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Evolution of the treatment approach to cryolipolysis using the CoolAdvantage® applicator family: results from a retrospective database review

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European Journal of Plastic Surgery Aims and scope Submit manuscript



The CoolAdvantage family of CoolSculpting applicators reduces skin tension and increases tissue contact compared with the previous CoolCore system. We assessed the impact of transitioning from CoolCore to CoolAdvantage in routine practice.


This was a retrospective, single-center analysis of consecutive cryolipolysis treatments conducted using the CoolSculpting procedure. Between January 2012 and January 2017, these were based on the CoolCore system; between January 2017 and July 2019, treatments used CoolAdvantage.


A total of 253 patients were included (n = 196 female [77.5%]). Of these, 111 received treatment with CoolCore (130 treatment areas; 338 cycles) and 151 with CoolAdvantage (248 treatment areas; 723 cycles). With CoolCore, all treatments were to the abdomen (262 cycles) or flanks (76 cycles); with CoolAdvantage, treatments were to the abdomen (231 cycles), flanks (227 cycles), and many other areas, including the inner thighs (78 cycles), outer thighs (68 cycles), and back (30 cycles). The number of body areas treated per visit was higher with CoolAdvantage versus CoolCore (1.59 ± 1.01 vs 1.14 ± 0.34, respectively; p < 0.0001), as was the mean number of treatment cycles per visit (4.63 ± 4.30 vs 2.96 ± 1.34; p < 0.0001). There were only two significant complications: one paradoxical adipose hyperplasia (with CoolCore) and one loss of sensation (with CoolAdvantage).


Transitioning to the new CoolAdvantage applicator family had no impact on safety and led to greater versatility and increased numbers of cycles per treatment.

Level of evidence: Level IV, therapeutic study.

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Writing and editorial assistance was provided to the authors by Timothy Ryder, DPhil, of Biological Communications Limited (London, UK) and funded by Allergan plc (now AbbVie) at the request of the investigator. All authors met the ICMJE authorship criteria. Neither honoraria nor payments were made for authorship.

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All authors made substantial contributions to the conception and design of the work and the acquisition, analysis and interpretation of data; participated in drafting and critical revision; approved the version to be published; and agree to be accountable for all aspects of the work.

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Correspondence to Alessandro Gualdi.

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Patients signed informed consent regarding publishing their data and photographs.

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Dario Bertossi is a consultant and speaker for Allergan S.p.A. The other authors report no conflict of interest to declare.

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The study was conducted in accordance with the Declaration of Helsinki and further ammendments. According to Italian law, approval by an Ethics Committee did not apply to retrospective studies.

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Informed consent was obtained from all participants included in the study.

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Gualdi, A., Gatti, J., Bertossi, D. et al. Evolution of the treatment approach to cryolipolysis using the CoolAdvantage® applicator family: results from a retrospective database review. Eur J Plast Surg 45, 133–138 (2022).

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