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| DERMAL REJUVENATION | ARTICLE


100 80 60 40 20 00


blood


Without CO2


in the


With CO2 the blood


in


Figure 1 The Bohr’s effect. Oxygen levels in the tissue increase oxygenisation (adapted from Albergati et al7


)


Acidosis


Vasodilation for increased


5 10 Partial pressure of oxygen/kPa and for its anti-infective properties, and interest was


reignited during the 1930s to treat organic and functional arteriopathies4


. The term ‘carboxytherapy’ to describe


the treatment was introduced over 60 years later, in 1995, by Luigi Parassoni during the XVI National Meeting of Esthetical Medicine in Rome5


. These days, the use of


carboxytherapy, particularly in aesthetic and anti-ageing medicine, is now a lot more prevalent and increasing in popularity, particularly throughout Europe. A range of different devices are available with which to administer treatment, but essentially the physician will need a device which meets CE and ISO standards, and has filters to avoid contamination, allows for flow regulation, has a pressure regulator, and administers heated gas in order to reduce pain. In carboxytherapy, carbon dioxide is introduced to the


patient’s skin. An excess of carbon dioxide in the injected tissue (hypercapnia) provides the stimulus in the oxygen requirement hypothesis6


. Approximately 70% of carbon


dioxide in the body reacts with plasmatic water to form carbonic acid:


CO2 + H2 H+ O = H2 + HCO3 - CO3


And ultimately reacting to leave bicarbonate dissolved in the blood plasma:


Figure 3 Technique when treating the periorbital area — typical injection points


15


Figure 2 The effects of carbon dioxide (NB. there are far more modes of action than those mentioned here)


microcirculation


Release of growth factors for angiogenesis


These reactions cause the pH of the blood to decrease


and a release of oxygen to bodily tissue, increasing capillary blood flow. This, in turn, promotes Bohr’s effect (the oxyhaemoglobin dissociation curve) (Figure 1), which explains how readily haemoglobin acquires and releases oxygen molecules into the fluid that surrounds it. An increased concentration in carbon dioxide leads to a lower binding affinity of oxygen and haemoglobin7 Furthermore, the release of growth factors takes places,


.


such as local angiogenic growth factors (Figure 2), which induce circulation, encourage lipolysis, and encourage dermal regeneration, for example.


Increased circulation The overriding point to consider pertaining to increased circulation in carboxytherapy is that hypercapnia improves tissue oxygenation8


. When applied topically (e.g. as CO2 water bathing), the increase in carbon dioxide


concentration within the tissue and peripheral blood vessels causes precapillary arterioles to dilate, ultimately increasing blood flow to the skin9


. Hypercapnia further


lowers the resistance of the arteries in the skin and muscles, which dilate on account of the decline in pH. This takes place even with carbon dioxide administration into the skin10


. Curri and Bombardelli11 reported the


verification of this increased vasodilation in the arterioles and metarterioles, as well as the increased vasomotion, using optic video capillaroscopy. The


prime-journal.com | January/February 2012





45


% saturation of haemoglobin with oxygen


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