Non-invasive fat reduction is a growing market and particularly popular among those with areas of stubborn fat, as well those reluctant to go under the scalpel. Revenues for non-invasive fat reduction procedures are expected to grow 40% annually until 2016 and one research group has even predicted the market to grow faster than that of more traditional fat reduction procedures, such as liposuction. One man hoping to benefit from the growth of this market is Mark Foley, CEO of ZELTIQ.

ZELTIQ is the company behind the CoolSculpting non-invasive fat reduction system. CoolSculpting uses a cooling process known as cryolipolysis to break down fat cells in the body. The process was discovered by dermatologists Dieter Manstein and R. Rox Anderson of the Wellman Center at Massachusetts General Hospital, Boston, a teaching affiliate of the Harvard Medical School. They discovered that under carefully controlled conditions, subcutaneous fat cells were naturally more vulnerable to the effects of cold than  the surrounding tissue. This is, as Mark explains, owing to the higher lipid content in fat, which is very sensitive to cold. Through this they discovered that prolonged, controlled local tissue cooling could induce selective fat cell reduction and subsequent loss of subcutaneous fat, without damaging the overlying skin. They called this discovery ‘selective cryolipolysis’ and it led to the patented technology behind the CoolSculpting system.

Mark believes there are three key factors that set CoolSculpting apart from other non-invasive fat reduction systems in the market. These are:

  • How CoolSculpting breaks down fat
  • The cooling technology
  • The duration of each treatment.


‘We’re the only company that uses cooling technology. All of the other companies use heat, whether that is laser, RF or ultrasound,’  Mark explains.

The use of cooling instead of heat determines what happens to the targeted fat cells.

‘One of the main differences is cooling selectively focuses on the fat cells. The heat-based technologies will end up with collateral damage. They acutely disrupt the cell, the contents of the cell is dumped into the surrounding tissue, it creates a more inflammatory response and the heat can affect the surrounding tissue,’  he continues.

‘In comparison, with cooling, the fat cells are broken down in a natural process known as apoptosis. The patient’s body recognises the cells have died and removes the fat in a natural way, just as they would the fat from food.

‘In 6 to 8 weeks the fat cells that were impacted by the cold will be removed and these fat cells will not regenerate.’


The use of cooling as opposed to heat has a significant impact on the amount of pain and discomfort the patient experiences during treatment.

‘The heat-based technologies have a trade‑off. If they are going to get consistent efficacy they have to deliver a certain amount of heat to the tissue, which will inevitably lead to an increase in pain for the patient.

‘By using CoolSculpting the patient experiences very little discomfort and we think that is a really important feature in driving adoption in the non-invasive fat reduction space,’ he explains.


Mark points out that with the heat-based devices, a physician or nurse is required to move the probe around the patient in order to deliver heat to the targeted tissue. However, with CoolSculpting, once the applicator is attached and the machine is turned on, there is no need for anyone to supervise for the duration of the treatment. The physician or nurse is free to continue with other treatments to the patient.

Treatment to Transformation

CoolSculpting has evolved from its beginnings as a short-cycle treatment for specific areas of the body and can now achieve transformative results comparable to more invasive procedures. This has been possible through changes in the way physicians are using the device on patients.

‘From doing two or three cycles in the mid‑section they are now doing 10 to 12 cycles and the results are dramatic,’ he says. ‘Now patients are getting liposuction-like results either from more treatments in areas next to one another, or multiple treatments in the same area over time.’

Treatment to Transformation is a physician-driven initiative that has been adopted by ZELTIQ to help physicians use CoolSculpting to its full potential and get the transformative liposuction-like results patients are looking for. Patients are assessed on what sort of outcome can be delivered and a practice plan is put together, with the physician recommending the total number of cycles the patient would need in order to achieve the desired results.


Mark has worked for a number of medical device companies throughout his career and it was with his experience in this market he was able to identify a great opportunity for growth at ZELTIQ. He began as an outside board member before taking a number of roles within the company, finally becoming President and CEO in August 2012. He identifies three factors that drew him to ZELTIQ and convinced him to take the CEO role. These were:

  • The technology: ‘I thought it was such a unique and novel way to remove fat cells. It came from great scientific pedigree, it worked, and it just really made sense to me’
  • The market opportunity: ‘I felt the ability to help patients lose fat non‑invasively and without pain was enormous. Look at the time and money people spend going to the gym or dieting, you can see it is a really large market opportunity’
  • The self-pay model: ‘A technology that is coming onto the market with a self‑pay model is increasingly appealing.’


During his time at ZELTIQ, Mark has been able to identify key factors he credits for the ongoing success of the company. The first and perhaps most important is the lengthy scientific work undertaken by the company before the device was launched.

‘It’s a space where there’s a lot of promise and not a lot of delivery,’ said Mark. ‘The scientific and rigorous clinical work done by ZELTIQ was one of the significant goals achieved by this company. So as this market evolves we can establish a leading position because we know this technology works.’

ZELTIQ has also recently brought experienced aesthetic leadership into the company, which has bolstered the senior team and enhanced the reputation of the company. Mark believes the company will benefit from the many years of aesthetic industry experience now present in the management team, and the willingness of industry veterans to join ZELTIQ is a clear sign that people believe in the device.

These new appointments were made during a time of large-scale restructuring across the management, sales, and marketing teams. This extensive reshuffle has allowed the company to improve its execution and can be attributed as a key driver in the company’s growth.


The restructuring of senior teams in the company can now be seen as one of the key successes under Mark’s leadership as CEO, but it began as his biggest challenge.

Mark believed ZELTIQ had failed to deliver on some of their growth initiatives as a public company and the emergence of competitor devices had increased market confusion. However, Mark and the rest of the team still believed they had the right product in the early stages of a new and growing market of non-invasive fat reduction. With the right product in a growing market, it was clear that changes had to be made to the structure of the company in order to realise CoolSculpting’s full potential.

‘We had to evolve our process from when we were the only company in the market and improve our execution. We restructured and brought in new leadership with more aesthetic experience. It’s a natural evolution that a company goes through from an early growth phase to a more competitive environment,’ he explains.

‘It has been challenging but I think the changes we have gone through are enabling us to maintain and grow our leadership in this space.’

The future

Mark won’t have much time to toast his successes just yet as ZELTIQ continue to implement their plans for growth. Central to this growth is listening to physicians and creating a more flexible, user‑friendly device.

‘Through learning of the limitations of our products, based on feedback, we’ve increased the versatility of the product by adding new applicators and creating a device that physicians want.’

Mark fully understands creating a device physicians want is of little use if the physicians themselves cannot market the device to their patients. That is why ZELTIQ launched its ‘Co-op Advertising Programme’, which he hopes will continue to deliver the CoolSculpting message to patients through shared advertising campaigns by ZELTIQ and physician practices.

By the end of our conversation I felt that Mark was truly looking forward to driving the company forward, and to continue to capitalise on the unique position CoolSculpting holds in this growing market.