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Figure 10 Clinical results when treating stretch marks on dark/ pigmented skin; (A) before treatment and (B) after eight sessions


Stretch marks


When treating stretch marks with carboxytherapy, it is better to perform the technique on old, white depressed marks rather than young, red stretch marks. Also, deep striae are better than thin striae. Contraindications for this treatment protocol are infection, pregnancy and anti-coagulation. Treatment should combine intradermal and subcutaneous injections using warm gas and a 30 G needle. The flow should be up to 80–150 cc/min. More often than not, the patient will not necessarily experience any pain with this treatment as the stretchmarks already represent ruptured tissue; this means that the gas can diffuse more easily and is therefore less painful. Results are usually seen between four and 10 sessions, and should be maintained with two to three sessions per year. After injection, patients may experience the popcorn effect, erythema and a warm sensation, but clinical results are excellent (Figure 10). It is necessary to explain the typical popcorn effect: this shows up only in the treatment of stretchmarks and relates to the fact that the ruptured tissue of the stretchmarks allows the gas diffuse far more easily, with the CO2


‘popping’ the skin up. This References


1. Brandi C, D’Aniello C, Grimaldi L et al. Carbon dioxide therapy in the treatment of localized adiposities: clinical study and histopathological correlations. Aesthetic Plast Surg 2001; 25(3): 170–4


2. Campos V, Bloch L, Cordeiro T. Carboxytherapy for gynoid lipodystrophy treatment: the Brazilian experience. J Am Acad Dermatol 2007; 56: AB196


3. Ferreira JC, Haddad A, Tavares SA. Increase in collagen turnover induced by intradermal injection of carbon dioxide in rats. J Drugs Dermatol 2008, 7(3): 201–6


4. Duchêne-Marullaz P, Talvard J. Influence d’injections sous-cutanées de gaz thermal de Royat sur la teneur en anhyride carbonique du sang veineux efferent. Therapie 1986; 21: 143–6


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5. Bartoletti CA, Parassoni L, Varlaro V. La carbossiterapia: una metodic in evoluzione. Rivista La Medicina Estetica. 1997; 2


6. Varlaro V, Manzo G, Mugnaini F et al. Carboxytherapy: effects on microcirculation and its use in the treatment of severe lymphedema. A review. Acta Phleobologica 2007; 8(2): 79–91


7. Albergati F, Parassoni L, Lattarulo P, Varlaro V, Curris SB. Carbossiterapia e vasomotion: comparazione tra immagini video-capillaroscopiche e referti doppler laser flow dopo somminiatrazione di anidride carbonica. Rivista La Medicina Estetica. 1997


8. Akça O, Doufas AG, Morioka N, Iscoe S, Fisher J, Sessler DI. Hypercapnia improves tissue oxygenation. Anaesthesiology 2002; 97(4): 801–6


9. Ito T, Moore JI, Koss MC. Topical application of CO2 increases skin blood flow. J Invest Dermatol 1989; 93(2): 259–62


10. Diji A, Greenfield AD. The local effect of carbon dioxide on human blood vessels. Am Heart J 1960; 60: 907–14


11. Curri SB, Bombardelli E. Local lipodystrophy and districtual microcirculation: proposed etiology and therapeutic management. Cosmet Toilet 1994; 109: 51


12. Irie H, Tatsumi T, Takamiya M et al. Carbon dioxide-rich water bathing enhances collateral blood flow in ischemic hindlimb via mobilization of endothelial progenitor cells and activation of NO-cGMP system. Circulation 2005; 111(12): 1523–9


13. Murohara T, Horowitz JR, Silver M et al.


Vascular endothelial growth factor/vascular permeability factor enhances vascular permeability via nitric oxide and prostacyclin. Circulation 1998; 97(1): 99–107


14. Wollina U, Heinig B, Uhlemann C. Transdermal CO2 application in chronic wounds. Int J Low Extrem Wounds 2004; 3(2): 103–6


15. Lee GS. Carbon dioxide therapy in the treatment of cellulite: an audit of clinical practice. Aesthet Plast Surg 2010; 34(2): 239–43


16. Nach R, Zandifar H, Gupta R, Hamilton JS. Subcutaneous carboxytherapy injection for aesthetic improvement of scars. Ear Nose Throat J 2010; 89(2): 64–6


effect will fade after approximately 10 minutes, although an erythema sometimes remains for a little while longer.


Carbon


dioxide therapy is a simple and cost-effective technique


with minimal side-effects.


Conclusions Carboxytherapy refers to the cutaneous and subcutaneous administration of carbon dioxide gas for therapeutic purposes. By injecting small amounts of carbon dioxide gas into dermal and subdermal structures (such as fat), the body is triggered to increase the oxygen flow to the area injected, and consecutively increases collagen neogenesis as well as lipolysis. Therefore, the most common indications for CDT are skin flaccidity, sun-damaged skin, dark under-eye circles, localised fat pads, stretch marks, and cellulite. Its ease of use, cost-effectiveness and safety makes CDT a successful treatment in aesthetic medicine.


To further prove the efficacy of carboxytherapy, however, further clinical trials are necessary.


 Declaration of interest None


 Figure images 3, 4, 9 © RioBlush; 8 © RioBlush/Dr Cyril Blum; 10 © RioBlush/Dr Bernard Mole; 5, 6 © Sabine Zenker


Key points


■ Carboxytherapy refers to the cutaneous and subcutaneous administration of carbon dioxide gas for therapeutic purposes


■ The most common indications for carboxytherapy are skin flaccidity, sun-damaged skin, dark under-eye circles, localised fat pads, stretch marks, and cellulite


■ Studies have demonstrated that carboxytherapy improves skin elasticity, circulation and the appearance of fine lines and wrinkles, aids collagen repair, and destroys localised fatty deposits


January/February 2012 | prime-journal.com


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