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What to know before coolsculpting

CoolSculpting is a revolutionary, non-invasive procedure that uses controlled cooling to eliminate stubborn fat. The treatment is the only FDA-cleared fat-freezing procedure, and it works by gently cooling the targeted fat cells to induce a targeted form of injury called apoptosis. This causes the fat cells to die, but leaves the skin unharmed.

Unlike traditional liposuction or other invasive methods, CoolSculpting targets and eliminates only the fat cells you want to get rid of. The treated area can be seen immediately with a well-defined edge where the cooling has taken place. As a result, you see smoother skin almost immediately. The number of treatments necessary varies from person to person and depends on your goals, but typically ranges from four to six sessions spaced one month apart for optimal results.

You may find it hard to access the right information on the internet, so we are here to help you in the following article, providing the best and updated information on What to know before coolsculpting, chemical peel at home for hyperpigmentation. Read on to learn more. We at cosmeticsurgerytips have all the information that you need about at home chemical peel vs professional. Read on to learn more.

What to know before coolsculpting

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In-office cosmetic treatments can be a touchy subject. Some view them as essential acts of self-care, others see these procedures as intrinsically linked to achieving unrealistic beauty standards. No matter how you feel, noninvasive treatments like Botox, fillers, lasers, and body-contouring devices are undeniably popular right now.

CoolSculpting is one of those treatments. The fat-freezing procedure may sound like futuristic wizardry, but it’s actually been around for more than a decade. The device initially received FDA clearance in 2010 as a nonsurgical fat-reduction treatment for love handles and is now approved to treat belly and bra fat, pockets on the thighs, buttocks, and arms, and even chub under your chin. Basically, anywhere there’s fat, CoolSculpting is there to give it the (very) cold shoulder: It’s the only FDA-cleared, noninvasive fat-freezing device on the market, and according to Harvard Medical School, there have been over eight million treatments performed worldwide.

But lately, the treatment has been in the news for all the wrong reasons. Supermodel Linda Evangelista recently filed a lawsuit against Zeltique Aesthetics Inc., the manufacturer of the CoolSculpting device, because in 2016, the ’90s-era icon developed a condition known as paradoxical adipose hyperplasia (PAH) after having multiple CoolSculpting treatments. (PAH is when the fat in treated areas actually increases, and that fat is a dense, enlarged, and lumpy mass.) It’s a side effect that, while rare, is truly disturbing. Evangelista said she was forced to have two corrective liposuction surgeries, which left her literally scarred.

“This is a devastating situation, and it’s started an important conversation about the risks of all noninvasive procedures,” says Michelle Henry, MD, a board-certified dermatologist in New York. “The possible complications involved are now at the forefront.” It’s a cautionary lesson: Just because something is “cosmetic” or “noninvasive” doesn’t mean it can’t go wrong.

So, let’s get real about CoolSculpting.

How does CoolSculpting work?

CoolSculpting is a device that reduces stubborn pudge in specific areas by freezing fat cells through a biologic process called “cryolipolysis,” which literally means cold (cryo) fat (lipo) destruction (lysis). The extreme cold is able to target the subcutaneous fat layer without damaging surrounding skin because fat freezes at a higher temperature than other tissue. The frozen fat cells then crystallize, and when they start to thaw out (over the next day or two), the fat liquefies and is eliminated through the lymphatic system (you basically pee it out). Traditional fat-removing procedures such as surgical liposuction, laser-assisted liposuction (Smartlipo), or plastic surgery are either minimally invasive or, well, surgery. While they remove fat for good, they involve more downtime, not to mention anesthesia.

CoolSculpting, on the other hand, can legally be administered by an aesthetician at a spa or a salon, but any doctor will tell you that this medical procedure should be done by a board-certified dermatologist or a plastic surgeon to be on the safe side. While it is noninvasive, CoolSculpting isn’t as easy-peasy as getting a facial, so it’s always best to have it done by a medical professional. It ain’t cheap, either: Each treatment will set you back $750 to $1,000 per area, depending on the size of the area being treated.

What happens during a CoolSculpting treatment?

First, a gel pad is placed over the skin to protect it, and then the applicator is vacuum-sealed on top. You sit with this contraption on for at least half an hour. “After the treatment, we massage the area to help break up the crystallized fat cells,” says Ellen Marmur, MD, a board-certified dermatologist in New York. The treatment itself takes 30 to 45 minutes, depending on the size of the area being treated.

“Does it hurt?” you’re asking right about now. “There’s a strange suctioning feeling for the first few minutes, and the area begins to get colder as the device drives that cold temperature to your fat layer,” says Marmur, who’s had the treatment done on herself. “It’s uncomfortable and feels weird, but I wouldn’t call it painful.”

How long does it take to see results?

Most people need two treatments to get optimal results, which is a reduction of about 26 percent of fat, and should start to notice the fat layer shrinking after six to 12 weeks. Those results typically improve for six months post-treatment.

There are some side effects—and risks

“After your treatment, you may feel a slight numbness and tingly sensation to your skin, and a soreness deeper down for about a week or two,” says Marmur. “The skin may also be red, bruised, and swollen. The area can also feel firm, but that hardness should soften up and go away within a couple days. This temporary firmness is due to the fat layer being frozen, and it’s normal.”

The most serious potential side effect to CoolSculpting is what Evangelista unfortunately experienced: PAH, an overgrowth of new fat cells that forms in the localized treatment area—exactly the opposite result you were trying to achieve. It tends to occur eight to 24 weeks after the procedure. To make matters worse, this new fat isn’t like the soft, flabby fat you had removed. It is irregular, bumpy, and dense, and you can actually see a bulging, lumpy mass under the skin.

It’s theorized that PAH may be due to an exaggerated wound-healing response gone wild, but there is no data to prove this yet. “A keloid scar is a good analogy,” says Marmur. “This raised, large, firm scar happens when the body’s healing response goes overboard, and there’s an overgrowth of scar tissue in a localized area. It’s possible that PAH may share a similar mechanism, but we just don’t know.”

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The bottom line: “This complication could happen to anyone after a CoolSculpting procedure, and the risk factors are unknown,” says Bruce Katz, MD, a board-certified dermatologist in New York, who had samples of PAH fat analyzed by a pathologist to see if there was anything unusual about it. “We found out that it was normal fat cells,” he says. “There was just a large proliferation of them in one area.” To date, the medical establishment does not understand how PAH works, why it occurs, and who may be at higher risk for it. “I always tell my patients that even though a side effect is very rare, it is still possible,” says Henry. “I would rather give someone all the information I have so she can make an educated decision than to undersell the risk. Hopefully the situation with Linda Evangelista will bring about active research on PAH, so we can get some answers.”

But know this: PAH is pretty rare

According to published scientific research, paradoxical adipose hyperplasia has been estimated to occur in one out of every 4,000 treatments, for an incidence of 0.025 percent globally. “I’ve done hundreds of CoolSculpting procedures in the past eight or nine years, and I’ve never had an incidence of PAH,” says Henry. But Katz (who chooses not to do CoolSculpting at his office) thinks PAH is underreported and “may be more common than once thought.” He’s successfully treated seven cases of PAH since 2018.

How is PAH treated?

It can usually be successfully corrected with surgical liposuction or minimally invasive laser-assisted lipo. “I have successfully treated seven cases of PAH with Smartlipo, which uses laser energy to heat up and liquefy that dense fat, which is then suctioned out,” says Katz. “The patient experiences swelling for about three days afterward and has to wear a compression garment during that time to keep pressure on the area, but I’ve had excellent results, with no abnormalities or scarring of the skin.” Marmur has had one case of PAH occur after doing hundreds of CoolSculpting treatments in her office since 2012. “I treated her with a one-week course of oral steroids to offset the inflammation, and her PAH went away in about four weeks.”

How to know if CoolSculpting is right for you

The first thing to understand is that this technology is not meant for general weight loss. CoolSculpting works best to spot-treat stubborn problem areas that are hard to exercise away, like a little belly fat or love handles. An ideal candidate is close to her ideal body weight (give or take a couple of pounds), but can pinch an inch or two of fat in a certain spot. (Hello, muffin top.)

Make sure that the doctor administering your treatment has a lot of experience using the device. “I recommend asking the physician how many of these procedures he or she has done, and also ask to see before-and-after photos,” says Katz. In addition to this important advice, don’t neglect to do your homework, and ask your doctor a ton of questions—about side effects, downtime, pain level, everything—during your consultation. This advice goes for any cosmetic procedure you’re thinking about, from fat freezing to lasers or injectables. “We want you to google all the badness, and bring in a long list of questions!” says Henry.

And please, read the consent form. Every doctor will have you sign a medical intake form (with all that info about medications you take and allergies you have) and a consent form for the procedure you are going to have. “This lays out all the potential side effects and risks involved,” says Marmur. “I urge my patients to actually read every sentence, and then ask any and all questions before you sign off. You need to be your own educated advocate.” And if you’re the least bit ambivalent about doing any elective procedure, don’t do it at all, she adds. “Listen to what your sixth sense is telling you. You just may not be ready at this time, and that’s okay.”

Chemical peel at home for hyperpigmentation

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If you’ve ever been hesitant to reach for a chemical exfoliant to help fade unwanted hyperpigmentation, there’s a good reason. “In general, chemical peels are intentionally irritating and not essential to balanced skin, unless indicated otherwise by a board-certified dermatologist for things like acne vulgaris or melasma,” dermatologist Dr. Ellen Marmur tells Elite Daily, adding, “Self-directed treatment is rife with overdoing it.” When needed, the best at-home chemical peels for hyperpigmentation contain a lower concentration of chemical exfoliants to lessen the chance of irritation. “If you’ve ever experienced hyperpigmentation, as I have in my 20s from patches of melasma on my upper lip and face, you want to do anything bionic to remove it,” Dr. Marmur says of her own experience. “But slow and steady is the only way to conquer hyperpigmentation, so be patient,” she advises, while stressing the importance of checking in with your dermatologist before using any at-home chemical exfoliants.

In addition to taking things slow and consulting with a professional, Dr. Marmur advises that it’s best not to exceed a concentration of 5% of the active ingredient in question. “Mandelic acid and tranexamic acid tend to be slow and steady for hyperpigmentation treatment at home, along with proper sun protection and LED green light,” shares Dr. Marmur. She also adds that other AHAs and BHAs, like glycolic acid and salicylic acid, are popular when it comes to at-home chemical treatments for hyperpigmentation.

As for the delivery method, Dr. Marmur confirms that mechanical exfoliants, like scrubs, should be avoided because they can worsen hyperpigmentation. “Liquids and serums applied and massaged into the skin with your fingertips work much better than pads, which increase waste,” she adds. “Never brush, scrub, or rub chemical exfoliants on skin that’s prone to excess pigment because this will backfire and put you back at square one,” she stresses. “Baby your skin, protect it well, and let your derm help you in your journey against hyperpigmentation.”

Keep scrolling to shop five of the best at-home treatments for hyperpigmentation, from serums to cleansers to face masks.

1. Best Tranexamic Acid Serum For Hyperpigmentation

Naturium Tranexamic Topical Acid 5%


Naturium Tranexamic Topical Acid 5%


Tranexamic acid is typically a well-tolerated ingredient when it comes to fading unwanted hyperpigmentation and preventing new dark spots from forming. Naturium’s Tranexamic Topical Acid 5% gives you a potent concentration of the active ingredient, while other effective brightening ingredients like kojic acid, licorice root extract, and niacinamide bolster the acid’s skin-evening effects. This combination makes it one of the best hyperpigmentation treatments you can buy for $20 — while plenty of hydrating ingredients like glycerin, panthenol, and hyaluronic acid prevent it from drying out your skin.

2. Best AHA Serum For Hyperpigmentation

Honest Beauty Resurfacing Serum


Honest Beauty Resurfacing Serum


Honest Beauty’s Resurfacing Serum combines three AHAs to target unwanted hyperpigmentation: Glycolic, lactic, and citric acids. Additional ingredients like hyaluronic acid, glycerin, and aloe leaf juice all work to soothe and hydrate skin, while niacinamide offers double the skin care benefits by helping to treat hyperpigmentation and calm inflammation. At less than $25, it’s a great entry point into the world of chemical exfoliants. For best results, use it at night and don’t forget to apply sunscreen the next morning (as is the case with any AHA product).

3. Best BHA Exfoliant For Hyperpigmentation

Paula’s Choice Skin Perfecting 2% BHA Liquid Exfoliant


Paula's Choice Skin Perfecting 2% BHA Liquid Exfoliant


Among the 40,000-plus five-star ratings on Amazon, you’ll find dozens of reviews that specifically mention how helpful Paula’s Choice Skin Perfecting 2% BHA Liquid Exfoliant is when it comes to treating hyperpigmentation. The tried-and-true formula uses a 2% concentration of salicylic acid to clear out congested pores and exfoliate dead skin cells, while green tea extract soothes and provides antioxidant protection. Because of salicylic acid’s pore-clearing benefits, this is a great choice if your primary skin concerns are hyperpigmentation and acne or blackheads.

Though it doesn’t have nearly as many Amazon reviews, the brand’s Discoloration Repair Serum, which features tranexamic acid, niacinamide, and bakuchiol extract, is another solid pick for treating hyperpigmentation.

4. Best Exfoliating Mask For Hyperpigmentation

Juice Beauty Green Apple Peel Full Strength Exfoliating Mask


Juice Beauty Green Apple Peel Full Strength Exfoliating Mask


If you like to use the occasional skin-pampering mask, Juice Beauty’s Green Apple Peel Full Strength Exfoliating Mask gives you a powerful chemical treatment in just 10 minutes. AHAs in the form of malic, glycolic, and lactic acids combine with the BHA salicylic acid to slough away dead skin cells and even out your skin. Bakuchiol and vitamin C give you more skin-brightening benefits, and aloe leaf juice, grape seed extract, and glycerin help with hydration. Though the mask is formulated with mostly naturally derived ingredients (many of which are organic), it still has the potential to cause irritation. Because of this, the brand suggests doing a patch test on your arm before putting the mask on your face.

5. Best Splurge

Sunday Riley Good Genes Lactic Acid Treatment


Sunday Riley Good Genes Lactic Acid Treatment


This multi-purpose treatment can be used as a leave-on serum morning or night, or as a 15-minute mask that you rinse off if your skin is hyper-sensitive. Sunday Riley’s Good Genes Lactic Acid Treatment is a cult favorite for its ability to improve the clarity and texture of your skin, while still being pretty gentle. In addition to the AHA lactic acid, licorice root extract works to brighten skin and fade unwanted hyperpigmentation, while soothing and hydrating ingredients like squalane, arnica, aloe leaf, and prickly pear keep the formula balanced. It offers both immediate and long-term benefits, and has a lightweight texture that layers under other products beautifully.

You May Also Like

Dermalogica Daily Glycolic Cleanser


Dermalogica Daily Glycolic Cleanser


Though not exactly a peel, a cleanser with chemical exfoliants, like Dermalogica’s Daily Glycolic Cleanser, is a great place to start because the active ingredient gets rinsed right off (as opposed to treatments and serums that are left on and therefore pose a higher risk of irritation). This cleanser uses glycolic acid to exfoliate away dead skin cells, the buildup of which can contribute to hyperpigmentation. You’ll also find jojoba seed oil, hyaluronic acid, glycerin, calendula, and allantoin in here to help condition skin and calm any signs of irritation.

At home chemical peel vs professional

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Dullness. Dark spots. Acne scars. Fine lines and wrinkles. What do all of these skin concerns have in common? They can be treated with medical-grade chemical peels. Depending on your aesthetic goals and needs, chemical peels are available in an array of potencies and have the ability to resurface the skin for more even tone and texture. For those looking to achieve glow-inducing results at-home, less concentrated chemical exfoliators can slough away dead skin cells for a more radiant complexion. Here, we’re breaking down everything you need to know about in-office chemical peels and at-home chemical exfoliators.

What Is a Chemical Peel?

Professional chemical peels employ chemical solutions of varying strengths to target and remove the outer layers of the skin. “The benefits of a medical-grade chemical peel are endless,” says Lizette Ludwig, RN, an aesthetic nurse and injector in southern California. As she explains, they are a good option for anyone looking to address skin imperfections. “Chemical peels allow you to remove dead skin cells and address fine lines, hyperpigmentation, and uneven skin tone in a safe and effective way,” she shares.

Professional chemical peels can be broken down into three categories:

  1. Superficial chemical peels
  2. Medium chemical peels
  3. Deep chemical peels

These classifications are based on the potency of the peels and the ingredients used in the chemical solution. “Ingredients found in medical-grade peels usually include alpha hydroxy acids (lactic acid and glycolic acid), beta hydroxy acids (salicylic acid), trichloroacetic acid (TCA), and phenol,” Ludwig says. Below is an overview of each:


The lightest and gentlest of the group, superficial chemical peels remove the epidermis (i.e. top layer of the skin) and are generally tolerated by most skin tones. “These peels are usually made from alpha hydroxy or beta hydroxy acids, but they can also include enzymes or other natural exfoliating ingredients,” Ludwig notes. Because they focus on the epidermis, superficial peels provide a slight improvement to the skin and usually require a series of treatments for best results. Some mild dryness and flaking are a part of the healing process and can last for three to five days.


Falling in the middle of the scale, medium-depth chemical peels produce a more dramatic result in a single treatment than light peels. “Skin will be significantly smoother with an even tone and blemishes removed,” Ludwig says. This type of peel usually contains trichloroacetic acid (TCA) to penetrate the skin and remove layers below the epidermis. Peeling, redness, and swelling are all to be expected post-peel and can last three to 10 days.


Needless to say, deep chemical peels are the strongest and most invasive. They usually involve a potent formulation of TCA or phenol that can penetrate the deep layer of the dermis. As Ludwig shares, the depth allows them to produce “drastically smoother” and “youthful-looking” skin. “Deep peels can achieve amazing results for sun damage, scarring, and wrinkles,” she says. Due to their strength, however, deep peels can be painful and healing requires patience. Several weeks of downtime is needed, and full recovery could take weeks or months.

Professional Chemical Peel Treatments

Medical-grade chemical peels involve the application of a chemical solution to the face and (possibly) neck. The chemical solution is either applied lightly or rubbed more vigorously onto the skin using a gauze pad. During the application, you may experience a slight tingling (superficial to medium peels) or burning (deep peels). “I like to give my clients a mini fan which helps the tingling or burning sensation,” Ludwig shares. With certain types of chemical peels, the solution may need to be ‘neutralized’ after the appropriate time has elapsed, though most chemicals neutralize on their own.

Regardless of what strength peel you choose, patients are usually sent home with post-care instructions. “Make sure to discuss with your provider how to care for your skin after the peel,” Ludwig says. Even for the lightest peel, you’ll likely need to make changes to your skincare routine for a few days pre- and post-treatment. If you’re planning on a medium or deep peel, antiviral medication may be prescribed beforehand.


Professional chemical peels are meant to be performed in a doctor’s office or a medical spa by a licensed skincare professional. As we’ve reported, the DIY dermatology trend that’s fueled by social media and social distancing had led some to try medical-grade treatments (like TCA peels) at home with dangerous and damaging results. “Beware of chemical solutions sold online, as they are usually sold illegally and can cause permanent damage to your skin,” Ludwig warns. “Chemical peels should be applied by a licensed professional.”

Professional Chemical Peels vs. At-Home Chemical Exfoliators

The main difference between a superficial in-office peel and chemical exfoliators or treatments you can find at, say Sephora, is that at-home solutions do not provide the same chemical concentration as their professional counterparts. While similar active ingredients may be found in both versions, the potency is quite different. As Ludwig explains, at-home percentages of glycolic acid, for example, max out around 10 percent, while medical-grade glycolic acids (applied by a professional) can reach as high as 70 percent.

At-Home Chemical Exfoliators

If you’re dealing with mild cases of uneven skin tone and texture or wish to maintain your complexion in between in-office appointments, at-home chemical exfoliators and enzyme treatments can impart a subtle and sustained glow with regular use.

When it comes to choosing a treatment, Ludwig suggests reading the label closely. “I recommend looking for brightening ingredients like AHAs, BHAs, vitamin C, and active enzymes such as pumpkin, papaya, and pineapple,” she explains. “Every ingredient serves a purpose, so do your homework when it comes to the ingredient list.”


While your skin likely won’t peel or flake the way it will after a professional treatment, irritation is possible with at-home exfoliating products. “Read all instructions carefully when it comes to at-home peels,” Ludwig cautions. “Most will ask you to wash it off after 10 to 15 minutes of application and gradually build up to leaving it on overnight.”

Another way to ensure your skin ends up radiant, not ruddy? “I recommend skipping out on ingredients like retinol and other active serums on days you choose to exfoliate at home,” Ludwig shares. She suggests exfoliating one to two times per week and alternating days with any actives already in your routine. “Less is more, in my opinion,” she says. “Over-exfoliating can disrupt our skin’s microbiome.”

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