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May 5, 2010

Freeze Your Fat Away

A new, high-tech procedure at the dermatologist's office zaps unwanted bulges — no needles or scalpels required.

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a woman's stomach and hips

Photo Credit: Diego Alvarez de Toledo/iStock

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Since my teens, I've been dogged by my secret fat: a stubborn slab across my lower abdomen that no amount of running would remedy. It was an irritating ripple that seemed to double in size from morning to night, yet it was also isolated enough to conceal in well-cut clothes. On bad days, I could gather it in my hands and fashion it into a giant bagel, which dampened my mood almost to the point of distraction. It was impervious to exercise and diet (I eat pretty healthily), and, since my two pregnancies, it had rested above a depressingly wide horizontal crease above my bikini line. It looked like my whole torso was frowning.

So my usual skepticism was trumped by sheer, childlike giddiness when I learned that my roll of shame was the perfect target for a new, noninvasive gadget called Zeltiq, which permanently zaps fat on the stomach, waist, hips, and back via Cryolipolysis (translation: freezing it). "It's best suited for women who are close to ideal body weight with specific areas of unwanted fat, like the belly," said Dr. Jeffrey Dover, an associate clinical professor of dermatology at Yale University School of Medicine and the chairman of the scientific advisory board of Zeltiq. Had he seen my vacation photos? "These candidates can be as fit as possible," Dover added, "and they'll still never get rid of that fat." I felt strangely absolved, realizing that I'd viewed my band of blubber as a personal failure. I also realized how much emotional energy I've spent trying to accept my stomach the way it is (I've carried two precious boys, blah, blah)—to no avail. Did this mean I was incredibly vain, or insecure, or both? Suddenly, a new question popped into my head: Who cares?

I scheduled a consultation with dermatologist Dr. Arielle Kauvar, the gentle but no-nonsense director of New York Laser & Skin Care, who has been using the machine on patients since last fall. Zeltiq has been approved for fat removal in Europe, Asia, and South America since mid-2009. In the U.S., it's FDA-approved for skin anesthesia but is still under review for fat removal. In the meantime, a handful of American doctors are using it off-label (a legal practice).

"Fat cells are damaged at a higher temperature than normal tissue and nerves," Kauvar explained. "This device extracts heat and cools the skin so the fat in cells crystallizes, then is slowly eliminated over two months, and the bulge gets smaller. And fat cells do not regenerate." (Dover later explained that once frozen, the cells dissolve and the released fat is likely processed by the liver. Clinical trials reported an average fat-layer reduction of 22.4 percent as measured by ultrasound.) Kauvar moved on to the nuts and bolts. "There's no anesthesia, no needles. I attach the device to you with a vacuum, and it sucks the fat area into the applicator. You sit for an hour each session and may feel bruised or numb for about two weeks. Now, shall we take a look?"

I stood up. Kauvar crouched down in front of me, and I lifted my shirt, squeezing my flab as she worked her way from side to side. "Oh, yeah," she said. "You're a good candidate." She called in an assistant, and they discussed how they would place the device on me. "You could almost do it in one application or two overlapping ones," Kauvar said. Dermatologists charge $600 to $1,000 per application; two in Kauvar's office would run $1,500—versus around $5,000 for abdominal liposuction. Dover added one caveat: "The long-term benefits are still unknown, and if someone binges, they could get fat elsewhere." But his words barely stuck. I was sold.

A week later, Kauvar took "before" photos of me from five angles. I lay back in a chair next to the Zeltiq machine, which is about the size of a freestanding ATM, as her assistant spread a cotton pad saturated with cool gel across the right side of my lower abdomen. Kauvar approached with the vacuum, a translucent nozzle with an 8"x2" opening, and placed it precisely onto the pad. Her assistant pressed the start button, and within seconds the vacuum sucked in half of my stomach, leaving the surrounding area shockingly taut. Next, I felt the cold. It tingled and stung at first, then subsided into a tolerable chill, like when you ice a sore muscle. As I lay there for an hour watching CNN, I felt pain only twice: first, when I coughed (I felt like my abdominal muscles were ripping), and second, for the last few minutes, when the weight of the applicator began to pull on my already-stretched-to-the-limit skin. Still, on my personal pain meter, the experience registered lower than a bikini wax or teeth cleaning.

When Kauvar removed the sucker after an hour, the flesh that had been inside it looked and felt like a pink, raw, wrinkled, frozen block of beef—or, as Kauvar described it, "a stick of cold butter." As I stared at it in horror, I reminded myself that, theoretically, this was precisely the hunk of fat I was getting rid of, and I averted my eyes for the second session on my left side. Afterward, as I hobbled to the bathroom in my blue paper robe, I felt a little like I had after giving birth: completely disconnected from my midsection and terrified to touch it. Which made it even odder when I pulled on my skinny J Brand jeans and walked right out onto Fifth Avenue.

Kauvar had told me that I'd experience numbness, tightness, and maybe even some charley-horse-like cramping for two weeks post-treatment. (Indeed, these have been the only reported complications of Zeltiq.) My stomach was numb to the touch for the first couple of days, and I felt deep jolts of pain when pushing through a subway turnstile. Once the numbness wore off, the area felt achy. During the second week, the soreness spiked, and the whole area felt so tight that it burned, especially when my pants pressed against it. I tried to visualize my fat cells shrieking in agony, shriveling, and disintegrating, but it didn't help. Had the procedure gone awry? Was I having some kind of allergic reaction? But on day 14, the date of my first follow-up with Kauvar, the pain vanished. "I've noticed that the less fat in the treated area, the more symptoms there are afterward," she said. "It may be from the pulling of the surrounding tissue." I then confessed that on a trip I'd taken right after my Zeltiq session, my usually mindful diet had taken a nosedive for five days. "Will that cancel out the fat freezing?" I asked. She smiled patiently. "No. If anything, the fat you've eaten has avoided the area." And gone to my butt? My wrists?

Over the next six weeks, I saw and felt a very gradual change. One day I noticed that I didn't have to suck in my abs to close my skirts anymore, and another day when I pulled on some non-stretch jeans right out of the hot dryer, they felt snug around my hips and thighs but didn't cut into my gut. Remarkably, I'd even gained a couple of pounds from not running as often in the brutal last months of winter. But even more striking than the physical changes was the revelation that my psyche felt lighter, trimmer, sexier. A tiny part of me felt like I'd "cheated," and for that reason I had told only my husband, sisters, and best friends what I'd done. But rather than judge, their general response was, "I want to do it. How much does it cost?" This wasn't about achieving a distorted celebrity ideal; my whole body finally jibed with the intensity of my runs and workouts; this is the way it deserved to look.

Which is not to say, of course, that I'd achieved taut-tummy perfection. The day of my three-month follow-up, I took inventory. The skin on either side of my navel was smooth, snug, and flat. The center of my stomach was still soft and easy to grab, but it was no longer a pouch, and I couldn't tell if the slackness was due to leftover fat or loose skin. When I looked in the mirror, I saw slight lines of definition that had been buried before.

At Kauvar's office, she crouched down once again and gently pulled at my skin. "The sides are definitely better," she said, "and if you want, you can do one more application right in the center." You've probably guessed the next question that popped into my head, as I stood there marveling at what was possible: How soon can you fit me in?


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