, so we're going to talk and dive into all that. First of all, can you tell us a little bit about CoolSculpting, what it is and why it works?

Anh Bridgewater (01:35):
CoolSculpting is something that we do quite frequently in our practice at La Jolla Cosmetics. It is an FDA-approved treatment that's non-surgical for, essentially, permanent fat reduction. Lots and lots of people come in wanting some sort of improvement to certain areas on their body. Whether it's through diet and exercise, they haven't seen the results that they want to see, or they have an upcoming event and they want to look their best. That's where CoolSculpting will come in. Not everyone wants surgery, and this is where CoolSculpting really shines.

Monique Ramsey (02:10):
What areas of the body can be treated with CoolSculpting?

Anh Bridgewater (02:14):
There are so many areas that are possible with CoolSculpting. Essentially, there are nine FDA areas that are approved. We have the thighs, abdomen, flanks, you can do your bra fat even, back fat, submental region. Submandibular region's also very popular. Those are the main areas that we treat. Oh, and the upper arm.

Monique Ramsey (02:36):
A lot of places. Who would you say is a good candidate for CoolSculpting?

Anh Bridgewater (02:44):
CoolSculpting is ... I would say, the majority of people are a good candidate. It really comes down to candidate selection, at the end of the day. Those that are breastfeeding or pregnant are unfortunately not. It's contraindicated that they get CoolSculpting done. For that matter, any aesthetic treatment. Certain patients with disease processes where they are triggered by extreme cold are also not a good candidate for this procedure. I would say another candidate that wouldn't be quite suitable for CoolSculpting is those that have severe laxity of the skin. CoolSculpting is something that will treat the fat. However, skin is skin. The skin's going to be there. When the skin has a lot of laxity, even if you reduce the fat, the skin's going to appear even more lax because now you don't have that bulk sitting there. So that's something that you also have to take into consideration. It really is something where patients will have to come in, and the providers will have to take a look at it and assess whether or not they would be a good candidate.

Monique Ramsey (03:47):
Is the skin laxity issue more of a factor that is age dependent or is it dependent on the area of the body? Or both?

Anh Bridgewater (04:00):
Well, both. Obviously, our skin as we age will lose that laxity. We see it on our face, on our neck, on our chest. That's why patients come in and get these different treatments that we provide, whether it's ultrasound or radiofrequency. Those are things that we can do to help tighten the skin, in addition to great skin care. However, when an area essentially is stretched beyond where it really should be when you bulk reduce, then the skin will have time to bounce back. It depends on the age and how quickly that skin will bounce back, as well. So it really depends on that patient, that particular patient. That's where that customized treatment will come into play.

(04:42):
When patients come in, we really individualize your treatment program so that it actually fits your body and how to contour it for you and what your goals are. There are things that we can offer, say for patients who have some mild laxity. Once you reduce an area, that laxity may be a little bit more obvious and that's where we can offer different types of options for our patients.

Monique Ramsey (05:05):
To tighten it up. So if you're left with some lax skin afterwards, there's maybe ways to deal with it.

Anh Bridgewater (05:13):
Exactly.

Monique Ramsey (05:14):
Now, how many treatments are needed for one area, let's say?

Anh Bridgewater (05:21):
For one area ... say a patient comes in and the abdomen is an area that bothers them the most. I would say that's one of the more common areas that we treat. For the abdomen, or any area for that matter, we usually recommend a minimum of two treatments. These two treatments will be done about four to six weeks apart. That's really to allow for our body to remove that excess fat. Essentially, CoolSculpting will essentially freeze these fat cells and the fat cells will die off. Then our body will slowly eliminate it over the next few weeks. It's a very natural process in the sense that your body's doing the work, but it does take time for the body to do all that. Then we'll see our patients in four to six weeks and then we repeat that again.

(06:05):
Each time that you're doing the CoolSculpting, you're looking at about a ... up to 20 to 25% reduction in fat. It is permanent, so that's the great thing about it. Yeah, it's really permanent. Once it's gone, it's gone. However, our body will still ... There will be some fat cells remaining, 80 to 75%. Those can essentially get bigger through time. Say if you slack in your diet and exercise, and you gain an absurd amount of weight, that is going to ... essentially, those fat cells can grow. However, the quantity of fat cells will have been reduced because of the CoolSculpting.

(06:42):
Now, I don't want to say that two sessions is where you're plateaued. You absolutely can go above and beyond that. You can do three sessions, four sessions. It really depends on what your goals are, and how much your skin essentially can take, and what kind of other treatments we need to bring on board in order to maintain the skin as well as reduce the fat at the same time.

Monique Ramsey (07:02):
Let's say just the average person maybe has two treatments four to six weeks apart. You can't really have this ... If your goal is to be ready in two weeks for a wedding, fitting into a pair of pants you haven't ... then this isn't ... you need to plan ahead is what I think I'm hearing.

Anh Bridgewater (07:19):
Yes.

Monique Ramsey (07:20):
What's your recommendation as far as your event and how far you need to backdate to get ready?

Anh Bridgewater (07:28):
Yeah, that's a really good question. I would say at a minimum, say your standard patient that needs two treatments, we're looking at about 12 weeks, so about three months before you're ready. And again, that depends on the person. It does take some time. It takes time to gain all that weight. It takes time to reduce it as well. So think of it like that. But I think at the end of the day, it's going to be a lot quicker than just diet and exercise, especially for those really stubborn fat that just don't go away.

(07:57):
Say, for example, a lot of patients come in and they want to look good for the summer, say summer body ready by June. I would at the very latest come in March. Or even end of February, get a consultation. And then start your treatments in March and then be ready by June. I would say that because CoolSculpting really doesn't have any downtime. Even if after you get your treatment, you will continue to see that improvement from then until three months, that area's going to get slimmer, it's going to get more taut. You're going to notice that you're going to have some reduction there, your pants are going to fit better. But for your final result, you're looking at about at least three months out. It continues to improve thereafter.

(08:37):
I would stress with my patients in general that it's very important to continue your diet and exercise. That will just help accelerate those process and to get you closer to your goals a little bit more quickly. That's not something that we want to essentially neglect. Just because we're doing an in-office treatment doesn't mean that we can just eat whatever we want, because it's defeating the purpose. You want to protect your investment.

Monique Ramsey (09:01):
Yeah, for sure. Now, I know we have a couple products in the office that are made specifically to help with maybe this CoolSculpting fat elimination process and to help with the skin tone. I think SkinMedica has a new one called the Firm & Tone body lotion. Alastin has the TransFORM body lotion. What do you think about those?

Anh Bridgewater (09:25):
I think it's a great addition to CoolSculpting. It definitely won't hurt. A lot of my patients who do CoolSculpting, I would typically recommend that they also either do the Transform or the SkinMedica in order to just ... You're celebrating that process again, just once again, and it's going to get you better results. It's not mandatory, but it is a really nice addition.

Monique Ramsey (09:46):
Okay. When you were talking a little bit about percentages, is there any way to say what kind of results you can expect in terms of inches or percent decrease? Or how can people be thinking about how they'll get to their result or what that result would be?

Anh Bridgewater (10:06):
That's really unfortunately a really difficult thing to predict because every individual's so different. Honestly, we're talking about, ideally, you would get that 20 to 25% reduction with each session, but you could have better than that. Or maybe you're looking at 15, 10%. It's really hard to say. But I would say that if you are also focusing on other aspects to help with that weight reduction or that fat reduction, then your results will just be better.

Monique Ramsey (10:41):
Let's say the person wants to do maybe their upper and lower abdomen and their arms. What does that look like in the chair, and with how many machines or how many applicators that you can do at a time?

Anh Bridgewater (10:57):
When it comes to CoolSculpting, the patients will come in, and essentially, what we do as providers is that we will assess where they have their bulk. We would kind of mark out everything and see how many applicators they will need. Each applicator, depending on the size of the applicator, is going to focus on one particular area. In the chair, typically, my patients are really, really comfortable. A lot of them will just sit there, read a book or watch Netflix, go on their phone. So you're really comfortable while you're there. I would say that the first five to 10 minutes is when you start feeling a little bit of tingling and a little bit of that sensation where it's not so comfortable, but we provide things to help our patients better tolerate the first five to 10 minutes. I would say the majority of people really don't need anything. This is a really comfortable treatment.

(11:44):
You'll be laying there. Essentially, you'll have these applicators that are kind of suctioned onto the abdomen or the arms. We keep them in place, and then you just wait the 35 to 45 minutes during the cycle. And then we take them off and we massage them, and then we do another area. Because we do do dual sculpting, meaning that we have two machines in our office. So we are able to put on up to four applicators at a time. So it just makes it go a lot more quickly. That's one of the beauties of having multiple machines in our office, is that we can really get you in a little bit quicker and get you out a little bit quicker, as well.

Monique Ramsey (12:20):
So you can just sit there and sort of wait, really. And then afterwards, is there any ... You said no downtime, but is there pain afterwards? Or people can just go back to do whatever they're doing, or go exercise at the gym later if they feel like it?

Anh Bridgewater (12:36):
I would say that when you initially take off the applicator, it's going to be a little bit red in the area. That pretty much resolves by the time they leave the office. So you really don't see anything substantial, looking at it visibly on the surface. However, it's pretty common to feel some tingling and some cramping over the next few days. A lot of patients may also experience a little bit of bloating. Nothing where people will notice, but you will notice it, perhaps. But however, it's really common for you to go back to your normal daily routine. You can go work out. You can go back to work. Pretty much do whatever it is that you would normally do. Really, there's no social downtime there.

Monique Ramsey (13:18):
That's good. Is there any bruising or anything like that?

Anh Bridgewater (13:21):
Yeah, it's pretty rare honestly to get any sort of bruising. Majority of people walk away with pretty much nothing going on. You can't even tell that something was done, honestly.

Monique Ramsey (13:33):
Now, do you have your patients do anything leading up to that CoolSculpting session, in terms of, I don't know, pre-treatment care? Or do you have them doing anything specific afterwards to help flush the body? I'm kind of thinking almost in a detox sort of way.

Anh Bridgewater (13:52):
Yeah, I normally would have my patients start the Alastin even before they start their treatment. Then they would already have it available immediately after their treatment, so they can get started on that pretty much right away. That or the SkinMedica. And then I urge my patients to please continue your diet and exercise. That's always going to be very, very helpful. Your body needs to eliminate essentially all these dead fatty tissue. What's the best way to really do that is to be essentially as healthy as you can, and hydrating. Hydrating is really important. Just to allow your lymphatics to do its job and just flush out everything.

Monique Ramsey (14:27):
Okay. Now, there's some misconceptions out there. I alluded to that at the beginning of the show. I saw something where somebody was saying, "Oh, it's like non-invasive liposuction." Is that a good way to talk about CoolSculpting? Would that give you a similar result?

Anh Bridgewater (14:45):
CoolSculpting is completely different than liposuction. CoolSculpting is non-surgical. It's non-invasive, meaning that there's no cuts, there's no ... there's not even a needle that's being stuck in your body. It's literally like an applicator just sucks on there. It freezes it. Really, you don't have any sort of downtime that you would have normally with other aesthetic procedures or surgery.

(15:07):
I would not compare it to liposuction. However, if a patient comes in wanting to ... they're looking for something very drastic, meaning a really big difference ... Because liposuction, essentially, you're taking majority of that fat cell. You're sucking out all that fat. The CoolSculpting, again, we're talking about 20 to 25% reduction each session. So it's completely different. Again, because it's non-surgical, it's not going to have a big before and after kind of look as you would with surgery. I would say CoolSculpting has its place when it comes to fat reduction. At the end of the day, it really depends on what my patients are looking and expecting out of their treatment. If they come in and they really want something really substantial and they're looking for something really, really drastic, then I would say that probably liposuction would be a better treatment for them, or something closer to what they're looking for.

Monique Ramsey (16:07):
Now, I also saw that people are buying at-home CoolSculpting kits, not really branded CoolSculpting, but at-home kits to help reduce fat. Have you seen anything like that or have you been asked about them? And why might that be a bad idea, I'm guessing? Put ice cubes all over yourself.

Anh Bridgewater (16:31):
Yeah. This is news to me, honestly. I did not know that that was an option, but I've got to say I'm not surprised. Almost every single treatment that we do in the office, there's some sort of at-home way of doing it. You have to remember at the end of the day, this is an FDA-approved treatment. Meaning that it's gone through clinical trials. It has been established to be safe and effective. You don't want to be putting something into your body or on your body without knowing exactly what it's going to do to you. Because if something were to happen, who's going to be able to help you at that point, because we have no idea what exactly this device is doing. It really takes a professional to really look at you and recommend these devices for that very reason, because these are safe and effective tools at fat rejection. I wouldn't buy anything over the counter that's marketed to help with fat. There's probably tons and tons of things on the market that help you reduce fat, but honestly, you don't know what's in it. You don't know what it's doing exactly.

Monique Ramsey (17:36):
That makes me think of a few different stories over the years. One was there was a cream being marketed to give you these amazing results on your face. It happened to be my stepmom who was the face of the before and after. She had had a facelift.

Anh Bridgewater (17:55):
Oh.

Monique Ramsey (17:56):
She's very open about it, so I'm not sharing secrets. She was on our website. This company took the photos off our website and used those before and afters to market their face cream. She saw herself and she was like, "What the heck is this?" So, even sometimes if you see a before and after, you're thinking, "Oh, that's really from whatever this product is," it doesn't even mean that it is.

(18:21):
Like you said about being FDA approved, being so close to the border, we had a patient call who had gone to a filler party on this side of the border, but the person who was doing the injections had brought product through Mexico. So when she told what she had put in her lips and she was having complications, it was something that we didn't even know anything about. It was something that isn't even allowed to be sold here in the USA. Then it's like, "If you're having problems and we don't even know what it is or ..." It's really scary.

Anh Bridgewater (19:00):
I definitely agree. That's a really scary thing. Because really, I would say that it's not worth it at the end of the day.

Monique Ramsey (19:04):
Not worth it. Right. It's true, it is tempting. We're all tempted even when we know we shouldn't be. If it looks like it's too good to be true, as they say.

Anh Bridgewater (19:14):
Sure.

Monique Ramsey (19:15):
You mentioned that skin laxity, that crepiness or extra drooping of the skin can happen after CoolSculpting. Not necessarily for sure, but it can happen. If that happens, then what are your tools that you use to then help that skin get back into shape?

Anh Bridgewater (19:35):
First, I have to preface this by saying that CoolSculpting is FDA approved for skin laxity in the submentum area, as well. So not only does it treat the actual fat in this area, it actually helps tighten the skin there. That would be like best of both worlds. However, if a patient comes in and say they treat a different area or they want to tighten their submentum even more because they want that really nice defined jawline, we do have other modalities and treatments that we have available in our practice to help our patients reach their goals.

(20:04):
So, radiofrequency microneedling, we're going to be offering Morpheus8, which is essentially microneedling with radiofrequency. I'm sure a lot of people have heard about microneedling, but this is literally like microneedling on steroids. A lot more powerful. A lot more effective. I love it for skin tightening, especially in the face and the submentum area. It looks beautiful. You can do it on your abdomen. I had it done on my abdomen, postpartum, just to help with that skin laxity. Love it so far.

(20:34):
We also have ultrasound, Ultherapy, which we talked about in a previous podcast. That will also be very effective for helping to tighten that skin, as well. And we do PDO threads. You can play some threads in there to help lift that abdomen. You can do it on the arms. You can do it on the knees. So there's a lot of options that are available for patients who come in with some skin laxity, either before CoolSculpting or after CoolSculpting, whatever it may be, that we can essentially help them with. You would come in, we can assess for that and see what would be the best treatment plan.

Monique Ramsey (21:07):
That's really encouraging, because even if you're worried about that afterwards, that there's sort of some ways to address it, if it happens. Or even if you're not having CoolSculpting, you just have some lax skin, it's nice to know there's so many different tools that you have. We're super excited about the Morpheus8. That will be only in our Carlsbad location. That's where you are going to be.

Anh Bridgewater (21:28):
Yes.

Monique Ramsey (21:28):
So yeah, that's super exciting. I encourage everybody, because we have now our online booking, where you can book your consultation online. You can book a couple of different types of treatments online. And then you can then be seen in the new office once it opens starting on March 1st. We've got a bunch of specials coming up that we'll sort of roll into our grand opening celebration. We've got a really exciting contest coming up. I'm just putting the finishing touches on that. So lots of really exciting things. Go to ljcsc.com and you can see all kinds of information coming up about the new location, about Morpheus8, about Anne.

(22:16):
I just wanted to talk a little bit about how much your patients love you. It's so cute. We see new reviews come in every day. It's so sweet. I mean, people are just adorable. One of your CoolSculpting patients said, "Anne was extremely patient, knowledgeable, and friendly. The procedure went very well, and every effort was made to make me feel comfortable." She's happy with her experience, obviously with you. How do you make patients feel comfortable during the procedure, and what can they kind of expect from you as a provider during a treatment?

Anh Bridgewater (22:51):
That's such a sweet thing to hear, honestly. That just really makes my day. I'll just say, we strive for our patients to be really comfortable during their treatments. Honestly, I've got to say, CoolSculpting really does do the majority of the work for me when it comes to that particular treatment. It really is just so ... It really doesn't hurt. It's a very mild treatment. You're getting the fat reduction, but it's not a needle. There's nothing being stuck inside of you. We're not cutting you, so it doesn't really hurt for ... I would say most of my patients are just very comfortable while they're there. Some of them would fall asleep. It's such a comfortable treatment that, really, I don't have to do a whole lot, honestly. I think I'm taking too much credit there.

(23:37):
But for some patients who do struggle a little bit in that first five to 10 minutes, we do offer PRO-NOX, which we had talked about in our Ultherapy podcast. If you haven't already listened to that one, you can head on over there and listen to that as well. Essentially, it's laughing gas, so it helps you ... It's only in your system for about five minutes. You inhale it and it just helps you look past whatever sensation it is that you're feeling. We have a TV in there for them. They can read their book or they can go on their phones. We try to keep you as comfortable as possible, just so you feel like, really, you're at home.

Monique Ramsey (24:14):
One last thing, and I don't know ... we'll see what you think about this. Was it Linda Evangelista who had a very rare complication with CoolSculpting? Do you know much about that and what that was? Because I think it's super unusual given the millions of CoolSculpting treatments that happen, and have happened since 2008 or '09 when it started. Is there some group of people who this might not be good for?

Anh Bridgewater (24:42):
I think that's a really important topic to bring up, actually. I talk to all my patients about this, whether or not they're aware about it. Although, it's been in the tabloids quite a bit. So yes, a known complication for CoolSculpting, which she may have experienced, is paradoxical hyperplasia. Meaning that instead of these fat cells getting frozen and dying off, for some odd reason, these fat cells started to grow in that particular area. That's obviously very tragic for the patient that had to go through that. It's completely opposite of what she had in mind when she came in looking for CoolSculpting.

(25:22):
This is a very rare ... However, I have to say, it's a very rare complication. However, it is a possible complication. Unfortunately, there is no way for us to look at a patient and say, "Your percentage of getting this is X, Y, Z." It's impossible. There's no way to look at someone and tell them whether they may or may not. So it's not something I would promise. However, CoolSculpting as a company, they're aware of this as a complication, a potential side effect. At that point, the only treatment then on is actually liposuction.

Monique Ramsey (25:56):
In the rare instance that it happens, the liposuction would be the solution to the ...

Anh Bridgewater (26:04):
Yes. The company, if they deem that it's due to the CoolSculpting, will essentially help with the liposuction. That's not something for the patient to feel like they are financially burdened by.

Monique Ramsey (26:18):
I want to bring up one other thing that people might not realize. CoolSculpting ... Because you were saying the company, and I'm like, "Oh, Allergan." Allergan may be familiar to you because they make Botox. They make all the Juvéderm family of fillers. They make Kybella. They make SkinMedica. If you're part of that Allē rewards program ... It used to be called Brilliant Distinctions a few years ago, but they've changed it to Allē, A-L-L-E. In your applicator price, if people want to say, "Well, how much is it for CoolSculpting?" When you're looking at CoolSculpting Elite, which is the newer version of the machines, which is what we have, you're looking at a per cycle price. That's going to be $750 for that one session.

(27:01):
For GLAMfam members, everything that we do is discounted, and we have special packages. So you're not going to pay that 750 price. I just wanted to make everyone aware of that. But on top of whatever we're giving you, if you have Allē, you're earning those points too. So you might have couple hundred dollars off of your next Botox treatment, or something like that. It's all within that Allergan family. I think people who work the system, I'm all for it. Stack all the discounts you can do. Because why not, right? It's free money.

Anh Bridgewater (27:37):
Why not? Free money.

Monique Ramsey (27:40):
I encourage anybody who's thinking about it ... Because it can add up a little bit based on how many areas you want to do, but we're there to help try to make it super affordable. We do have financing as well. Those are kind of the whats and wherefores of price. Tell me, Anh, how do your patients have consultations with you? Do you normally do a virtual or do you do it in the office?

Anh Bridgewater (28:06):
Yeah, we do both, virtual and in person, depending on what's most convenient for our patients.

Monique Ramsey (28:15):
Now, if you're listening today, we want to ask you for a special favor. If you like your podcast here that you ... the things that you're hearing or watching, we would love it if you would write us a review. Because it's very meaningful, it helps our subscriber base, it helps us move up in the rankings, but we also want to do our best. So if you have a topic that you're interested in us covering, let us know so we can address the topic. And lastly, if you have questions, need help with scheduling, we'll have all the links in the show notes. So you can just click, click, click. You will also have links to before and after photos.

(28:52):
One thing about our gallery that I want to emphasize is out of all the procedures ... We have tons and tons of photos on our website, but some people, when they're giving us permission to use their photos, only want it ... they don't want them on the web necessarily, but they'll allow us to use those before and afters in a consultation with a patient. So they're sort of in-house. So, there are more photos than are just on the website. We are adding photos all the time.

(29:21):
We will put all those links in the show notes. I think there are some really good blog posts that you would benefit from reading. Just because over the years ... This has been around a long time. Our practice actually was ... Before Allergan bought it and named it CoolSculpting, it was called Zeltiq. We were in the FDA trials for it, or the studies, our practice. So, way back in the day, it's actually kind of funny, they would treat half of you. I was in the back fat category. Isn't that lovely?

Anh Bridgewater (29:55):
[inaudible 00:29:57].

Monique Ramsey (29:56):
They treated half of my back fat, to see the difference. But it was kind of cool, actually. But it was something that we've been doing here for a very long time, and we're really comfortable with the technology and the safety of the procedure.

(30:15):
All right, everybody. Well, thank you. Thank you, Anh, for your time. I really appreciate it. Congratulations on your beautiful family.

Anh Bridgewater (30:23):
Thank you.

Monique Ramsey (30:23):
Thanks for joining us today, and we will see you all again next time.

Speaker 1 (30:33):
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment, or mention the promo code PODCAST to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I-5 San Diego freeway, in the XiMED building on the Scripps Memorial Hospital campus. To learn more, go to ljcsc.com, or follow the team on Instagram, @ljcsc. The La Jolla Cosmetic Podcast is a production of The Axis, the axis.io.