CO2 combos: Carboxytherapy reported to provide adjunctive advantages with aesthetic treatments

CO₂ combos
Carboxytherapy reported to provide adjunctive advantages with aesthetic treatments

John Jesitus
Senior Staff Correspondent

NEW YORK — Carboxytherapy delivers impressive results for cellulite, dark under-eye circles and stretch marks, says Marian Zilkha, M.D., Ph.D., a Brazilian-licensed ophthalmic plastic surgeon who coordinates aesthetic procedures at Manhattan's Integrated Center of Aesthetic Medicine. In Brazil and Europe, experts add, physicians use adjunctive carboxytherapy for everything from alopecia and anesthesia to pain management, psoriasis and wound healing.

Like many cosmetic treatments, Dr. Zilkha says, carboxytherapy works best in combinations. "Even with Botox (botulinum toxin A; Allergan, Irvine, Calif.,)" she explains, "one must add fillers and perhaps skin tightening devices for optimal results. Our menu of therapies is very vast today," and few treatments succeed solo.

The simplest combinations include carboxytherapy and skin care products such as retinoids. Carboxytherapy also works well with pulsed dye lasers or intense pulsed light, says Dr. Zilkha. "Stretch marks can be red or white, and carboxytherapy won't completely address the color component, although it tremendously improves overall skin quality, color and texture," she says. Stretch marks typically require five to eight treatments, she adds.

"RioBlush is the best treatment for stretch marks, a problem for which plastic surgeons normally have no effective solutions," says Sebastiano Montoneri, M.D., a plastic surgeon at Paris's Clinique Elysee Montaigne who also practices in Italy. The device helps to make the color and texture of scars and stretch marks more similar to that of the surrounding skin, thereby rendering them less noticeable, he says.

Dark Circles
To treat dark circles around the eyes, Dr. Zilkha uses intradermal injections, placed in the lower lid at the outside corner of the eye with a very fine needle. (Upper lids sometimes require injection as well, she says.) "Once the skin is lifted with a very small volume of gas — it takes two to four seconds maximum — you can remove the needle and treat the other eye," she explains.

In less than five minutes, "The gas is totally reabsorbed. The body recognizes the increase in CO₂, circulation to the area increases and hemoglobin transports it away. The increased blood flow stimulates collagen, which will soften fine wrinkles and decreases dark circles under the eye."

Patients start seeing results, including improved texture, fewer fine wrinkles and greater luminosity, after one or two sessions, according to Dr. Zilkha, although she usually recommends five or six treatments spaced weekly. The treatment works for all skin types, she adds, although she recommends one puncture per eyelid in Fitzpatrick skin types III and higher.

Additionally, she says that patients with small residual fat pockets under the eyes, mouth or chin notice an improvement after two to three CO₂ treatments. However, she cautions against performing carboxytherapy and injectable treatments such as Botox or fillers during the same visit because the flushing caused by CO₂ injections increases the chances of bruising.

For all types of treatments, adds Dr. Zilkha, "One of the big advantages of the RioBlush system is that the device has a built-in safety check: the tubes are totally drained of gas and oxygen prior to each treatment, when the device starts flowing." With some carboxytherapy systems, she says, physicians have been known to unintentionally inject air from within the tubing with the CO₂, causing residual eyelid distention that can last up to two days.

Creative Combinations
Overall, Dr. Zilkha says, "Carboxytherapy is still very new, and we're still learning more about it." However, its low morbidity allows physicians to continually fine-tune treatment protocols without placing patients at risk, she says.

As a result, international physicians have devised a host of creative combinations involving the RioBlush system.

"I normally use RioBlush in conjunction with mesotherapy, especially with hyaluronic acid (HA)," Dr. Montoneri says. RioBlush stimulates vascularization and neocollagenesis, and free-molecule HA (as opposed to the reticulated type used for dermal fillers) helps stabilize the new collagen, which improves aesthetic results, he says.

RioBlush also works very well for facial and neck rejuvenation, says Dr. Montoneri. "In these areas,” he says, "It improves the skin quality and reduces the small wrinkles that normally we're not able to treat with a facelift."

Because RioBlush improves tissue oxygenation and vascularity, Dr. Montoneri adds, he frequently uses this treatment before surgical procedures such as rhytidectomies. It's especially helpful when risk factors such as smoking present challenges for flap survival, he says.

Disclosures
Dr. Zilkha reports no relevant financial interests.
Dr. Montoneri is a trainer for RioBlush by Plum Systems Co.

For more information
www.clinique-montaigne.fr
www.RioBlush.com