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Cellulite light: CO2 rejuvenation provides advantages for addressing cellulite

Article-Cellulite light: CO2 rejuvenation provides advantages for addressing cellulite

Cellulite light
CO2 rejuvenation provides advantages for addressing cellulite

John Jesitus
Senior Staff Correspondent

NATIONAL REPORT — Carbon dioxide injections represent a safe, effective option for addressing cellulite, particularly when combined with other treatments, sources say. For mild cellulite cases, they add, CO2 injections sometimes can stand alone.

Also known as carboxytherapy, CO2 therapy originated more than 50 years ago in France as a treatment for vasculopathies, says Yan Trokel, M.D., a New York-based cosmetic surgeon who has been using carboxytherapy for five years, including two years with the RioBlush system (Plum Systems Co, New York).

Over the years, physicians learned that CO2 injections could provide cosmetic improvements as well. Italian and Brazilian researchers found that "People who get CO2 treatment have increased vasculature and a little lysis of the most superficial adipocyte layer," Dr. Trokel tells Cosmetic Surgery Times. "Some also say that the treatment provides dermal improvement," with collagen bundles more tightly packed after treatment, he adds.

How it Works
Since CO2 is a byproduct of the breathing process, Dr. Trokel says, "Receptors in the body actually pick up the [presence of] CO2 and read it as an area of hypoxia or some sort of insult or trauma. The body responds by making new blood vessels and bringing in the nutrients needed to heal the area."

In his practice, Dr. Trokel says, "I really like the improvement in skin color and texture carboxytherapy provides around the eyes, because it improves the circulation and provides some dermal thickening." Because CO2 is nonembolic, he adds, CO2 therapy is very safe.

CO2 and RF for Cellulite
In addition to treating the eye area, Dr. Trokel frequently uses carboxytherapy in combination treatments for cellulite. Carboxytherapy also can improve some very mild cases monotherapeutically, he adds.

"We know that CO2 will improve the dermal collagen, so it can improve skin texture. The other benefit is that CO2 therapy lyses some of the superficial fat, which creates that orange peel texture," he says.

The combination of CO2 and radiofrequency (RF) energy in particular yields excellent results, Dr. Trokel says. He typically staggers eight weekly treatments of each, using VelaShape (Syneron; Yokneam, Israel) on Monday and carboxytherapy on Thursday, for example.

Dr. Trokel has tried applying topical anesthetic before carboxytherapy, "But the topical anesthetic doesn't do much because what patients are actually feeling is the gas moving as it's going in," he says. Patients usually find the treatment slightly uncomfortable, he says, particularly on the hands and back of the legs.

"The RioBlush system is fully programmable and heats the CO2 gas to near body temperature, which reduces discomfort and increases efficacy," adds Glenn Fernandez, chief marketing and operations officer, RioBlush by Plum Systems Co.

"Gas temperature matters little in terms of pain for facial treatments since they involve small areas and smaller gas volumes. But I believe that heated gas improves treatment efficacy," adds Marian Zilkha, M.D., Ph.D., an ophthalmic plastic surgeon who practices in Brazil and coordinates aesthetic procedures at Manhattan's Integrative Center of Aesthetic Medicine (medical director: Alexander Kulick, M.D.). "And for body rejuvenation with higher gas volumes," she says, "heated gas is very important for pain management."

Regarding injection technique, Dr. Trokel says, "We use a 30-gauge needle to place the gas into the dermal layer, for a superficial effect, and deep into the fat layer, to stimulate lysis of the fat cells and new vasculature."

Each treatment area requires multiple injections. "I like to move the needle around circumferentially because this creates less distention, and patients feel less pressure," he says.

Treatments typically take 15 to 40 minutes total, says Dr. Trokel. Treating the face takes 20 to 30 minutes, while other areas such as the back of the legs or the abdomen require 15 to 20 minutes each, he explains.

After treatment, the treated area will raise, turn slightly red and undergo an inflammatory response. "The only side effect is that patients can bruise if one hits a vessel with the needle," he says. However, this only happens in around two percent of patients, he says.

"Once the procedure is done," says Dr. Trokel, "there's no pain," just possibly a crackling sensation under the skin that lasts until the gas is excreted. "I tell patients not to rub the area or immerse it in water for about four hours," he adds. External pressure can force the gas out prematurely, he explains. Similarly, Dr. Trokel advises patients not to bump the treated area due to temporarily increased skin and vessel fragility. However, he says that most patients can return to work immediately after treatment.

Results last about a year, after which patients usually return for touchup treatments. "I've seen some that have needed one or two touchup treatments, and some who needed the entire eight sessions again," Dr. Trokel says.

The Beauty Marathon
"Beauty isn't a race — it's a marathon," he says. Rather than waiting until their problems are bothersome again, Dr. Trokel says patients must appreciate that maintenance goes a long way.

Along with skin laxity, localized fat and vascular pooling (dark circles around the eyes), the RioBlush system also has been reported to provide effective treatment for reduction in the appearance of stretch marks, Mr. Fernandez adds. Moreover, physicians have reported success with the product in treating some kinds of hair loss, assisting wound healing (as in diabetic ulcers) and as a complement to liposuction, he says.

Although the RioBlush system is not currently FDA approved for marketing in the United States, Mr. Fernandez says, "We are in the process of preparing our FDA application and expect approval in 2009. We plan to begin clinical studies for a couple indications with some leading plastic surgeons and dermatologists to submit with our application." CST

Drs. Trokel and Zilkha report no relevant financial interests.

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