Laura Pietrzak has performed more CoolScultping aesthetic treatments than anyone else in the world. This presentation to the American Society of Aesthetic Plastic Surgeons describes her CoolSculpting patient success stories which led to her development of the new Treatment to Transformation protocol for CoolSculpting globally.

1. Treatment to Transformation
Assessment and Treatment Techniques
To Optimize Patient Satisfaction from
Cryolipolysis
Laura K. Pietrzak, MSHS, PA-C
Manager, The Institute at Marina Plastic Surgery
Marina del Rey, California

2. Disclosures
• Laura Pietrzak is an investigator for ZELTIQ
research studies

3. Off-Label Treatments
• In the US, CoolSculpting is cleared for non-invasive
fat reduction on the flank and
abdomen.
• This presentation contains off-label
treatments to additional areas.

4. "With our new comprehensive and customized patient treatment plans, our patients
have been ecstatic with their CoolSculpting results. In the last 3 years, our practice has
seen a dramatic increase in patients requesting non-surgical body contouring, many of
which are men. In my opinion, CoolSculpting should be a part of every plastic
surgeon's practice"
- Grant Stevens, M.D., F.A.C.S., Marina Plastic Surgery Associates
THE SCIENCE AND ART OF
COOLSCULPTING

5. The SCIENCE of Cryolipolysis for Fat
Elimination

6. Cryolipolysis
Developed from breakthrough research from Dieter Manstein, MD, PhD
and R. Rox Anderson, MD at Massachusetts General Hospital
• Derived from two case reports
– 1970 - Popsicle panniculitis1
– 1980 - Equestrian cold panniculitis2
• Key findings
– Fat cells are more susceptible to cold than
Skin, Nerve, Muscle
– Possible to trigger (apoptosis) natural cell
death by delivering cooling through the skin
surface
1. Epstein EH, Jr., Oren ME. Popsicle panniculitis. N Engl J Med 1970;282(17):966–967.
2. Beacham BE, Cooper PH, Buchanan CS, Weary PE. Equestrian cold panniculitis in women. Arch
Dermatol 1980;116(9):1025–1027.

7. Proven Evidence of Fat Layer Reduction1
Ultrasound
Pre-treatment and 3-month post-treatment
images of subcutaneous
fat showed 0.7 cm or >40%
decrease in thickness of fat layer
occurred over a 90-day period
Gross Pathology
Gross pathology from the same
treatment site showed superficial
fat layer at the center of treatment
site reduced 1 cm or 50% at 90
days post-treatment compared to
untreated region
Skin
Fat layer
Fascia
1.6 cm
0.9 cm
1.2 cm
1.3 cm
Pre-Treat 3 Months Post-Treat
Pre-treatment 3 months post-treatment
1 Zelickson, et al., Cryolipolysis™ for Noninvasive Adipocyte Cell Death: Initial Results from a Pig Model, Derm Surg, 35: 10: 1462 – 1470 10/09

8. The CoolSculpting System

9. The CoolSculpting Applicator
Treated Area
Vacuum
Applicator
Cooling Panel with
Freeze-Detect
TechnologyTM
Uniform
Treatment
Natural
Feathering
• Each cooling cycle is 60 minutes
• The applicator contains 2 opposing cooling
panels that perform a precise energy extraction
(cold) optimized to injure only adipocytes

10. Post-Treatment Massage
Pre-Procedure 2 Month Follow-Up
Non-massage Massage Non-massage Massage
• On average, at two months post-treatment, the fat layer reduction was 68%
greater in the massaged side than in the non-massaged side
Boey et al. Effect of Post-Treatment Manual Massage on Efficacy Following a
Cryolipolysis Procedure. Presented at 2012 ASLMS Conference.
Subject BOEYMAS008

11. Evidence of Long-Term Efficacy with
CoolSculpting
8 WEEKS AFTER
(Single side treatment)
2 YEARS AFTER
(Single side treatment)
(+10 pounds)
Procedure by Eric Bernstein, MD
BEFORE
2X

12. Evidence of Long-Term Efficacy with
5 YEARS AFTER
(Single side treatment )
(-10 pounds)
BEFORE
CoolSculpting

13. Clinical Publications
• More than 30 published
clinical papers and
abstracts
• Findings conclude:
• No rise above normal levels
for triglycerides or cholesterol
• Histologic evidence shows skin &
surrounding structures are safe
• MD observable reduction in
80% of subjects
• Overall patient satisfaction
from self-assessment
“Cryolipolysis is a very low risk, no downtime procedure
that produces consistent observations of modest, gradual
fat layer reduction in properly selected patients.”
A.J. Burns, et al, abstract accepted for 2010 ASLMS: Analysis of Side Effects of
Noninvasive Cryolipolysis for Subcutaneous Fat Layer Reduction – Interim Report
from Controlled Clinical Trials

14. Clinical Publications
• Largest cryolipolysis study published to date, presenting a retrospective
review of 528 patients.
August 2013

15. CoolSculpting Safety Mechanisms
Thermal Coupling Gel Pad
• Unique patented formula
• Applied to the skin surface before placement
of applicator
• Ensures consistent thermal contact
• Insulates skin during treatment
Freeze DetectTM Sensors and Software
• Patented technology detects changes in skin
temperature
• If freeze is detected, treatment stops
immediately
Thermal Coupling Gel Pad
Freeze DetectTM Sensors

16. The ART of Treatment to
Transformation

17. Reflecting on the Approach with Fillers Today
• With experience, physicians have changed the approach with fillers
– One syringe does not equal full correction
– Full correction can take 3+ syringes
vs.
Old Method New Method

18. Transformation Through
Customized CoolSculpting® Treatments
• Wide range of CoolSculpting® applicators available
• Applicators are essential tools for customized body sculpting

19. Where We’ve Been:
Localized Bulge Reductions
• Excellent results following our
original protocols
• Single treatment in as little as one
hour
• Diet and exercise-resistant fat
• Well defined fat bulges with
borders
• Treat at the peak of the bulge
8 Weeks After CoolSculpting
Procedure by Madeline Krauss, MD
Before
12 Weeks After CoolSculpting
Procedure by Edward Becker, MD
(No weight change)
Before

20. Effective Treatment of Discrete Bulges
BEFORE FOUR MONTHS AFTER
Procedure by Laura K. Pietrzak, PA-C

21. Effective Treatment of Discrete Bulges
BEFORE THREE MONTHS AFTER
Procedure by Laura K. Pietrzak, PA-C

22. Treatment to Transformation
• Global body assessment of all potential treatment
areas
• Customized treatment plan based on individual
patient’s shapes, needs, and goals
• Set expectations upfront for follow-up visit to re-assess,
re-plan and re-treat

23. Treatment to Transformation (T2T)
T2T is an advanced concept that allows our practices to successfully
treat patients that they may have previously turned away
• What is Treatment to Transformation?
– An advanced treatment plan focusing on enhancing CoolSculpting® outcomes
– A global approach to assessing the body; addressing all potential treatment areas
– Prescribing a sufficient number of hours in a given treatment area to achieve
desired results
– Re-assessing, re-planning, and re-treating
• Why is it important?
– It leads to more pleasing outcomes
– It’s likely to create the “wow” factor
– It results in greater patient satisfaction and word-of-mouth referrals
T2T Treatment
Plan Example

24. Treatment to Transformation (T2T)
Treatment to Transformation (T2T) is an advanced
CoolSculpting® concept
• What are the risks of under-treatment?
– Can lead patients to believe that the treatment did not meet expectations
– Increased chance of demarcation or step off
– Non-cosmetically pleasing outcomes that require correction

25. Example of Under-Treatment
Better Treatment
Plan
Applicator placed too low
Actual Treatment
Plan
Key Takeaways:
1. Under treated
2. Highlights importance of accurate
applicator placement

26. Example of Under-Treatment
Optimized Treatment Plan
Anterior
Optimized Treatment Plan
Posterior
Actual Treatment Plan

27. Treatment to Transformation (T2T):
Patient Assessment Techniques

28. Treatment to Transformation (T2T):
Patient Assessment Techniques

29. Treatment to Transformation (T2T):
Patient Assessment Techniques

30. Tools for Success
• With CoolSculpting, you can debulk and sculpt the
body
Debulk Sculpt

31. T2T Patient Assessment

32. Debulking and Sculpting:
Creating Beautiful Outcomes
BEFORE
FIRST TREATMENT SECOND TREATMENT
8 WEEKS AFTER
First CoolSculpting Treatment
9 WEEKS AFTER
Second CoolSculpting Treatment
Procedure by Edward Becker, MD
(No weight change)

33. Debulking and Sculpting:
Creating Beautiful Outcomes
ANTERIOR TREATMENT
4 MONTHS AFTER
Procedure by John B. Fasano, MD
(No weight change)
BEFORE
POSTERIOR TREATMENT

34. Debulking and Sculpting:
Creating Beautiful Outcomes
ANTERIOR TREATMENT
4 MONTHS AFTER
Procedure by John B. Fasano, MD
(No weight change)
BEFORE
POSTERIOR TREATMENT

35. Debulking and Sculpting:
Creating Beautiful Outcomes
3 MONTHS AFTER
Procedure by Laura K. Pietrzak, PA-C
(-4 pounds)
BEFORE
FIRST TREATMENT SECOND TREATMENT

36. Treatment to Transformation (T2T):
1 Year After
First CoolSculpting® Treatment
(No weight change)
2 Years After
Second CoolSculpting® Treatment
(No weight change)
Procedure by Laura K. Pietrzak, PA-C
FIRST TREATMENT SECOND TREATMENT
Before
Multiple Treatments in the Same Area

37. CoolSculpting the Abdomen and Flanks
FIRST TREATMENT SECOND TREATMENT
FOUR MONTHS
Procedure by Laura K. Pietrzak, PA-C
BEFORE TWO MONTHS

38. CoolSculpting the Abdomen and Flanks
FIRST TREATMENT SECOND TREATMENT
FOUR MONTHS
Procedure by Laura K. Pietrzak, PA-C
BEFORE TWO MONTHS

39. CoolSculpting the Abdomen
FIVE MONTHS
Procedure by Laura K. Pietrzak, PA-C
BEFORE

40. CoolSculpting the Abdomen and Flanks
TWO MONTHS
Procedure by Laura K. Pietrzak, PA-C
BEFORE

41. CoolSculpting the Abdomen and Flanks
BEFORE
THREE MONTHS
Procedure by
Laura K. Pietrzak, PA-C
ANTERIOR TREATMENT POSTERIOR TREATMENT

42. CoolSculpting the Back
THREE MONTHS
Procedure by Laura K. Pietrzak, PA-C
BEFORE

43. CoolSculpting the Chest
TWO MONTHS
Procedure by Laura K. Pietrzak, PA-C
BEFORE

44. CoolSculpting the Arms
FOUR MONTHS
Procedure by Laura K. Pietrzak, PA-C
BEFORE TWO MONTHS
FIRST TREATMENT SECOND TREATMENT

45. CoolSculpting the Buttocks
FOUR MONTHS
Procedure by Laura K. Pietrzak, PA-C
BEFORE

46. CoolSculpting the Inner Thighs
TWO MONTHS
Procedure by Laura K. Pietrzak, PA-C
BEFORE

47. CoolSculpting the Inner Thighs
TWO MONTHS
Procedure by Laura K. Pietrzak, PA-C
BEFORE

48. CoolSculpting the Outer Thighs
BEFORE
FOUR MONTHS
Procedure by
Laura K. Pietrzak, PA-C
Unilateral treatment

49. CoolSculpting the Legs
FOUR MONTHS
Procedure by Laura K. Pietrzak, PA-C
BEFORE

50. CoolSculpting Formula for Success
• Assess the whole body globally
• Look at the body through the eyes of a surgeon
• Review expectations and timing of results
• Ensure proper placement of the applicator
• Be sure to take consistent before / after photos
• Post-treatment massage to enhance outcomes
• Schedule a 4-8 week follow-up to reassess and establish
retreatment protocol
• Have a well trained CoolSculpting® team
– Treat yourself and your staff as part of training
– Staff enthusiasm – “walking CoolSculpting billboards”
– Staff will want to share success stories and personal results!

51. DualSculptingTM
• Patients can take advantage of shorter treatment times
• It increases profit potential per hour
• Opportunity for complementary services during treatment

52. Summary
• Tremendous business growth opportunity
• Backed by science
• Proven clinical efficacy
• Technique matters!
• Treatment to Transformation achieves non-surgical
body contouring results that rival
liposuction

53. The Marina Plastic Surgery Team