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Gassing up: CO2 injections may reduce or eliminate localized post-operative fat deposits

Article-Gassing up: CO2 injections may reduce or eliminate localized post-operative fat deposits

Key iconKey Points

  • Subcutaneous injections of carbon dioxide can safely and successfully treat a variety of cosmetic concerns, according one expert
  • This treatment may be beneficial for skin laxity, fatty deposits that may remain following liposuction, psoriasis, hair loss, stretch marks, scars and cellulite

BEVERLY HILLS — 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.

54-year-old female patient who did not want liposuction (left) before and (right) after 12 carboxytherapy treatments given once per week. All photos credit: Raphæl Nach, M.D.
"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.

SCOPE OF TREATMENT Carboxytherapy dates back to 1932, when French cardiologists developed it to treat vascular disorders such as atherosclerosis. "As a side benefit," says Dr. Nach, "they found that it also treats other problems such as cellulite, fat and scars." In 2004, Drs. Brandi, D'Aniello and others described the addition of carbon dioxide therapy as an adjunctive treatment for conventional liposuction. Dr. Nach says he's also found carboxytherapy extremely helpful in treating post-operative and post-traumatic scarring. "Here the CO2 gas is injected directly into the scar tissue," says Dr. Nach, who adds that he's achieved similar improvements in treating psoriasis this way. Similarly, Dr. Nach says he is also treating men and women with hair loss, employing the CO2 as adjunctive therapy, with "very promising results."

47-year-old female (left) before and (right) after 8 carboxytherapy treatments given once a week. Patient had a tummy tuck 8 months before treatment; Kenalog-40 injections were tried before carboxytherapy.
BIOLOGY & BENEFITS Carboxytherapy's effect is two-fold. "Firstly," Dr. Nach explains, "it kills fat cells by a process of lipolysis, meaning that the gas directly kills the fat cells. The metabolized fat cells pass through the liver and are excreted in feces." Secondly, he says, carboxytherapy causes blood vessels to dilate, which increases blood flow and hence oxygenation to the treated area. "As a result," he states, "it eliminates the built-up fluids between the cells, resulting in fewer fat cells and firmer tissues."

Adverse events are limited to mild injection-site pain, possible tissue bruising and a crackling sensation in treated tissue, all of which are self-limiting, says Dr. Nach, based on his personal and professional experience. He adds that practitioners needn't worry about overinflating tissues because CO2 is nontoxic.

"Carboxytherapy is safe, simple to perform and relatively painless. And there are no restrictions on activity after the treatment," Dr. Nach notes. He says most patients notice results after their fifth treatment, and can see after the eighth to tenth treatment that their skin is firmer. How long benefits last depends on the patient, as well as their dietary and exercise habits, Dr. Nach says. As with many rejuvenation treatments, he recommends one to two maintenance visits every three to six months.

BROAD APPEAL Because carboxytherapy is noninvasive and very successful, the treatment's future appears bright, according to Dr. Nach. Furthermore, he says, "CO2 gas can be applied to any part of the body." As a result, Dr. Nach thinks the treatment carries broad appeal. "Everybody I've treated so far has been very happy with the results," he states. And word is spreading. Dr. Nach says he already gets three or four e-mails weekly, largely from patients in Florida, requesting referrals to local practitioners. For now, he says, "There are a handful of physicians in different states using the technique," although it's difficult to quantify specifically how many. "Maybe we need to connect a long hose to Florida," he laughs.

Dr. Nach reports no relevant financial interests.


Brandi C, et al. Carbon dioxide therapy: effects on skin irregularity and its use as a complement to liposuction. Aesthetic Plast Surg. 2004;28:222-225.

Brandi C, et al. Carbon dioxide therapy in the treatment of localized adiposities: clinical study and histopathological correlations. Aesthetic Plast Surg. 2001;25:170-174.

For more information
Raphael Nach, M.D.

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