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| DERMAL REJUVENATION | ARTICLE


Figure 1 It is important to identify some landmarks in order to analyse the areas to treat. (A) Anterior view: red line = inguinal ligament; blue line = line from mid-inguinal ligament to knee; yellow line = anterior mid-thigh line. Area a = superoexternal thigh; area b = superointernal thigh; area c = inferoexternal thigh (external knee area); area d = inferointernal thigh (internal knee area). (B) Posterior view: red line = contour of buttock; orange line = contour of hip; green line = contour of trochanter; blue line = line from buttock fold to popliteal; yellow line = posterior mid-thigh line. Area e = hip adipocity area; area f = buttock area (muscle area); area g = trochanter adipocity area; area h = external superior thigh; area i = internal superior thigh; area m = inferior external thigh (external popliteal area); area n = inferointernal thigh (interior popliteal area)


Why CO2 CO2


therapy? is one of the basic elements in the biological


processes of plants and animals. It derives from the combustion of organic compounds in the presence of sufficient oxygen to complete the oxidation process. It is a colourless, odourless, inert, inflammable, and inactive gas, which is only toxic in elevated concentrations. At 0  C, CO2


has a density of 1527 g/cm3 1977 kg/m3 and its mass is in normal pressure and temperature


conditions. It liquefies at a critical pressure of 73 825 bar and at the critical temperature of 31.06  C. Savin et al 5


in 1995, and Hartmann et al 6,7 in 1997, carried


out experimental studies to verify the modifications induced by CO2


the skin. They demonstrated the beneficial effects of transcutaneous CO2


pharmacological properties of C02


in patients suffering from peripheral arteriopathies. Furthermore, Brandi et al demonstrated the in


plastic surgery and aesthetic medicine. As histological data showed the favourable effects of CO2


on collagenous fibre


networks and major vascular and nervous structures, it became justified to use this technique in the treatment of localised fat and Ô fat-linkedÕ skin irregularities 8


, or as an


ancillary procedure following superficial liposuction 9


. In 2010, Lee 10


applications of CO2 wound treatment 12


also described. confirmed


the biological processes of plants and animals. It derives from the combustion


CO2


of organic compounds in the presence of sufficient oxygen to complete the oxidation process.


BrandiÕs results in a cohort of 101 patients with the same characteristics undergoing CO2


therapy in lipomatosis 11 , and vascular acrosyndromes 13,14


treatment. Possible , chronic were


treatment on both microcirculation and administration on microcirculation


Figure 2 Vector of CO2


infiltrations


Summarising, the effects of transcutaneous and subcutaneous administration of CO2


are:


■ Active arteriolar vasodilatation ■ Neoangiogenesis ■ Artificial Bohr effect ■ Lipolytic and lipoclasic effect. These properties can be applied to the treatment of:


■ Peripheral arteriopathies and vascular acrosyndromes


■ Local adiposities and skin irregularities ■ Improving aesthetic outcomes after liposuction ■ Chronic wounds.


In 2011, Balik et al investigated the effects of CO2 therapy with breathable air in an animal model.


Why just CO2


Results showed how the differences obtained in terms of lipolytic effect and the microcircular modifications were not statistically significant 15


. is one of the basic elements in


Significant data has been obtained using different gases in experimental models, but they do not contraindicate the use of CO2


therapy. However, BalikÕs model had some bias. transcutaneous oxygen pressure (tcPO2


It was not built using a clearly described gas administration technique and protocol. Secondly, the researchers did not test the association between ) and laser


Doppler flow because it is not easily applicable to the model used 16


was not discussed and this is a key point to consider in the treatment of humans 16


prime-journal.com | March 2013 ❚


. Furthermore, the absence of toxicity of CO2 .


73 ?


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