Carboxytherapy

Stretchmarks Protocol Technique Gesture Results

妊娠纹
CADIC Philippe, MD, FRANCE
pcadic@gmail.com

www.carboxyworld.com

Monaco June, 2012

CO2 Gas medical effects
Main carbon dioxide health effects and uses in the human body
• • Vasodilation (expansion of arteries and arterioles). The Bohr effect The Bohr effect states that arterial hypocapnia will cause reduced oxygen release in tissue capillaries. Cells Oxygen Levels Oxygen Transport Free Radicals Generation Inflammatory Response CO2 is the key anti-inflammatory agent. Nerve Stabilization Muscle relaxation or relaxation of muscle cells is normal at high CO2 • Brochodilation - dilation of airways: bronchi and bronchioles by carbon dioxide, and their constriction due to hypocapnia. Blood pH regulation and regulation of other bodily fluids. CO2: Lung Damage Healer: Elevated carbon dioxide prevents injury and promotes healing of lung tissues. CO2: Skin and Tissue Healer. Synthesis of Glutamine in the Brain, CO2 fixation, and other chemical reactions: there are many other regulatory and facilitating effects related to uses of carbon dioxide. Regularity and Smoothness of Breathing is controlled by CO2.

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CO2 Gas medical effects
Carbon dioxide Dermatology effects
• Vasodilation (expansion of arteries and arterioles). • Neo vascularization stimulation • The Bohr effect The Bohr effect states that arterial hypocapnia will cause reduced oxygen release in tissue capillaries • Collagen fibers organisation & turnover improvement • Lipolytic effect

Vasodilation (expansion of arteries and arterioles).
CO2: most potent vasodilator
• • Studies related to CO2-induced vasodilation and vasoconstriction Dr. K. P. Buteyko and his colleagues found vasoconstrictive effects of hypocapnia (CO2 deficiency) on arteries and peripheral blood vessels (Buteyko et al, 1964a; Buteyko et al, 1964b; Buteyko et al, 1964c; Buteyko et al, 1965; Buteyko et al, 1967), while additional CO2 causes vasodilation, which is a normal state of arteries and arterioles.

Cell Oxygen Level
• The prime effect of overbreathing is reduced CO2 content in the lungs, blood and other body cells and tissues. Medical studies have found that hyperventilation reduces cell oxygen level in the following vital organs Reduced CO2  Reduced oxygen levels in cells

CO2+ H2O  H+ + HCO3−

heart. vasoconstriction. and suppressed Bohr effect • Since hypocapnia (carbon dioxide deficiency) causes constriction of arteries and arterioles and the suppressed Bohr effect.Carbon Dioxide Transport & Hypocapnia (CO2 Deficiency) • There are 3 independent mechanisms of hypocapnia or carbon dioxide deficiency that hampers efficiency of oxygen transport: chest breathing. • Hence. liver. the effects of chronic hyperventilation on oxygen transport are due to: – constriction of blood vessels: arteries and arterioles (less blood and oxygen is delivered to cells and tissues) – inefficient Bohr effect (less oxygen is released in cells and tissues). . and other vital organs.Cell Oxygen Level Oxygen . overbreathing (breathing more than the medical norm) reduces O2 tension in cells of the brain. kidneys.

They discovered several mechanisms to explain explain the protective antioxidant role of CO2 against free radical damage. Arterial hypocapnia (CO2 deficiency) causes tissue hypoxia Izv Akad Nauk Ser Biol. especially sick. 1997 Mar-Apr.Free Radicals Generation: Normal Effect of Low Body Oxygen Levels • • abnormal breathing is the most powerful source of free radicals and oxidative stress in modern. 2002). [Carbon dioxide--a universal inhibitor of the generation of active oxygen forms [free radicals] by cells (deciphering one enigma of evolution)] • • .(2):204-17. people. "The role of carbon dioxide in free radical reactions of the organism" (Veselá & Wilhelm.

Chronic Inflammation and Anti-Inflammatory CO2 Effects: CO2 has powerful anti-inflammatory abilities • • Abnormally low arterial CO2 is a marker of chronic hyperventilation. Cell hypoxia is a fuel for systemic inflammation CO2 has powerful anti-inflammatory abilities .

Carbon Dioxide  Natural Muscle Relaxant • • • . CO2 is natural sedative and tranquilizer of nerve cells.CO2: Natural Sedative and Tranquilizer: CO2 modifies Muscles and nerve sensitivity • “Studies designed to determine the effects produced by hyperventilation on nerve and muscle have been consistent in their finding on increased irritability” (Brown. 1953). Muscles and nerve cells become abnormally sensitive or irritated. 1965). CO2 has a strong calming effect on excessive excitability of brain areas responsible for thinking (Krnjevic et al.

CO2: Bronchodilator Best Bronchodilators: CO2 and NO • • relaxes smooth muscles or airways and causes dilation of bronchi and bronchioles. Carbon dioxide is probably the most powerful among all bronchodilators since it is the most potent relaxant of smooth muscles and vasodilator .

higher CO2 content causes blood acidification and pH decrease. Blood pH and Respiratory Alkalosis Carbonic Acid-Bicarbonate Buffer System • • • Changes in carbon dioxide and breathing cause immediate and long-term effects of blood pH. while reduced carbon dioxide levels increase blood pH CO2 also influences viscosity of blood. Acute hyperventilation and arterial hypocapnia makes blood more viscous .CO2.

CO2: a healing gas • • • Protective effect of carbon dioxide against bacterial contamination Hypocapnia worsens arterial blood oxygenation CO2 is a skin healer .

CO2. reductions in wrinkles consequent to CO2 therapy and also establish that intradermal injection is better than subcutaneous injection. • . Collagen stimulation Carbonic Acid-Bicarbonate Buffer System • Histological analysis showed intense collagen turnover in the skin samples of the animals treated with CO2. especially in those with intradermal treatment.

CO2. Fat reduction effect Physiological oxidative lipolytic effect • • • • positive effect upon the physiological oxidative lipolytic process Better local oxygenation Better local blood flow Cascading lipolytic enzymes (after pressure stress) ? .

. as revealed by the lysis of adipose cells. the effectiveness of carbon dioxide therapy was confirmed both by histological data and by those regarding variations in the maximum circumference of the areas subjected to treatment. The statistically significant reduction observed in the areas treated (Table 1) was attributable to both a direct effect on adipose tissue.Clinical Studies Cellulite and Localized Fat • Cellulite and Localized fat – Siena 1999 and 2000 . In our study.Italy. and to an indirect effect.

Italy. . Cnclusion: This study has shown that with CO2 therapy to obtain improvement of skin irregularity and cutaneous elasticity is possible.Clinical Studies Cellulite and Localized Fat • Cellulite and Localized fat – Siena 2004 . This has led us to consider the possibility of CO2 therapy as a complement to liposuction.

.Clinical Studies Cellulite 2010 Cnclusion: The results of this audit agree with those reported in smaller prospective series. confirming that carboxytherapy is safe and effective.

Clinical Studies Cellulite and Localized Fat Cnclusion: The percutaneous infiltration of CO2 reduces the population of adipocytes of the anterior abdominal wall and modifies their morphology. .

Specifically.2007 Cnclusion: Due to the vasomotor effects of CO2 and the absence of relevant major side-effects and toxicity. Carboxhytherapy has become increasingly diffused for the treatment of a variety of microcirculatory diseases.Clinical Studies Microcirculation and Lymphedema . the positive effect on lymphatic drainage in microcirculation let to use Carboxytherapy .

2011 Cnclusion: In the group that underwent subcutaneous treatment with CO2 therapy. the results highlighted a significant increase in tissue oxygenation values. . which was confirmed by greater progress of the lesions in terms of both healing and reduction of the injured area.Clinical Studies Chronic Wounds .

2006 .Clinical Studies Aesthetic medicine .

Collagen .2008 .Clinical Studies Aesthetic medicine .

2010 .Clinical Studies SCARS .

Indications .Carboxytherapy Carbon Dioxide Therapy indications Vascular indications • • • • Microvascularization diseases Raynaud’ phenomenon Lower limbs arterial diseases and ischemia Erectile dysfunction with microvascularization disorders Dermatology – Aesthetic indications • • • • • • • Cellulite Localized Fat Post liposuction Eye fatty prolapses Eye Dark circles Eye Wrinkles Naso genian folds • • • • • • Stretchmarks Neck + decolletage rejuvenation Face Wrinkles Surgical scars / acne scars Psoriasis Healing process .

Carboxytherapy Carbon Dioxide Therapy contra indications General contra indications • • • • • • • • • • • • • • • • • • needle phobia stress. cancer (healing disorders) patients with impaired healing connective tissue disorders or diseases bleeding diseases:Willebrand’ disorder. chronic obstructive lung diseases sleep apnea renal failure. . congestive heart disease recent heart infarction or instable angina pectoris restrictive pulmonary disease. with history of vagal unconsciousness event severe heart failure. dialysis recent cerebrovascular accident uncontrolled blood pressure epilepsy recent phlebitis or pulmonary embolism uncontrolled diabetes immunosupression or deficiency chemotherapy.Contra Indications . hemophilia.

.Carboxytherapy Carbon Dioxide Therapy contra indications Local contra indications • • • • • • • • bacterial infection: dermatitis. cellulitis foreign body in the area to be treated (jewellery implants and so on) herpes simplex in acute phase and other acute skin viral infection skin disease with abnormally increased local circulation facial rosacea poikiloderma of Civatte red necks and red decolletage.Contra Indications .

Contra Indications .Carboxytherapy Carbon Dioxide Therapy contra indications Temporary contra indications • • • • • pregnancy (precautionary principle) lactation (precautionary principle) anticoagulation. . recent aspirin or antiinflammatory drugs intake acute skin infection (wait until it is cured) other aesthetic procedure or skin traumatism less than 15 days prior to CDT.

Carboxytherapy Complications Classical complications • • • • Same profile of risk than mesotherapy Infection at the point of injection Inflammatory reaction at the point of injection (lack of purge) Eye oedema at the point of injection Hematoma at the point of injection • Gas embolism: never described since 1930. • . Single use disposable consumables. Blood virus transmission: never described. Cannot compare to laparoscopic surgery. Very small amounts of CO2.

Carboxytherapy Side effects Classical side effets / end points • • • • • • Pain at the point of injection because of an increase in pressure Erythema at the point of injection Temporary anesthesia lower than the infection point Emphysema sensation (temporary feeling) Heat sensation (vasodilatation) Vagal syndrome .

just wait a couple of minutes until the effect stops. Just wait Emphysema sensation (temporary feeling) – This is a end point. Last around 15 minutes. Temporary anesthesia lower than the infection point – The sensation of anesthesia lasts about 1 to 3 minutes. Wait 3 to 15 minutes until it stops . Heat sensation (vasodilatation) – This is a end point. Stimulate (vibration) other part of the skin • • • • Erythema at the point of injection – This is a end point.Carboxytherapy Prevent the occurrence of side effects • Pain at the point of injection because of an increase in pressure – – – – – Use lower injection flows Take breaks during injections shorten the duration of the injection & make multiple injections points Practice local massage to help the gas diffuse.

lower legs treatements) Get sure the patient is not with empty stomach Get sure the patient has no needle phobia Get sure the patient has no hypoglycemia Install your patient in a comfortable position • In case of Vagal syndrome – Stop the injection of CO2 – elevate the legs of patients for more blood to the brain – assess the interest of injecting atropine .Carboxytherapy Prevent the occurrence of side effects • Vagal syndrome – – – – – Vagal syndrome might be severe (sensitive patients.

Lowering pain  achieve a gradual increase in pressure Intradermal injections pain is related to dermis traumatism Lowering pain  reduce the trauma = reduce flow value note that reduced flow value = reduced efficacy • .Carboxytherapy Carboxytherapy managing pain levels Pain levels and painful area • Subcutaneous injections pain is related to an increase of pressure in the hypodermis and fat tissue.

Protect cylinders from damage Never insert an object (e. Test for sufficient oxygen. wrench.g. Toxicity • • • • • CO2 tanks and cartridges : 50 bars / 700 PSI  Risk of explosion and injury Pressurized CO2 ~-78°C : Risk of burn by freezing skin or cornea High pressure and grease: risk of explosion with pressure regulators Not Flammable Personal Precautions. before allowing reentry.Security considerations with CO2 Necessary precautions with CO2 gas.. screwdriver. Ventilate area or move cylinder to a well-ventilated area. pry bar) into cap openings Open valve slowly Never put cylinders of tank into the fire or expose to high temperatures Use CO2 detectors in rooms • • • • • . especially in confined spaces.

Hold the eyelids open and away from the eyeballs to ensure that all surfaces are flushed thoroughly. If breathing is difficult. SKIN CONTACT: For exposure to cold vapor or solid. Toxicity • INHALATION: Immediately remove to fresh air. immediately warm frostbite area with warm water not to exceed 105°F (41°C). If not breathing. SWALLOWING: An unlikely route of exposure. EYE CONTACT: For exposure to cold vapor or solid. immediately flush eyes thoroughly with warm water for at least 15 minutes. qualified personnel may give oxygen. give artificial respiration.Security (First Aid) Necessary precautions with CO2 gas. remove contaminated clothing while showering with warm water.  ophthalmologist • • • . In case of massive exposure.

CO2 machines parts Main parts of a CDT machine • • • • • • • • • CO2 tank connector Pressure regulator Pressure gauge (high . low) Flow regulator Low pressure sensor + modulator Heater (optional) Co2 exit port Bacterial filter 30 G needle .

Schematic Diagram Various types of options in a Carboxytherapy equipment .

viruses) Disposable. dusts.22% filter (filters bacteria.Consumables Key injections parts • • • • Mesotherapy needles: 30G (yellow) needle 0. one use consumables (security) Plastic tubings (optional) . fungus.

Injections layers / planes Intradermal or Sub cutaneous planes • • Fat  Sub-cutaneous injections Stretchmarks. Skin rejuvenation. Eyes. …  Intradermal Subcutaneous Deep Dermis Superficial dermis .

Injections layers / planes Intradermal or Sub cutaneous planes Sub cutaneous injections • Subcutaneous CDT injections are administered to reach the localized fat area. activate lipolysis and improve blood flow. • Subcutaneous CDT injections are also used for – – – – Raynaud’ phenomenon Lower limbs arterial diseases and ischemia Microvascularization disorders Psoriasis .

Injections layers / planes SUB CUTANEOUS LAYERS INJECTION • Needle angle ~ 40-45° .

Angle > 45° The plan is injected subcutaneously surface so you can tracks & see the progression of the gas under the skin. Being too deep can complicate the visual tracking of the gas diffusion. the operator moves the needle to cover the contiguous zone. When the disk is obtained. Aspect of crepe paper with a slight erythema. . The injection time is generally 60 to 90 sec per injection point It forms a disk of about 15 to 20 cm in diameter.Injections layers / planes Sub cutaneous injection • • • • • • • • The subcutaneous injection is performed by 30G needle (mesotherapy needle). The patient may report a heat sensation (vasodilation).

Injections layers / planes Sub cutaneous injection • Video on the DVD .

Injections layers / planes Intradermal or Sub cutaneous planes Intradermal injections • Intradermal CDT injections are administered to improve collagen turnover and stimulate fibers orientation. Eye Dark circles . • • • • • • Acne scars Surgical scars Traumatic scars Stretch marks Skin rejuvenation Eye wrinkles .

Injections layers / planes INTRADERMAL LAYERS INJECTION • Needle angle <15° .

Intradermal injection of normal skin gives a small disc of about 1. (papule). The injection causes an immediate detachment of the skin. • . Normal skin  Papule (2 cm) Intradermal injection of stretch mark skin gives a linear detachment following stretch mark’s alignment.Injections layers / planes INTRADERMAL injection • • • • • • Intradermal injection is performed by 30G mesotherapy needle. beveled edge upwards. Stretch marks  Popcorn effect A rash/erythema usually follows the injection It lasts 5 to 10 minutes. The needle is inserted at an angle of 15 ° or less. Injected into the dermis (same technique as for intradermal tuberculin tests).5 to 2 cm.

Injections layers / planes INTRADERMAL injection .

Injections layers / planes INTRADERMAL injection .

pregnancy.Hematoma • . severe heart/respiratory/renal disease. localised infection. recent cerebrovascular accident are the most published CI. Complications: infection  Mesotherapy like technique = complication of mesotherapy.Co2 for old stretch marks • CO2 injections striaes would benefit from: – Improved neovascularisation and blood flow in treated areas (red color under white color  Pink …) – Improved collagen synthesis into the dermis (trauma  Remodeling) – Suspected stimulation of melanocyte’s pigment production (Bohr’s Effect causing a better release of oxygen from hemoglobin to the superficial skin layers) • • Indications : White old stretch marks (depressed and/or hypopigmented) Contraindications: healing disorder. Scars (hypertrophic/keloids) . anticoagulation.

. deep depressed stretch marks. irregular old stretch marks are the main indications. 1 month apart. laser treatment is preferred: KTP or pulsed dye laser. • For young pink/red stretch marks. one to three sessions.Stretchmarks CDT protocol Principle • Stimulate blood flow : for a better oxygenation of the lid • Stimulate the synthesis of Collagen • Break fibrous septa of depressed SM Indications • Old white stretch marks.

Spaced each 2 cm approx.Protocol for Striae • Based 2006 CDT Consensus Meeting protocols (Brazil). Number of sessions: 4 to 10 sessions Subcutaneous injection Best indications from experience ( ~ 100 procedures) Old Striaes > Young red striaes (other modalities such as laser) Deep striaes > Thin striaes Corrugated striaes > White superficial striaes Internal side of thighs > external side Abdomen > Lower limbs > Upper limbs Dark skin > white phototypes Intradermal injection . • • • • • Combined Intradermal injections + Subcutaneous 1 session per month Flow 80 to 150 cc/min (painful) Puncture inside the mark.

End point & Results • After injection – – – – Pop-corn effect. lasts from 5 to 10 minutes after injection Warmth sensation 5 to 10 minutes after injection Then back to normal appearance • Improvement may usually be seen after 1 to 2 sessions – White color improves because red vessels below striaes. 1 to 2 minutes after injection Erythema. and pigment stimulation – Stretch marks depth improves because of collagen synthesis stimulation – Skin thightening may be seen also in treated areas .

Protocol for Striae .

Results 3 sessions . Dr CADIC – May 2008 . 90 cc/min. 52 years old French Female. monthly spaced.

Results 10 sessions – black skin french female Courtesy Dr Mole (Paris) .

3 sessions on her legs at 80cc/min every 3 weeks Sept 2008 .Results Female: PhotoType 4 .

4 sessions .150cc/min every 4 weeks Nov 2009 .Results Female ~ Age 23: Old SM after pregnancy PhotoType 3 .

– A minimally invasive technique (similar to mesotherapy) with few side effects – A quick technique in the realization of gesture – No down time – A technique that can be delegated to a nurse – Visible improvements from the first or second session when it works – An inexpensive equipment .Conclusion • Advantages – An opportunity to propose something where there are not many alternatives.

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