Thursday, June 12, 2008

A Lot of Hot Air?

There is an article in the Cosmetic Surgery Times Vol 11 No 5 2008 on the subcutaneous injection of carbon dioxide (CO2). The treatment is called carboxytherapy.
Subcutaneous injections of carbon dioxide (CO2) can safely and successfully treat cosmetic concerns such as skin laxity and fatty deposits that may remain following liposuction, as well as psoriasis and hair loss, says an expert based here. Additional uses for this treatment — called carboxytherapy — include stretch marks, scars and cellulite, he says.
This is the first time I have ever read or heard of carboxytherapy. So I did a search using carboxytherapy on Medscape -- no articles. I searched the database of the Journal of Plastic and Reconstructive Surgery -- no articles. I changed the search to carbon dioxide/ subcutaneous injections and got this one relevant hit:
  • Carbon dioxide therapy in the treatment of localized adiposities: clinical study and histopathological correlations. Aesthetic Plast Surg, May 2001
I didn't do any better with a google search. At least not for scientific information. So back to the CST article, here is a description of carboxytherapy:
I've been using this technique for more than a year, and getting fantastic results," says Raphael Nach, M.D., a head and neck surgeon in private practice. He estimates that he has treated at least 40 patients for post-liposuction problems such as persistent islands of fatty tissue, skin irregularities and skin laxity. Dr. Nach explains that by adding CO2 gas to the subcutaneous tissues, localized post-operative accumulations of fat can be reduced or eliminated." Alternative forms of treatment have been advised to assist the general recuperate process," he says, "but none have been as successful in eliminating these localized fatty deposits."
TECHNIQUE IN BRIEF The technique requires no anesthesia. First, one sterilizes the skin with Hibiclens (chlorhexidine topical antiseptic; Mölnlycke Health Care U.S., Norcross, Ga.) or its equivalent, he details. "Then a 30-gauge needle connected to the carboxytherapy machine is used to infiltrate the tissues with different volumes of carbon dioxide gas, depending on the condition that's being treated," Dr. Nach explains. A typical treatment site requires about 50 cc to 200 cc of gas, injected either once or twice a week, he says. Each session lasts 15 to 20 minutes. Depending on the treatment area, he says, four to six puncture sites with the 30-gauge needle may be necessary.
I found some references that state that this procedure is FDA approved (including Dr Nach), but according to the ASPRS website (2008) it isn't.
Injection of carbon dioxide for cosmetic purposes, namely to treat cellulite. Not U.S. FDA approved.
I then tried a search of the FDA website and got no hits on carboxytherapy or carbon dioxide/ cellulite.

So for now I would suggest being very skeptical of any claims that carboxytherapy would improve anything. Dr Oliver or anyone else have any information on this? Preferably scientific information.


Margaret Polaneczky, MD (aka TBTAM) said...

Great job of counteracting quackery in medicine. Fighting fiction with fact...

Jeffrey Parks MD FACS said...

I have a feeling no one is going to be able to come up with something scientific to support blowing a bunch of gas under your skin....

rlbates said...

TBTAM, thanks.

Buckeye, I agree.

Ian Furst said...

We see SQ emphysema occasionally in the dental world when an air driven drill forces air/nitrogen beneath a flap. It causes a quick and nasty cellulitis that takes weeks to resolve. It can also travel way beyond typical anatomical planes. For some reason it is much worse than your run of the mill cellulitis (I presume the inflammatory response is more dramatic). I guess the C02 treatment uses that reponse to make the skin 'tighter'. Sounds dangerous.

rlbates said...

Thanks for the information Ian. Yet another reason to be skeptical.

Anonymous said...

while i totally understand your skepticism, as i was once skeptic about this treatment too, I have seen personally that it does work on localized fat deposits. I have seen perhaps more than 20 patients who have undergone this and are quite happy with the results. While I have come across only 2 medical journals/RCTs on carboxyTx and of course the trend nowadays is the practice of evidence-based medicine, I cannot discount the overwhelming anecdotal evidence that is out there. I do hope there will be more RCTs so that we can all find out if it is worth it or not. And if not, throw it out the window.

JL said...

Can i suggest some articles in pubmed? just type the reference number .. also there is an important one in the Journal American Academy Dermatology
and one book about Cellulite with an chapter of co2 therapeutical injection.

PMID: 18380201
PMID: 17168416
PMID: 17845862
PMID: 11444885
PMID: 11059501
PMID: 3128016
PMID: 7631285
PMID: 14097963
PMID: 8017066
PMID: 5172621
PMID: 5172621
PMID: 3109137
PMID: 3133733

Valéria Campos et cols.
[Carboxytherapy for gynoid lipodystrophy treatment : The Brazilian experience.]
Journal American Academy Dermatology 2007 P2900 AB196

Goldman M., Bacci P., Leibachoff G., Hexsel D.
Cellulite: Pathophysiology and Treatment (Basic and Clinical Dermatology)

Also visit the website

with information about CO2 application for vascular disease.