CARBOXY THERAPY 2009
CARBOXY THERAPY AMELIORATES MILD, CHRONIC CUTANEOUS PSORIASIS-LESIONS MANAGED WITH CONVENTIONAL TOPICAL TREATMENT
Anecdotal and case-reports indicate that carboxy therapy can ameliorate focal lesions in patients with mild drug-induced cutaneous psoriasis, stable plaque psoriasis and receiving conventional topical treatment (DOVENEX®-Ointment/ calcipotriol hydrate). Amelioration, but not cure, has been observed after 3 months, by intermittent CDT-CO2 insufflation ( or first-generation Carbomed™), sub-lesionally, in selected persons, in persons presenting with extremity lesions. Improvement has been detected in the quality of the skin (epidermis), reduction in scaling and redness. See illustrations of a patient followed-up for 3-months, and on intermittent add-on Co2 , apart from conventional medication. These changes have been recorded in the elbow and knee-extensor areas ( focal lesions) and objective measured skin improvement has been confirmed by digital skin-biometry, and microrelief analysis, but not biopsy. Carboxy Therapy does not appear to prevent development of new lesions at other sites ( flare-ups), but does complement conventional treatment in existing lesions. This reduces scaling, itching and picking by patients, and becomes evident after numerous treatments.
Carboxy therapy efficacy is based on the gentle inflation of subcutaneous carbon-dioxide in its gases state that leads to improvement of the micro-circulation and therefore tissue status. So that means that a carefully measured and controlled amount of CO2, via an insufflator ( either with warm or cold CO2, depending on the model) is infused under the skin. The careful usage thereof and the administration are approved by the FDA in the USA. CO2 is used daily in thousands of patients especially for laparoscopic surgery, and so the safety status/record is well accepted and known in surgical, anaesthetic and gynaecological clinical practice. The gas has an excellent safety profile, and is suited to aesthetic practice and regenerative medicine, provided proper medical supervision is present in the clinic when the client undergoes treatment. Mild tenderness and burning at the administration site in the skin is well known, and can be ameliorated by pre-procedural application of local anaesthetic cream. The speed of insufflation is important, directly related to discomfort, and one must adhere to the manufacturer’s instructions.
POTENTIAL INDICATIONS FOR THE USE OF CO2 IN AESTHETIC MEDICINE INCLUDE:
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Cellulite and cellulite syndrome ( paniculpatia edemato fibro sclerotica and other localized adiposities, adipose panniculus irregularities)
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Skin laxity
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Stretch marks ( legs, saddle bags, lower abdomen) after pregnancy ( stria gravidarum)
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Sculpting of buttock ( gluteal) cellulite
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Sculpting of “ saddle bags” ( remodelling)
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Sculpting of ”love handles” ( remodelling)
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Sculpting of symmetrical abdominal lipomatosis
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Dark rings around the eyes in selected patients meeting inclusion criteria
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Complements liposuction with noticeable and enhanced reduction in the circumference at the thigh and knee level. Reduction in extremity circumference appears clinically superior to the use of other non-invasive cellulite-reducing devices such as Ultrashape™, LPG™, Synergie™, Endermologie™, Ultrashape™, Thermage™, Alma Accent™ radiofrequency, mesotherapy and Velasmooth™. So “ cellulite” can be treated by various modalities including local CO2 insufflation, ultrasound, massage, radiofrequency, liposuction etc…….an important focus being on the correction of the microcirculation.
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Double-chin reduction
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Arm and leg anti-aging
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Neck-line and décolleté anti-aging and waist-line improvement
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Surgical scars ( after breast surgery , abdominal incisions)
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POTENTIAL ROLE OF CO2 IN MEDICAL CONDITIONS (THERAPEUTIC):
Leg ulcers, psoriasis, diabetic foot and gangrenous toes (also for atherosclerosis obliterans), varicose ulcers, peripheral arteriopathies, microangiopathies and alopecia. Urology (erectile dysfunction, and rheumatology ( acute arthritis and sports medicine). Combination with autologous platelet-rich plasma (PRP) (A-PRP) seems an attractive approach for stubborn and recalcitrant ulceration, and no doubt will be in competition with hyperbaric oxygen therapy.
CARBOXY THERAPY: EARLY PROOF OF SCIENCE PUBLICATION: Dr Jean Baptiste Romuef. Reported number of cases treated in the world, number about 400,000 and documentation show safety and efficacy.
CARBOXY THERAPY MORE EFFECTIVE THAN RF OR ULTRASOUND FOR THE TREATMENT OF CELLULITIS: More objective results from the University of Siena (Brandi and D’Aniello et al)
- Reduction in thigh and knee circumference and of extremity after treatment appears to be clinically greater than those achieved by radiofrequency and ultrasound
- There is improved microcirculation and increased transcutaneous PO2 levels, as measured by laser Doppler: thus objective measured data showing improved tissue perfusion and arterial activity ( D’Aniello et al)
- Positive histological changes ( dermal thickening and possibly neocollagenesis, development of fracture lines in adipose tissue, with retention of deep vital structures ( D’Aniello et al)
- Improved tissue PO2 partial pressure values ( tPO2) after administration of CO2 ( D’Aniello et al)
- Skin changes after carboxitherapy include reduced local adiposity, compaction of skin and elastin and reduced dimpling
ACADEMIC SUPPORTING PUBLICATIONS REGARDING CARBOXY THERAPY:
- Brandi C, D’Aniello C et al. Carbon dioxide therapy in the treatment of localised adiposities: clinical study and histopathological correlations. Aes Plas Surg 2001: 3, 170-4
- Brandi C, D’Aniello C et al. Carbon dioxide therapy: effect on skin irregularity and its use as a complement to liposuction. Aes Plas Surg 2004: October
INTERNATIONAL SUPPORTING REGISTRIES REGARDING CARBOXY THERAPY ( REGISTRATION, REGISTRY, AUTHORIZATION, ACCREDITATION).
AREAS OF RESEARCH (CARBOSSI TERAPIA ITALIANA)
- Plastic surgery
- Aesthetic medicine
- Dermatology
- Phlebotomy and wound care
- Further information: www.bestermed.co.za
CARBOXY THERAPY PROCEDURE: Controlled administration of Co2 gas via a tiny 30 gauge needle and special insufflator, into subcutaneous site, dermis and adipose tissue.
PROPOSED MECHANISM OF ACTION.
- Improved tissue perfusion, and oxygenation
- Arterial and capillary vasodilatation
- Improvement in micro-circulation
- Improved tissue perfusion in persons undergoing carboxitherapy for cellulite syndrome, possibly triggering triglyceride and FFA mobilization. Promotes lypolysis
- Possible collagen production and skin retraction
SUGGESTED CARBOXY THERAPY PROTOCOL FOR CELLULITE SYNDROME
- Careful patient selection including obtaining a medical history: Treatment twice weekly for a total of 10-15 contact sessions and maintenance thereafter
- A minimum of 10 sessions is recommended
- Exclusions and general guidelines: Serious systemic and hormonal disorders, emotional lability, skin infections including cellulitis, cardiac, respiratory, renal and liver failure, thrombophlebitis, anti-coagulation, bleeding disorders, clotting disorders, haematological disorders, morbid obesity
TREATMENT SITES POSSIBLE AND OTHER INFORMATION: DISCLOSURE
- Under the chin, skin laxity ( knowledge of anatomy and vital structures is important)
- Arms, neck ( but knowledge of superficial anatomy is important)
- Décolleté
- Lower abdomen, saddle-bags, love-handles
- Acne scars, facial rejuvenation, upper and lower-lids ( knowledge of anatomy is important to avoid orbital tracking)
- White stretch-marks and old-scars
- Can be combined with other aesthetic procedures
SIDE EFFECTS
- Local discomfort at the needle-prick site (common and treatment dependent). Local anaesthesia may be of benefit. Minor skin puncture site oozing in persons on aspirin.
- Heavy feeling in extremeties: peri-orbital gas insufflation, sub-conjuctival tracking, including retro-orbital tracking if used in the area of the eye
- No down-time
- Injection-site infection ( rare) , redness, burning, crackling
- Bruising at needle-prick site and adjacent skin ( common)
- Exclusion-criteria would include: Cardiac, respiratory and neurological disorders, severe hypertension, liver and renal impairment, coagulation disorders, terminally-ill persons with reduced life-expectancy, recent major-operations, cancer, chemotherapy, pregnancy and lactation, emotionally unstable persons) .
GENERAL ASPECTS OF CELLULITE TREATMENT
- Cellulite (a lipodystrophic disease), is elusive to treatment and treatment options. Treatment options are controversal
- “Orange peel skin” is a typical characteristic in the saddle bag and love-handle areas
- For cellulite therapy to succeed, a dietary and exercise program must be followed
- All non-invasive treatments render mild and temporary results, and require frequent and many treatment sessions ( costly and time consuming), requiring maintenance treatment
- There are extreme differences in option regarding the treatment of cellulite
- Local treatments are far less effective than plastic surgery removal of fat, such as liposuction and abdominoplasty
- Predisposing factors seem to effect cellulite: gender, hereditary, race, body-weight, and age
- Microcirculation and lymphatic disturbances, metabolism , gender and hormones play an important role in the aetiology of cellulite
DISTRUBUTORS OF CDT CARBOXY THERAPY DEVICE (AND OTHER AESTHETIC NEEDS) IN SOUTH AFRICA: Bester Medical Aesthetics, Welgelegen, Cape Town. ( www.bestermed.co.za or bmed@telkomsa.net)
Posted 5 January 2009: Consultant Biomed Expert.
DISCLAIMER: Medical supervision is needed, including informed consent after a sensible consultation with a medically qualified health –care giver or provider.
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