Effectiveness of carboxytherapy in the treatment of cellulite in healthy women: a pilot study

Pathological and Immunohistochemical Assessment of Aging of the Abdominal Skin Treated with Carboxytherapy: A Randomized, Split-body Trial

Background

Skin aging as a continuous and irreversible process is mainly the result of alterations of function and structure of the dermis. Among the modalities used for treating skin aging, carboxytherapy has been introduced as a safe minimally-invasive method for rejuvenation, reparation, and reconditioning of the skin.

Objective

We assessed the efficacy of carboxytherapy for the treatment of intrinsic skin aging through pathological and immunohistochemical (IHC) investigations.

Methods

Our study was a split-body, randomized clinical trial on 15 female patients with intrinsic skin aging of the abdomen. Carboxytherapy was performed on one side of the abdomen, weekly for 10 sessions, while the other side was left untreated. Two weeks after the last session, skin biopsies were taken from both sides of the abdomen. Staining with hematoxylin-eosin, Masson-trichrome, and Orcein Giemsa was performed for the assessment of epidermal and dermal thickness, collagen, and elastin organization, respectively. IHC examination was performed for investigation of TGF-β1 and VEGF.

Results

Pathological examination showed a significant increase in epidermal and dermal thickness and re-organization of collagens and elastic fibers with carboxytherapy. IHC examinations revealed a significantly increased expression of TGF-β1 and VEGF with carboxytherapy.

Conclusion

Our study demonstrated the effectiveness of carboxytherapy in treating and reversing intrinsic aging skin through pathological and IHC studies.

Evaluation of the effects of carboxytherapy in the treatment of periorbital dark circles

BACKGROUND

Dark eye circle (DEC) is one of the most common cosmetic problems. It has a great impact on the patients' quality of life. Carboxytherapy is a cosmetic technique using pure carbon dioxide for different uses in different areas of the body. The goal of this study is to evaluate the efficacy and tolerability of carboxytherapy in the cosmetic correction of DECs.

METHODS

This study was conducted on 27 patients requesting the correction of DEC. The treatment was performed using a carboxy device in medical grade. The gas injection was performed intradermal after local anesthesia, with a pressure of one tenth bar and a speed of 20 cc/min, 1 cc in each upper and lower eyelid. The treatment sessions were done every 2 weeks for four sessions.

RESULTS

The mean physicians' score of DECs before and after treatment was 8.7 ± 0.81 and 4.6 ± 1.1, respectively. The mean patients' score before and after treatment was 9.2 ± 0.5 versus 5.41 ± 1.37. The mean scores showed a significant reduction of skin discoloration without major side effects (p < 0.00001).

CONCLUSION

Carboxytherapy seems to be an effective treatment option for dark circles around the eyes with a good safety profile and patient satisfaction.

Aesthetic Rehabilitation Medicine: Enhancing Wellbeing beyond Functional Recovery

Although rehabilitation medicine emphasizes a holistic health approach, there is still a large gap of knowledge about potential interventions aimed at improving overall wellbeing through cosmetic interventions. Therefore, this narrative review investigates the role of different rehabilitative techniques in enhancing aesthetics, quality of life, and psychosocial wellbeing for patients with disabilities. The study follows the SANRA framework quality criteria for a narrative review. Literature searches across PubMed/Medline, Web of Science, and Scopus identified articles focusing on rehabilitation strategies within the aesthetic rehabilitation domain. The review identified evidence supporting injection procedures, such as Botulinum Toxin, Platelet-Rich Plasma, Hyaluronic Acid, Ozone, and Carboxytherapy, and assessing their applications in several disabling disorders. Additionally, physical therapies like Extracorporeal Shock Wave Therapy, Laser Therapy, Microcurrent Therapy, Tecar Therapy, and physical exercises were explored for their impact on cutaneous microcirculation, cellulite treatment, wound healing, and scar appearance improvement. Lastly, the manuscript underlines the role of manual therapy techniques in addressing both physical discomfort and aesthetic concerns, discussing their effectiveness in adipose tissue therapy, scar tissue mobilization, and regional fat thickness reduction. Taken together, this review emphasizes the role of a multidisciplinary approach, aiming to provide valuable insights into potential benefits for both functional and aesthetic outcomes.

Non-invasive Body Contouring Technologies: An Updated Narrative Review

INTRODUCTION

Nowadays, a lot of body contouring devices and methods are introduced all over the world. The object of the present narrative review was to update and classify existing evidence on these methods and devices.

METHODS

We searched databases including PubMed, Cochrane, and Google Scholar for 11 essential keywords, including cryolipolysis, high-intensity focused ultrasound (HIFU), shock wave, low-level laser therapy (LLLT), radiofrequency (RF), capacitive resistive electrical transfer (TECAR), high-intensity focused electromagnetic (HIFEM), electromyostimulation (EMS), carboxytherapy, mesotherapy, and acupuncture and their abbreviations, in addition to obesity, overweight, cellulite, subcutaneous fat, and body contouring.

RESULTS

Totally 193 references were used in 11 main topics.

CONCLUSION

In order to help physicians with finding the best evidence in different methods, the data were summarised in 11 topics. Furthermore, FDA-approved devices, side effects and common protocols were described in each section.

LEVEL OF EVIDENCE I

This journal requires that authors 39 assign a level of evidence to each article. For a full 40 description of these Evidence-Based Medicine ratings, 41 please refer to the Table of Contents or the online 42 Instructions to Authors www.springer.com/00266 .

Assessment of efficacy of carboxytherapy in management of skin aging through evaluation of gene expression profile: a 2-split randomized clinical trial

Skin aging is a continuous and irreversible process which results in impairment of the skin role as barrier against all aggressive exogenous factors. It mainly manifests by photoaging, laxity, sagging, wrinkling, and xerosis. Carboxytherapy is considered as a safe, minimally invasive modality used for rejuvenation, restoration, and recondition of the skin. In the current study, the efficacy of carboxytherapy in the treatment of skin aging was assessed through investigation of gene expression profile for Coll I, Coll III, Coll IV, elastin, FGF, TGF-β1, and VEGF. Our study is a 2-split clinical trial in which carboxytherapy was performed on one side of the abdomen in 15 cases with intrinsically skin aging manifestations weekly for 10 sessions, while the other side of the abdomen was left without treatment. Two weeks after the last session, skin biopsies were taken from both the treated and control sides of the abdomen in order to assess gene expression profile by qRT-PCR. The analysis of gene expression levels for all of Coll I, Coll III, Coll IV, elastin, TGF-β1, FGF and VEGF genes showed a statistically significant difference between the interventional and control groups. The findings for all of these seven genes showed increase in the interventional group, among which Coll IV, VEGF, FGF, and elastin showed the higher mean changes. Our study confirmed the effectiveness of carboxytherapy in treating and reversing the intrinsically aging skin.Clinical Trial Registration Code and Date of Registration: ChiCTR2200055185; 2022/1/2.

An overview of the role of carboxytherapy in dermatology

BACKGROUND

Carboxytherapy is defined as intradermal and/or subcutaneous microinjections of sterile purified carbon dioxide into different parts of the body for therapeutic aims. The vasodilatation effect and intradermal collagen reorganization associated with carboxytherapy have advantages for aesthetic dermatology and cosmetology.

OBJECTIVE

In the current article, we have reviewed some of the most important indications of this modality in dermatology and aesthetic dermatology.

METHOD

Our review is a narrative one which has gathered some of the most important indications of carboxytherapy in dermatology and cosmetology.

RESULTS

Carboxytherapy has successfully been applied for some dermatologic and cosmetic conditions among which skin aging, cellulite, localized fat deposits, striae distensae, infraorbital hyperpigmentation, scar, lymphedema, androgenetic alopecia, alopecia areata, psoriasis, morphea, and vitiligo are the most important.

CONCLUSION

Carboxytherapy can be considered as a safe, minimally-invasive modality used for rejuvenation, restoration, and recondition of the skin.

Modified Mediterranean-Ketogenic Diet and Carboxytherapy as Personalized Therapeutic Strategies in Lipedema: A Pilot Study

In recent years, the use of the ketogenic diet as a proper nutritional treatment for lipedema has been hypothesized in the literature. This is the first clinical study evaluating the ketogenic diet and carboxytherapy in lipedema patients. In the present study, it was decided to use a modified Mediterranean ketogenic diet (MMKD) in combination with carboxytherapy. Since lipedema is characterized by microangiopathy, local hypoxia, and increased subcutaneous adipose tissue (SAT) deposition, carboxytherapy could improve painful symptoms and skin tone. A total of 22 subjects were included in the data analysis, divided into three groups; 8 patients underwent MMKD combined with carboxytherapy sessions (KDCB group), 8 underwent MMKD nutritional treatment alone (KD group), and 6 patients underwent only carboxytherapy sessions (CB group), for a total of 10 weeks of treatment for all three groups. It was observed that the ketogenic diet effectively induced weight and fat mass loss, including in the limbs, areas considered unresponsive to diet therapy in lipedema patients. However, the best results were obtained from the combination of the ketogenic diet and carboxytherapy, which showed improvements in both body composition and skin texture and a reduction in pain, along with an improvement in sleep quality. It would be helpful to conduct a clinical trial on a larger scale and over a more extended period to observe the results in the long term as well.

Analgesic electrical currents associated with carboxytherapy in women with cellulite: A randomized controlled trial

BACKGROUND

Pain is considered the main limiting factor in carboxytherapy. Electroanalgesia has gained recognition in the field of dermatology and to date, only transcutaneous electrical nerve stimulation (TENS) has proved to be effective at reducing pain associated with carboxytherapy; however, the effect of medium frequency currents has yet to be investigated.

AIMS

Compare the effects of TENS, interferential current (IFC), and Aussie current on pain intensity associated with carboxytherapy and sensory comfort in the treatment of cellulite.

PATIENTS/METHODS

Seventy-five women aged 18-49 years with moderate and/or severe gluteal cellulite were randomized into three groups: TENS (n = 25), IFC (n = 25), and Aussie current (n = 25), which underwent three sessions of carboxytherapy associated with an electrical current. Current amplitude was adjusted after each puncture, according to the maximum tolerance reported by participants, below the motor threshold. Pain intensity was measured using a numeric rating scale (0-10) and sensory comfort with the visual analogue scale (0-10).

RESULTS

There was no significant intergroup difference in pain intensity (p > 0.05) and sensory comfort (p = 0.502) during the application of carboxytherapy throughout the three treatment sessions.

CONCLUSION

TENS, IFC, and Aussie currents showed no difference in pain intensity reduction and no current was found to be more comfortable.

Preliminary results of the use of carboxytherapy in the treatment of pathologic scars: A minimally invasive alternative

BACKGROUND

Carboxytherapy involves injecting carbon dioxide in the dermal and subcutaneous layers to achieve an increase in the local microvascularization of the tissue where it is applied. Our aim is to analyze its effectiveness in the treatment of pathological scars, as well as its adverse effects.

METHODS

We conducted a prospective single-center study in patients under 18 years of age with atrophic and hypertrophic scars caused by surgical interventions or trauma, mainly burns. Each patient underwent two sessions, 6 weeks apart in time. Scar quality was evaluated using the Vancouver Scar Scale before the first session and 6 weeks after the second session. Adverse effects observed during the procedure and at follow-up in outpatient clinic were collected.

RESULTS

A total of 16 patients were included (5 males; 11 females), with a median age of 12.7 years (interquartile range 8.5-15.2), in whom 25 pathologic scars were treated (14 atrophic and 11 hypertrophic). All sessions were performed under sedation, and patients were discharged the same day, without the need for hospitalization. Regarding scar quality, an improvement was observed in the median Vancouver scale score at 6 weeks after the second session (7 points) compared to the initial median score (12 points), this difference being statistically significant (p = 0.031). No serious adverse effects were observed during the procedure or during subsequent follow-up, with a median follow-up of 14 weeks.

CONCLUSIONS

Carboxytherapy is an effective and safe minimally invasive therapy for pathologic scars, achieving a significant improvement in scar quality, with almost no contraindications.

LEVEL OF EVIDENCE

Level IV.

TYPE OF STUDY

Prospective Single-Center Case Series.

The correlation between the severity of symptoms and the thickness of the fat fold in cellulite-affected areas-A pilot study

OBJECTIVE

The aim of the study was to assess the correlation between the cellulite severity and the thickness of the fat fold.

MATERIAL AND METHODS

The study comprised 62 women aged 22 to 26 years. A palpation and visual evaluation of cellulite severity was performed on the basis of the Nurnberger and Muller classification, and the thickness of adipose tissue (fatty tissue) was measured with the use of a skinfold caliper.

RESULTS

The H0 hypothesis was rejected in favor of the H1 hypothesis (p < 0.001) in the chi-square independence test; therefore, a relationship between the thickness of the adipose tissue fold and the severity of cellulite was confirmed. Moreover, on the basis of obtained results, the hypothesis of the independence of the studied variables (p < 0.0000001) was also rejected. It can be concluded that there is an association between the thickness of adipose tissue and the degree of cellulite. Moreover, the values of the obtained coefficients are greater than zero (the correlation is positive), and the obtained Spearman's R (0.89) and Kendall's tau (0.79) values indicate a very strong correlation between the studied variables.

CONCLUSIONS

On the basis of obtained results and their statistical analysis, we can state that there is a relationship between the degree of cellulite and the thickness of the fat fold-the degree of cellulite increases with the increase in the thickness of the measured fat fold.

Improvement of body contour in young women using a high-power radiofrequency device

Localized fat and excess body fat: this is one of the main causes of dissatisfaction with body contour and decreased self-esteem. The objective of this report is to present the results of treatment using Capenergy C 200 in a group of young volunteers who received treatment only in the right half of the body. We will review the science and literature of the effect of TECAR and its role in body contouring. The average decrease in the arm is 2.9 cm p = .026. The nipple rise was 2.1 cm, p = .002. The decrease in abdominal diameter was 3.3 cm, p = .027 at the end of the treatment. For the thigh, the difference in diameter was 3.9 p = .026, this difference being statistically significant. TECAR radiofrequency treatment therapies, for body contouring in the breast, arms, abdomen and thighs, are effective and can show positive results after 6 treatment sessions, resulting in body satisfaction at the end of the treatment.

Cellulite: Presentation and Management

Cellulite is a common dermatological condition with a female preponderance, affecting up to 90% post-pubertal females. It is characterized with dimpling and denting of the skin surface, giving it a Peau d'orange appearance. Once considered to be a benign physiological isolated skin condition of only an aesthetic concern, cellulite is now considered a pathological entity with systemic associations and a negative psychological impact on patients. Several treatment options from lifestyle modifications, topical cosmetic therapies to energy-based devices have been studied for its treatment. However, treatment remains a challenge despite many new modalities in the armamentarium. Laser and light therapies along with radiofrequency are useful treatment options with good safety profile. Acoustic wave therapy, subcision, and 1440-nm Nd:YAG minimally invasive laser are beneficial in cellulite reduction. Methodological differences in the trials conducted, makes it difficult to compare different treatment modalities. Overall, treatment needs to be individualized based on the patient characteristics and severity of the condition. Combination of treatments is often required in most patients for reducing cellulite.

Vibration anesthesia during carboxytherapy for cellulite: a study protocol

Background: To date, there has been no investigation addressing the effects of vibration anesthesia during carboxytherapy. Aim: Investigate the analgesic effect of different vibratory devices during carboxytherapy for the treatment of cellulite. Materials & methods: A total of 78 women between 18 and 49 years of age with cellulite in the gluteal region will be randomly allocated to three groups: Group A (carboxytherapy and vibratory device A), Group B (carboxytherapy and vibratory device B) and control group. Pain intensity will be assessed using a numerical rating scale after each puncture. Expected outcome: Vibration anesthesia is expected to be effective at diminishing the pain intensity caused by carboxytherapy comparison with the control group, with no differences between the vibratory devices. Trial registry: Brazilian Registry of Clinical Trials- ReBEC (RBR-8jcqy7c).

Fractional Carbon Dioxide Laser Versus Carboxytherapy in Treatment of Striae Distensae

BACKGROUND AND OBJECTIVES

The aim of this study was to compare the efficacy and safety of fractional carbon dioxide (CO₂ ) laser versus carboxytherapy in treatment of striae distensae.

STUDY DESIGN/MATERIALS AND METHODS

This study was conducted on forty female patients with striae distensae on the abdomen. Patients were selected and divided randomly into two matched groups; group I was treated with fractional CO₂ laser resurfacing and group II with carboxytherapy. Assessment and evaluation of the results were done by comparing photographs and the Global Aesthetic Improvement Scale (GAIS).

RESULTS

Pregnancy, obesity, and long-term steroid use were the most common causes of striae in both groups. Both groups showed a statistically significant improvement in both the width and length of striae with no statistically significant difference between them. Patients' satisfaction was comparable in both groups. Pain and post-inflammatory hyperpigmentation were the two most common side effects in group I while bruising at the injection site was the most common in group II.

CONCLUSIONS

Both modalities could be effective in management of striae distensae. Lasers Surg. Med. © 2021 Wiley Periodicals LLC.

Treatments of Periorbital Hyperpigmentation: A Systematic Review

BACKGROUND

Periorbital hyperpigmentation (POH) is an aesthetic concern for patients. Etiologies of the condition include pigmentary, structural, vascular, and mixed causes.

OBJECTIVE

To systematically review the current literature for treatment of POH.

METHODS

A systematic literature review was performed on PubMed. Search terms included "infraorbital dark circles," "dark circles," "periorbital hyperpigmentation," "idiopathic hyperchromia AND orbital," "under-eye circles," "ICHOR (idiopathic cutaneous hyperchromia of the orbital region)," "dark circles" AND "treatment," and "filler" AND "dark circles."

RESULTS

A total of 39 studies were included. Effective treatments for POH include lasers, topical creams and serums, fillers, chemical peels, carboxytherapy, plasma-rich platelet injections, blepharoplasty, and normobaric oxygen.

CONCLUSION

Soft tissue fillers and autologous fat grafting are most effective in treating dark circles due to volume loss. Blepharoplasty surgery is best when excessive skin laxity is the underlying cause. Various topical creams and chemical peels are useful in treating pigment-based POH, whereas lasers are mildly to moderately beneficial for both vascular and pigment types. Given the scarcity of high-quality evidence supporting these results, recommendations should be interpreted selectively. Additional randomized clinical trials studying POH will be helpful.

Post periorbital carboxytherapy orbital emphysema: a case report

Periorbital carboxytherapy is used as one of the non-surgical facial rejuvenation methods in recent years. In this modality, the sterile carbon dioxide is injected into the subcutaneous space, assuming that to improve blood supply and repair of the injection site. Here, we report a 24- year-old woman who presented with acute bilateral orbital emphysema starting one day after cosmetic periorbital carboxytherapy. On physical examination, bilateral non-tender, non-erythematous swelling of both upper and lower lids was noted with crepitus on palpation. Uncorrected visual acuity (UCVA) of the patient in both eyes was 10/10 and RAPD was negative. The orbital computed tomography (CT) scan of the patient confirmed bilateral preseptal emphysema extending into orbital space through the orbital septum. Oral prednisolone 50 mg per day was prescribed, and the patient was observed closely. Gradually, periorbital pain and swelling subsided, and the symptoms resolved within one week.

Electroanalgesia during a carboxytherapy procedure for cellulite: a study protocol for a randomized controlled trial

The aim of the present study is to describe a study protocol to compare different types of analgesic electrical currents on pain intensity and sensory comfort during the application of carboxytherapy for the treatment of cellulite. Seventy five women with the presence of moderate and/or severe gluteal cellulite will be randomly allocated into three groups: carboxytherapy plus transcutaneous electrical nerve stimulation, carboxytherapy plus interferential current or carboxytherapy plus Aussie current. Pain intensity, which is the primary outcome, will be measured by a numeric rating scale (0-10). The secondary outcome is sensory comfort, which will be measured using the visual analogue scale (0-10). Trial registration: Brazilian Clinical Trials Registry: ReBEC (RBR-6z82zb) www.ensaiosclinicos.gov.br/rg/RBR-6z82zb/.

Effects of carboxytherapy on skin laxity

BACKGROUND

Carboxytherapy is capable of inducing tissue repair which results in an increase in elastic and collagen fibers.

OBJECTIVES

To evaluate the effects of carboxytherapy upon human skin collagen and elastic fiber synthesis.

METHODS

Case study of nine volunteers who received a single application of carboxytherapy in the left infraumbilical region, with infusion rate of 100 mL/min and 0.6 mL/kg weight over an area of 25 cm² . After 60 days on average, the skin was collected for histological analysis and stained with picrosirius red for collagen and Verhoeff for elastic fibers. The percentage of fibers found was marked by the Image J^® program and recorded in a Microsoft Excel spreadsheet. Statistical analysis was performed using SPSS (version 20), with a significance level of 95%.

RESULTS

An increase in the collagen and elastic fibers sample was observed in the treated group. Morphometrically, a significant increase in the percentage of collagen in the Carboxytherapy group (41.44 ± 4.50%) was observed compared with the control group (37.44 ± 3.87%) with P = .04; for elastic fibers, the percentage showed no significant difference between the control group (10.55 ± 4.33%) and the carboxytherapy group (10.44 ± 3.71%).

CONCLUSIONS

Carboxytherapy with the parameters used in this study was able to stimulate collagen and elastic fiber synthesis, with significant differences in the morphometry for collagen fibers.

Effectiveness of the Electromagnetic Shock Wave Therapy in the Treatment of Cellulite

In the past centuries, the human body was undervalued; nowadays, however, it is overvalued, and thus the manifestation of the dissatisfactions regarding the body has been increasing. Most of the time, these dissatisfactions are related to cellulite, which is most common in women. Its treatment is one of the challenges which encourage the development of new therapeutic modalities, among them the shockwave therapy. Objective. To evaluate the efficacy of ESWT in the treatment of cellulite in gluteus and posterior of thigh. Method. This is a prospective and comparative study, in which volunteer women who attended the criteria of inclusion were selected and who were subjected to 10 sessions of ESWT. The following were performed as an evaluation method: anthropometry, perimetry, skin viscoelasticity with the Cutometer®, thickness of hypodermis with diagnostic ultrasound, analysis of the scale of severity of cellulite (CSS), and quality of life by the Celluqol® questionnaire. The evaluations occurred before the first session (baseline), after 6 and 10 sessions, and during a follow-up of 3 months after the last session. The statistical test applied was the ANOVA one-way with post hoc of Tukey (P-value < 0.05). Results. There was significant improvement (P<0.05) for CSS, for the variable referring to gross elasticity and skin deformation ability evaluated in the Cutometer® and improvement of quality of life represented by Celluqol®. The result was maintained particularly in the follow-up of 3 months after the end of the treatment. Conclusion. The results presented demonstrated the effectiveness and safety of ESWT in the treatment of cellulite and in the decrease of the degrees, improvement of the aspect of the skin, and reestablishment of quality of life. This trial is registered with ClinicalTrials: NCT03275259.

Carboxytherapy Versus Skin Microneedling in Treatment of Atrophic Postacne Scars: A Comparative Clinical, Histopathological, and Histometrical Study

BACKGROUND

Acne scarring has been a challenge to treat. Microneedling gained popularity in treatment of such scars. Meanwhile, carboxytherapy (CXT) is considered a novel treatment modality for acne scars.

OBJECTIVE

To evaluate efficacy of CXT versus microneedling in treatment of acne scars.

METHODS AND MATERIALS

Thirty-two patients with atrophic acne scars received 6 sessions of microneedling and CXT on right and left sides of face, respectively. Clinical evaluation with histopathological and computerized morphometric analysis was performed at 2 months after treatment.

RESULTS

After either microneedling or CXT, there was significant decrease of total acne scars and its 3 types separately (icepicks, boxcar, and rolling) (p ≤ .001). Comparing both sides of face, there was no significant difference regarding grading response and reduction percentage of total scars and its types (p > .05). Histopathologically, there was an improvement of character and organization of collagen and elastic fibers in addition to significant increase in epidermal thickness on both sides of face, with no significant difference between them (p > .05).

CONCLUSION

Both CXT and microneedling are equally effective, tolerable, safe, and noninvasive treatment modalities of atrophic acne scars. Similar histopathological changes were observed after both modalities, helping in better understanding their action.

Carboxytherapy-Induced Fat loss is Associated with VEGF-Mediated Vascularization

BACKGROUND

Carboxytherapy is the transcutaneous administration of CO₂ gas for therapeutic purposes. Although this non-surgical procedure has been widely used for reducing localized adiposity, its effectiveness on fat loss in obese patients and its underlying mechanisms remain unclear.

METHODS

C57BL/6 mice were fed with a high-fat diet for 8 weeks to generate obese animal models. Obese mice were randomly assigned to two groups: One group was administered air to both inguinal fat pads (air/air), and the other group was treated with air to the left inguinal fat pad and with CO₂ to the right inguinal fat pad (air/CO₂). Each group was treated every other day for 2 weeks. Morphological changes and expression levels of genes associated with lipogenesis and vascularization in fat were determined by histological and qRT-PCR analyses.

RESULTS

Mice treated with air/CO₂ showed lower body weights and blood glucose levels compared to air/air-treated mice. Paired comparison analysis revealed that CO₂ administration significantly decreased adipose tissue weights and adipocyte sizes compared to air treatment. Additionally, CO₂ treatment markedly increased vessel numbers and expressions of Vegfa and Fgf1 genes in adipose tissues. The expressions of Fasn and Fabp4 genes were also modestly reduced in CO₂-treated adipose tissue. Moreover, Ucp1 expression, the target gene of VEGF and a key regulator in energy expenditure, was significantly increased in CO₂-treated adipose tissue.

CONCLUSIONS

Carboxytherapy is effective in the reduction of localized fat in obese patients which is mechanistically associated with alteration of the vasculature involved in VEGF.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effectiveness and Safety of Contrast Cryolipolysis for Subcutaneous-Fat Reduction

Cryolipolysis is the noninvasive treatment of localized fat through cold-induced panniculitis. The purpose of the present study was to evaluate the safety and efficacy of contrast cryolipolysis for subcutaneous-fat reduction. Contrast cryolipolysis mixes the principles of conventional cryolipolysis and periods of heating in accordance with the contrast lipocryolysis process. Twenty-one subjects aged 34 ± 9 years were treated with contrast cryolipolysis in the regions of abdomen and flanks through the Polarys® device. Anthropometry, standardized photographs, measurements with a skinfold caliper, and diagnostic ultrasounds were performed at the baseline and during follow-ups at 30, 60, and 90 days after the treatment. The safety assessments included laboratory testing and monitoring of the adverse events. The level of significance for all tests was set at P < 0.05. No significant differences in weight and body mass index were found. The waist measurements at the baseline and 30-day follow-up had significant differences, as did the measurements at the 30-day and 60-day follow-ups. The skinfold and ultrasound measurements were significantly reduced in the treated areas in all the time points compared to the baseline. The laboratory results showed no significant changes from baseline. Temporary adverse effects were resolved spontaneously. This study confirmed that contrast cryolipolysis is safe and effective in reducing the fat layer and improving body contouring.

Cellulite: A Surgical Treatment Approach

BACKGROUND

Cellulite is one of the most common skin and subcutaneous tissue conditions, affecting predominantly the thighs and hips in postadolescent women. Its etiology is not well defined, and multiple available treatments show variable efficacy.

OBJECTIVES

To describe a technique for treatment of cellulite of the gluteal region, thighs, and hips through superficial liposuction utilizing a special cannula, combined with subcutaneous autologous fat grafting.

METHODS

A retrospective review was performed of patients treated over 26 years at the Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil. Patients underwent pretreatment evaluation as to the extent of their cellulite, and pretreatment and posttreatment photographs were obtained for visual evaluation of the results.

RESULTS

Procedures were performed on 126 patients: 121 (96%) women and 5 (4%) men. The majority considered their results good or excellent. The complication rate was low, with the most common complications being ecchymosis, contour irregularities, partial recurrence of cellulite, seroma, and numbness.

CONCLUSIONS

We describe an effective method for the treatment of cellulite. Whereas subcision techniques utilize a needle or microblade to cut fibrous septa, we utilize a special cannula; larger areas can be treated than with subcision. Fat grafting is utilized to correct depressions and improve skin quality, which are added benefits compared to traditional subcision. Considering the multiple available cellulite treatments and their limitations, and the high patient satisfaction rate we achieved, with a low recurrence and complication rate, this technique can be a safe and effective option for patients with cellulite.

LEVEL OF EVIDENCE 4

Synergistic effects of Combined Therapy: nonfocused ultrasound plus Aussie current for noninvasive body contouring

BACKGROUND AND OBJECTIVES

Nowadays, there are several noninvasive technologies being used for improving of body contouring. The objectives of this pilot study were to verify the effectiveness of the Heccus® device, emphasizing the synergism between nonfocused ultrasound plus Aussie current in the improvement of body contour, and to determine if the association of this therapy with whole-body vibration exercises can have additional positive effects in the results of the treatments.

SUBJECTS AND METHODS

Twenty healthy women aged 20-40 years participated in the study. Ten patients received Combined Therapy treatment (G1) and the other 10 participants received Combined Therapy with additional vibratory platform treatment (G2). Anthropometric and standardized photography analysis, ultrasonography, cutometry and self-adminestered questionnaires of tolerance and satisfaction levels with the treatment were used.

RESULTS

Compared with baseline values, reduction of fat thickness was observed by ultrasonography in the posterior thigh area in the G1 group (P<0.05) and in the buttocks (P<0.05) and the posterior thigh areas (P<0.05) in the G2. All the treated areas in both groups showed reduction in cellulite degree in the buttocks, G1 (P<0.05) and G2 (P<0.05), and in posterior thigh areas, G1 (P<0.05) and G2 (P<0.05). Optimal improvement of skin firmness (G1, P<0.0001; G2, P=0.0034) in the treated areas was observed in both groups.

CONCLUSION

We conclude that the synergistic effects of the Combined Therapy (nonfocused ultrasound plus Aussie current) might be a good option with noninvasive body contouring treatment for improving the aspect of the cellulite, skin firmness and localized fat. If used in association with the whole-body vibratory platform, the results can be better, especially in the treatment of localized fat. Further studies with larger sample size should be performed to confirm these results.

Microfocused Ultrasound with Visualization and Calcium Hydroxylapatite for Improving Skin Laxity and Cellulite Appearance

Age-associated skin laxity contributes to worsening of cellulite appearance. This study evaluated the effects of microfocused ultrasound with visualization (MFU-V; Ultherapy) in combination with diluted calcium hydroxylapatite (CaHA; Radiesse) on cellulite appearance and on neocollagenesis.