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| DERMAL REJUVENATION | ARTICLE


are contraindications that the physician should take into account: ■ Acute, untreated cardiovascular disease, uncontrolled blood pressure, and vasovagal episodes


■ Acute respiratory problems ■ Bleeding syndromes, cerebrovascular accident (stroke), acute thrombosis or recent pulmonary embolism


■ Connective tissue disease ■ Skin infection ■ Uncontrolled diabetes ■ Pregnancy and lactation (although no data is available in this regard).


It is also important to note that with carboxytherapy


there is an absence of toxicity and any other relevant side-effects.


Injection techniques and treatment protocols Depending on the type of treatment to be performed, the injection technique will vary. Intradermal injections should be used for dermal rejuvenation, while subcutaneous injections are reserved for lipolytic effects. When injecting for skin rejuvenation, the injection is performed intradermally using a 30 G needle. The injection angle should be maintained at < 150 with bevel border up. Immediately after injection, the CO2


gas diffuses into the


needle-surrounding tissue. The clinical endpoint of each injection is at the occurrence of an erythema and distension of the injected tissue. The flow of the CO2


gas has to be


following injection, an erythema will occur around the treated area and the upper eyelid will inflate (Figures 4 and 5). However, no post-treatment care is necessary, and the appearance of the eyes after the prescribed number of sessions is greatly improved (Figure 5).


Facial fat pads To treat mild under-eye fatpads, a mixture of subcutaneous and intradermal injections should be used. Subcutaneous injections alone should be used for mental fat pads. Indications for the use of carboxytherapy in the submental area include skin laxity, prejowl sulcus, an undefined jawline, and a mild fat pad under the chin. Techniques and results are shown in Figures 6–8.


Dermal rejuvenation Carboxytherapy can be used to rejuvenate the skin on the face, décolletage, neck and hands, and improves rhytides, withered skin, fine wrinkling, lost tissue luminosity and skin laxity. Using a 30 G needle, flow should be up to 80 cc/min, with intradermal injections spaced out by 1–2 cm. Patients will generally receive between four and eight treatment sessions every 3–4 weeks. Clinical results are shown in Figure 9.


Carbon dioxide


therapy can be used to rejuvenate the skin on the face, décolletage, neck and hands, and improves rhytides, withered skin, fine wrinkling, lost tissue luminosity and skin laxity.


adjusted individually. For subcutaneous injections, the injection will be into the subcutaneous structures; the injection angle should be 30–450, using a 30 G needle. The same clinical endpoints will determine each injection. The gas should be cold for fat pad treatment, as it seems to be more effective (although the author was unable to find any evidence in the literature to support this).


Periorbital area When used in the periorbital area, carboxytherapy can treat rhytides, dark circles, vascular pooling, tissue luminosity, skin laxity, and mild fatty prolapse. Dark circles and wrinkles should be treated with intradermal injections, while mild fat pads should have a mix of intradermal and subcutaneous injections. Flow should be up to 40–60 cc/min, with warm gas and using a 30 G needle. Generally, patients will receive four to eight sessions, with one session every 2–4 weeks. The technique and typical injection points are shown in Figure 3. Injections are usually painless, so anaesthesia is rarely used, but the patient will feel a warm sensation on injection (vasodilation). Between 5 and 10 minutes


Figure 9 Skin rejuvenation on the neck, before (A) and after (B) eight treatment sessions (using RioBlush)


prime-journal.com | January/February 2012





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