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Carbon Dioxide Therapy: ‘Magic Gas or Hot Air?’ An overview with Dr. Patrick Treacy RSM March 2014

Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

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Carboxytherapy is a non-surgical cosmetic medicine treatment. Carboxytherapy employs injections to infuse gaseous carbon dioxide below the skin into the subcutaneous tissue through a needle. It claims to kill fat cells, stimulate blood flow, improve the skin's elasticity and reduce the appearance of cellulite although it has not been clinically tested nor approved by the FDA

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Page 1: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

Carbon Dioxide Therapy lsquoMagic Gas or Hot Airrsquo

An overview with Dr Patrick Treacy RSM March 2014

RioBlush

So where are we

lsquoMagic Gas or Hot Airrsquo

What is Carboxytherapy

Carbon dioxide therapy (Carboxytherapy) is a procedure similar to mesotherapy It consists of intradermal or subcutaneous injections of medical grade CO2 using 30G needles

The gas in injected either into the subcutaneous layers to improve fat either into the dermis layers to improve wrinkles stretch marks and under-eye circle

Carboxytherapy has been widely used in the last 10 years in South America in Brazil for cosmetic purposes stretch marks cellulite localized adiposities and under-eye dark circles in combination with other minimally invasive procedures

Carboxytherapy can be performed at the office with no down time It requires the physician to get a CO2 insufflator equipment tubing bacterial filters and small needles

Where does the CO2 story start

Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could

continue his experiments was cut short by the judge La Reacutepublique na pas besoin de

savants ni de chimistes le cours de la justice ne peut ecirctre suspendu

The Republic needs neither scientists nor chemists the course of justice cannot be

delayed

Lalouette (1777 )

bull Joseph Black isolated carbon dioxide in 1757bull Henry Cavendish isolated hydrogen in 1766 bull Daniel Rutherford isolated nitrogen in 1772 bull Joseph Priestly isolated oxygen in 1772

bull Lalouette showed in 1777 that carbon dioxide improved chronic and inveterate skin problems especially in foot ulcers not response to convention treatments such as daily dressings and debridement

bull Carbon dioxide water bath therapy (carbothera) springsrdquo or (artificial) therapeutic CO2 officially recognized in France as medications

bull

Scientific Publications

Carbotherapy continued to be used in France and publications begin to appear in the early 1930sDoctors in the medical spa of Royat found that transdermal use of CO2 in enriched warm baths improved vascular ischemia symptoms because of a strong direct vasodilator effect a neo-angiogenesis effect and better oxygen release in superficial tissues

Neo-angiogenesis effect

The first experiments in the 1930s consistedof injecting CO2 into the leg of a frog They

showed a strong vasodilatation associated with the creation of new capillaries

Mechanism of action Effects of CO2

bull Vasodilatation

bull The first effects following CO2 injection is a strong vasodilatation a blood flow increase and a higher pO2 in the treated area

bull The Bohr effect bull Local oxygen release is improved because of the Bohr effect The

Bohr effect describes the tendency of haemoglobin to have less affinity for oxygen when the blood concentration of CO2 is increased This lower affinity leads the haemoglobin to release the oxygen better in superficial tissues and muscles CO2 is quickly converted to bicarbonates and H+ acid in presence of the carbonic anhydrase enzyme

bull CO2 + H2O 1048774 H+ + HCO3

Bohr Effect

bull This reaction causes the tissuersquos pH to become acidic with even more dissociation of O2 from haemoglobin allowing the tissue to become even more oxygenated

Stimulation of collagen synthesis

bull A 2008 Brazilian study showed a reorganization of collagen fibres following intradermal injections of carbon dioxide and demonstrated that the CO2 is capable of increasing the collagen turnover a trauma to the dermis launches a healing process with collagen synthesis

bull CO2 improves the process by first increasing neovascularization with more healing substances and factors to be on site In second it releases more oxygen around and in the healing area improving the recovery phase

Stretch marksPrinciple

Improve neovascularization and blood flow (red color seen via skin transparency will appear pink close to the natural skin color) improve melanocyte pigment production to darken white stretch marks Improve collagen synthesis to reduce the wave appearance of old stretch marks

Indications

Old white stretch marks deep depressed stretch marks irregular old stretch marks are the main indications Young pinkred stretch marks should preferably have laser treatment (KTP or pulsed dye laser)

Protocol Combined intradermal and subcutaneous injections One session per month Flow 80ndash150 ccmin Puncture inside the mark Number of sessions four to ten

Technique Start injecting the dermis and when done push the needle further to inject the subcutaneous layers Endpoints Popcorn appearance (inflated stretch marks) for 1 or 2 minutes then erythema Injection points Follow each stretch mark and inject each 1ndash2 cm Post-treatment care No post injection care is required Pain management Injecting stretch marks is often painful Patients describe a burning sensation Although flow greater than 100 ccmin is recommended it is sometimes impossible to maintain these values because of the pain Lowering flows to 70ndash80 ccmin may make the patient more comfortable

Periorbital AreaPrinciple

Increase blood flow stimulate collagen production reduce fatty prolapse in some cases

Indications

Fatty prolapse eye wrinkles under-eye dark circles Smoker female with dark circle are good indications

Protocols

Eye wrinkles Combined intradermal and subcutaneous injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six

Under-eye dark circles Intradermal injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six Fatty prolapse Subcutaneous and intradermal injections One session per month Flow 20ndash40 ccmin Puncture in the fatty area Number of sessions three to six

Technique Injection points Fatty prolapse will receive two to four quick punctures in the area where the fat

resides Eye wrinkles and dark circles require from 2 to 3 punctures 1 or 2 cm spaced 1 or 2 seconds each made all along the external inferior border of the eye orbit next to the orbit bones (zygomatic bone)

Endpoints Eye lid becomes distended and inflated Upper eye lid distension may be important

Fatty prolapses are inflated and red The eye returns to normal appearance within 2 or 3 minutes

Post-treatment care No post-treatment care is required Sun protection may be used in the next 2 weeks

Pain management Emlareg if treatment is too painful (This cream lowers the Bohr effect vasoconstriction

reduces blood flow) To reduce pain lower the flow and increase the number of punctures

Caution

One of the major CO2 side effects and complication is pertinent to the eyelid procedure It is important to purge and remove any trace of oxygenair in the tubes and needle O2 injection into the eye lid leads to a strong inflammatory reaction which lasts 4 or 5 days with redness edema closed eye and pain

Celluliteorange peel skin

Principle Stimulate blood flow and activate receptors involved in the natural lipolysis of the body Improve skin tightening to reduce orange peel skin Fibrous cellulite treatments will require mechanical disruption of fibrous septae with higher CO2 flows Indication All types of cellulite from grade IndashII to grade IIIndashIV Subcutaneous irregularities after liposuction Complementary treatment to liposuction which does not have any efficacy on cellulite

Protocol

Cellulite grade I or II

Combination of subcutaneous and intradermal injections One session per day to one per week Flow 1ndash2 cckgmin ndash approximately 2 minutes per injection Punctures 15ndash20 cm spaced no overlapping - Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Cellulite grade III or IV Combination of subcutaneous and intradermal injection One session per day to one per week Flow gt2 cckgmin Punctures 15ndash20 cm spaced no overlapping Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Technique The operatorrsquos hand movement should target both the subcutaneous layer and the intradermal layer as

both lipolysis and collagen synthesis need to be activated

Injection points Injections points should be made in the area where cellulite resides hips and thighs

Endpoint Subcutaneous injection will let the gas diffuse and create a 15ndash20 cm diameter granite-like appearance

disk After several sessions the skin offers less resistance to the gas diffusion so a few injections point may then be enough to treat the all cellulite area

Post-treatment care No post-injection care is necessary

Pain management Pain is more frequent in the first sessions CO2 can be reduced in the first sessions and progressively

increased from session to session If too much pain is reported change the injection point and reduce the treatment time giving more shorter injections

Maximizing results CDT may benefit from combination with such treatments as RF Cellu-M6 Velasmooth and manual

lymphatic massage Dietetic advice should be given to help the patient maintain a stable weight

Reinforcement sessions Patients are usually advised to renew the treatment at least once a year in order to maintain the

Localized fat

Indication Any kind of localized fat or skin irregularity after liposuction Can also be a complementary treatment to liposuction to treat the remaining fat Protocol Subcutaneous layer 1 session per day to 1 per week Flow 1ndash2 cckgmin (50ndash80 ccmin) approximately 2 minutes per injection point Punctures spaced 15ndash20 cm apart Number of sessions 10ndash20 ndash First results usually seen after session 4~6 Progressive flow (automatic mode) available with some machines Submentonian area deep dermis (andor subcutaneous) Flow 1ndash2 cckgmin (50ndash80 ccmin) Approximately 30ndash60 seconds per area injected (until onset of erythema or pain) - Usually three punctures (one in the center one left side one right side) May trigger a tempo-mandibular articulation pain (lasts 1 or 2 minutes)

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 2: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

RioBlush

So where are we

lsquoMagic Gas or Hot Airrsquo

What is Carboxytherapy

Carbon dioxide therapy (Carboxytherapy) is a procedure similar to mesotherapy It consists of intradermal or subcutaneous injections of medical grade CO2 using 30G needles

The gas in injected either into the subcutaneous layers to improve fat either into the dermis layers to improve wrinkles stretch marks and under-eye circle

Carboxytherapy has been widely used in the last 10 years in South America in Brazil for cosmetic purposes stretch marks cellulite localized adiposities and under-eye dark circles in combination with other minimally invasive procedures

Carboxytherapy can be performed at the office with no down time It requires the physician to get a CO2 insufflator equipment tubing bacterial filters and small needles

Where does the CO2 story start

Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could

continue his experiments was cut short by the judge La Reacutepublique na pas besoin de

savants ni de chimistes le cours de la justice ne peut ecirctre suspendu

The Republic needs neither scientists nor chemists the course of justice cannot be

delayed

Lalouette (1777 )

bull Joseph Black isolated carbon dioxide in 1757bull Henry Cavendish isolated hydrogen in 1766 bull Daniel Rutherford isolated nitrogen in 1772 bull Joseph Priestly isolated oxygen in 1772

bull Lalouette showed in 1777 that carbon dioxide improved chronic and inveterate skin problems especially in foot ulcers not response to convention treatments such as daily dressings and debridement

bull Carbon dioxide water bath therapy (carbothera) springsrdquo or (artificial) therapeutic CO2 officially recognized in France as medications

bull

Scientific Publications

Carbotherapy continued to be used in France and publications begin to appear in the early 1930sDoctors in the medical spa of Royat found that transdermal use of CO2 in enriched warm baths improved vascular ischemia symptoms because of a strong direct vasodilator effect a neo-angiogenesis effect and better oxygen release in superficial tissues

Neo-angiogenesis effect

The first experiments in the 1930s consistedof injecting CO2 into the leg of a frog They

showed a strong vasodilatation associated with the creation of new capillaries

Mechanism of action Effects of CO2

bull Vasodilatation

bull The first effects following CO2 injection is a strong vasodilatation a blood flow increase and a higher pO2 in the treated area

bull The Bohr effect bull Local oxygen release is improved because of the Bohr effect The

Bohr effect describes the tendency of haemoglobin to have less affinity for oxygen when the blood concentration of CO2 is increased This lower affinity leads the haemoglobin to release the oxygen better in superficial tissues and muscles CO2 is quickly converted to bicarbonates and H+ acid in presence of the carbonic anhydrase enzyme

bull CO2 + H2O 1048774 H+ + HCO3

Bohr Effect

bull This reaction causes the tissuersquos pH to become acidic with even more dissociation of O2 from haemoglobin allowing the tissue to become even more oxygenated

Stimulation of collagen synthesis

bull A 2008 Brazilian study showed a reorganization of collagen fibres following intradermal injections of carbon dioxide and demonstrated that the CO2 is capable of increasing the collagen turnover a trauma to the dermis launches a healing process with collagen synthesis

bull CO2 improves the process by first increasing neovascularization with more healing substances and factors to be on site In second it releases more oxygen around and in the healing area improving the recovery phase

Stretch marksPrinciple

Improve neovascularization and blood flow (red color seen via skin transparency will appear pink close to the natural skin color) improve melanocyte pigment production to darken white stretch marks Improve collagen synthesis to reduce the wave appearance of old stretch marks

Indications

Old white stretch marks deep depressed stretch marks irregular old stretch marks are the main indications Young pinkred stretch marks should preferably have laser treatment (KTP or pulsed dye laser)

Protocol Combined intradermal and subcutaneous injections One session per month Flow 80ndash150 ccmin Puncture inside the mark Number of sessions four to ten

Technique Start injecting the dermis and when done push the needle further to inject the subcutaneous layers Endpoints Popcorn appearance (inflated stretch marks) for 1 or 2 minutes then erythema Injection points Follow each stretch mark and inject each 1ndash2 cm Post-treatment care No post injection care is required Pain management Injecting stretch marks is often painful Patients describe a burning sensation Although flow greater than 100 ccmin is recommended it is sometimes impossible to maintain these values because of the pain Lowering flows to 70ndash80 ccmin may make the patient more comfortable

Periorbital AreaPrinciple

Increase blood flow stimulate collagen production reduce fatty prolapse in some cases

Indications

Fatty prolapse eye wrinkles under-eye dark circles Smoker female with dark circle are good indications

Protocols

Eye wrinkles Combined intradermal and subcutaneous injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six

Under-eye dark circles Intradermal injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six Fatty prolapse Subcutaneous and intradermal injections One session per month Flow 20ndash40 ccmin Puncture in the fatty area Number of sessions three to six

Technique Injection points Fatty prolapse will receive two to four quick punctures in the area where the fat

resides Eye wrinkles and dark circles require from 2 to 3 punctures 1 or 2 cm spaced 1 or 2 seconds each made all along the external inferior border of the eye orbit next to the orbit bones (zygomatic bone)

Endpoints Eye lid becomes distended and inflated Upper eye lid distension may be important

Fatty prolapses are inflated and red The eye returns to normal appearance within 2 or 3 minutes

Post-treatment care No post-treatment care is required Sun protection may be used in the next 2 weeks

Pain management Emlareg if treatment is too painful (This cream lowers the Bohr effect vasoconstriction

reduces blood flow) To reduce pain lower the flow and increase the number of punctures

Caution

One of the major CO2 side effects and complication is pertinent to the eyelid procedure It is important to purge and remove any trace of oxygenair in the tubes and needle O2 injection into the eye lid leads to a strong inflammatory reaction which lasts 4 or 5 days with redness edema closed eye and pain

Celluliteorange peel skin

Principle Stimulate blood flow and activate receptors involved in the natural lipolysis of the body Improve skin tightening to reduce orange peel skin Fibrous cellulite treatments will require mechanical disruption of fibrous septae with higher CO2 flows Indication All types of cellulite from grade IndashII to grade IIIndashIV Subcutaneous irregularities after liposuction Complementary treatment to liposuction which does not have any efficacy on cellulite

Protocol

Cellulite grade I or II

Combination of subcutaneous and intradermal injections One session per day to one per week Flow 1ndash2 cckgmin ndash approximately 2 minutes per injection Punctures 15ndash20 cm spaced no overlapping - Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Cellulite grade III or IV Combination of subcutaneous and intradermal injection One session per day to one per week Flow gt2 cckgmin Punctures 15ndash20 cm spaced no overlapping Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Technique The operatorrsquos hand movement should target both the subcutaneous layer and the intradermal layer as

both lipolysis and collagen synthesis need to be activated

Injection points Injections points should be made in the area where cellulite resides hips and thighs

Endpoint Subcutaneous injection will let the gas diffuse and create a 15ndash20 cm diameter granite-like appearance

disk After several sessions the skin offers less resistance to the gas diffusion so a few injections point may then be enough to treat the all cellulite area

Post-treatment care No post-injection care is necessary

Pain management Pain is more frequent in the first sessions CO2 can be reduced in the first sessions and progressively

increased from session to session If too much pain is reported change the injection point and reduce the treatment time giving more shorter injections

Maximizing results CDT may benefit from combination with such treatments as RF Cellu-M6 Velasmooth and manual

lymphatic massage Dietetic advice should be given to help the patient maintain a stable weight

Reinforcement sessions Patients are usually advised to renew the treatment at least once a year in order to maintain the

Localized fat

Indication Any kind of localized fat or skin irregularity after liposuction Can also be a complementary treatment to liposuction to treat the remaining fat Protocol Subcutaneous layer 1 session per day to 1 per week Flow 1ndash2 cckgmin (50ndash80 ccmin) approximately 2 minutes per injection point Punctures spaced 15ndash20 cm apart Number of sessions 10ndash20 ndash First results usually seen after session 4~6 Progressive flow (automatic mode) available with some machines Submentonian area deep dermis (andor subcutaneous) Flow 1ndash2 cckgmin (50ndash80 ccmin) Approximately 30ndash60 seconds per area injected (until onset of erythema or pain) - Usually three punctures (one in the center one left side one right side) May trigger a tempo-mandibular articulation pain (lasts 1 or 2 minutes)

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 3: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

So where are we

lsquoMagic Gas or Hot Airrsquo

What is Carboxytherapy

Carbon dioxide therapy (Carboxytherapy) is a procedure similar to mesotherapy It consists of intradermal or subcutaneous injections of medical grade CO2 using 30G needles

The gas in injected either into the subcutaneous layers to improve fat either into the dermis layers to improve wrinkles stretch marks and under-eye circle

Carboxytherapy has been widely used in the last 10 years in South America in Brazil for cosmetic purposes stretch marks cellulite localized adiposities and under-eye dark circles in combination with other minimally invasive procedures

Carboxytherapy can be performed at the office with no down time It requires the physician to get a CO2 insufflator equipment tubing bacterial filters and small needles

Where does the CO2 story start

Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could

continue his experiments was cut short by the judge La Reacutepublique na pas besoin de

savants ni de chimistes le cours de la justice ne peut ecirctre suspendu

The Republic needs neither scientists nor chemists the course of justice cannot be

delayed

Lalouette (1777 )

bull Joseph Black isolated carbon dioxide in 1757bull Henry Cavendish isolated hydrogen in 1766 bull Daniel Rutherford isolated nitrogen in 1772 bull Joseph Priestly isolated oxygen in 1772

bull Lalouette showed in 1777 that carbon dioxide improved chronic and inveterate skin problems especially in foot ulcers not response to convention treatments such as daily dressings and debridement

bull Carbon dioxide water bath therapy (carbothera) springsrdquo or (artificial) therapeutic CO2 officially recognized in France as medications

bull

Scientific Publications

Carbotherapy continued to be used in France and publications begin to appear in the early 1930sDoctors in the medical spa of Royat found that transdermal use of CO2 in enriched warm baths improved vascular ischemia symptoms because of a strong direct vasodilator effect a neo-angiogenesis effect and better oxygen release in superficial tissues

Neo-angiogenesis effect

The first experiments in the 1930s consistedof injecting CO2 into the leg of a frog They

showed a strong vasodilatation associated with the creation of new capillaries

Mechanism of action Effects of CO2

bull Vasodilatation

bull The first effects following CO2 injection is a strong vasodilatation a blood flow increase and a higher pO2 in the treated area

bull The Bohr effect bull Local oxygen release is improved because of the Bohr effect The

Bohr effect describes the tendency of haemoglobin to have less affinity for oxygen when the blood concentration of CO2 is increased This lower affinity leads the haemoglobin to release the oxygen better in superficial tissues and muscles CO2 is quickly converted to bicarbonates and H+ acid in presence of the carbonic anhydrase enzyme

bull CO2 + H2O 1048774 H+ + HCO3

Bohr Effect

bull This reaction causes the tissuersquos pH to become acidic with even more dissociation of O2 from haemoglobin allowing the tissue to become even more oxygenated

Stimulation of collagen synthesis

bull A 2008 Brazilian study showed a reorganization of collagen fibres following intradermal injections of carbon dioxide and demonstrated that the CO2 is capable of increasing the collagen turnover a trauma to the dermis launches a healing process with collagen synthesis

bull CO2 improves the process by first increasing neovascularization with more healing substances and factors to be on site In second it releases more oxygen around and in the healing area improving the recovery phase

Stretch marksPrinciple

Improve neovascularization and blood flow (red color seen via skin transparency will appear pink close to the natural skin color) improve melanocyte pigment production to darken white stretch marks Improve collagen synthesis to reduce the wave appearance of old stretch marks

Indications

Old white stretch marks deep depressed stretch marks irregular old stretch marks are the main indications Young pinkred stretch marks should preferably have laser treatment (KTP or pulsed dye laser)

Protocol Combined intradermal and subcutaneous injections One session per month Flow 80ndash150 ccmin Puncture inside the mark Number of sessions four to ten

Technique Start injecting the dermis and when done push the needle further to inject the subcutaneous layers Endpoints Popcorn appearance (inflated stretch marks) for 1 or 2 minutes then erythema Injection points Follow each stretch mark and inject each 1ndash2 cm Post-treatment care No post injection care is required Pain management Injecting stretch marks is often painful Patients describe a burning sensation Although flow greater than 100 ccmin is recommended it is sometimes impossible to maintain these values because of the pain Lowering flows to 70ndash80 ccmin may make the patient more comfortable

Periorbital AreaPrinciple

Increase blood flow stimulate collagen production reduce fatty prolapse in some cases

Indications

Fatty prolapse eye wrinkles under-eye dark circles Smoker female with dark circle are good indications

Protocols

Eye wrinkles Combined intradermal and subcutaneous injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six

Under-eye dark circles Intradermal injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six Fatty prolapse Subcutaneous and intradermal injections One session per month Flow 20ndash40 ccmin Puncture in the fatty area Number of sessions three to six

Technique Injection points Fatty prolapse will receive two to four quick punctures in the area where the fat

resides Eye wrinkles and dark circles require from 2 to 3 punctures 1 or 2 cm spaced 1 or 2 seconds each made all along the external inferior border of the eye orbit next to the orbit bones (zygomatic bone)

Endpoints Eye lid becomes distended and inflated Upper eye lid distension may be important

Fatty prolapses are inflated and red The eye returns to normal appearance within 2 or 3 minutes

Post-treatment care No post-treatment care is required Sun protection may be used in the next 2 weeks

Pain management Emlareg if treatment is too painful (This cream lowers the Bohr effect vasoconstriction

reduces blood flow) To reduce pain lower the flow and increase the number of punctures

Caution

One of the major CO2 side effects and complication is pertinent to the eyelid procedure It is important to purge and remove any trace of oxygenair in the tubes and needle O2 injection into the eye lid leads to a strong inflammatory reaction which lasts 4 or 5 days with redness edema closed eye and pain

Celluliteorange peel skin

Principle Stimulate blood flow and activate receptors involved in the natural lipolysis of the body Improve skin tightening to reduce orange peel skin Fibrous cellulite treatments will require mechanical disruption of fibrous septae with higher CO2 flows Indication All types of cellulite from grade IndashII to grade IIIndashIV Subcutaneous irregularities after liposuction Complementary treatment to liposuction which does not have any efficacy on cellulite

Protocol

Cellulite grade I or II

Combination of subcutaneous and intradermal injections One session per day to one per week Flow 1ndash2 cckgmin ndash approximately 2 minutes per injection Punctures 15ndash20 cm spaced no overlapping - Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Cellulite grade III or IV Combination of subcutaneous and intradermal injection One session per day to one per week Flow gt2 cckgmin Punctures 15ndash20 cm spaced no overlapping Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Technique The operatorrsquos hand movement should target both the subcutaneous layer and the intradermal layer as

both lipolysis and collagen synthesis need to be activated

Injection points Injections points should be made in the area where cellulite resides hips and thighs

Endpoint Subcutaneous injection will let the gas diffuse and create a 15ndash20 cm diameter granite-like appearance

disk After several sessions the skin offers less resistance to the gas diffusion so a few injections point may then be enough to treat the all cellulite area

Post-treatment care No post-injection care is necessary

Pain management Pain is more frequent in the first sessions CO2 can be reduced in the first sessions and progressively

increased from session to session If too much pain is reported change the injection point and reduce the treatment time giving more shorter injections

Maximizing results CDT may benefit from combination with such treatments as RF Cellu-M6 Velasmooth and manual

lymphatic massage Dietetic advice should be given to help the patient maintain a stable weight

Reinforcement sessions Patients are usually advised to renew the treatment at least once a year in order to maintain the

Localized fat

Indication Any kind of localized fat or skin irregularity after liposuction Can also be a complementary treatment to liposuction to treat the remaining fat Protocol Subcutaneous layer 1 session per day to 1 per week Flow 1ndash2 cckgmin (50ndash80 ccmin) approximately 2 minutes per injection point Punctures spaced 15ndash20 cm apart Number of sessions 10ndash20 ndash First results usually seen after session 4~6 Progressive flow (automatic mode) available with some machines Submentonian area deep dermis (andor subcutaneous) Flow 1ndash2 cckgmin (50ndash80 ccmin) Approximately 30ndash60 seconds per area injected (until onset of erythema or pain) - Usually three punctures (one in the center one left side one right side) May trigger a tempo-mandibular articulation pain (lasts 1 or 2 minutes)

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 4: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

What is Carboxytherapy

Carbon dioxide therapy (Carboxytherapy) is a procedure similar to mesotherapy It consists of intradermal or subcutaneous injections of medical grade CO2 using 30G needles

The gas in injected either into the subcutaneous layers to improve fat either into the dermis layers to improve wrinkles stretch marks and under-eye circle

Carboxytherapy has been widely used in the last 10 years in South America in Brazil for cosmetic purposes stretch marks cellulite localized adiposities and under-eye dark circles in combination with other minimally invasive procedures

Carboxytherapy can be performed at the office with no down time It requires the physician to get a CO2 insufflator equipment tubing bacterial filters and small needles

Where does the CO2 story start

Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could

continue his experiments was cut short by the judge La Reacutepublique na pas besoin de

savants ni de chimistes le cours de la justice ne peut ecirctre suspendu

The Republic needs neither scientists nor chemists the course of justice cannot be

delayed

Lalouette (1777 )

bull Joseph Black isolated carbon dioxide in 1757bull Henry Cavendish isolated hydrogen in 1766 bull Daniel Rutherford isolated nitrogen in 1772 bull Joseph Priestly isolated oxygen in 1772

bull Lalouette showed in 1777 that carbon dioxide improved chronic and inveterate skin problems especially in foot ulcers not response to convention treatments such as daily dressings and debridement

bull Carbon dioxide water bath therapy (carbothera) springsrdquo or (artificial) therapeutic CO2 officially recognized in France as medications

bull

Scientific Publications

Carbotherapy continued to be used in France and publications begin to appear in the early 1930sDoctors in the medical spa of Royat found that transdermal use of CO2 in enriched warm baths improved vascular ischemia symptoms because of a strong direct vasodilator effect a neo-angiogenesis effect and better oxygen release in superficial tissues

Neo-angiogenesis effect

The first experiments in the 1930s consistedof injecting CO2 into the leg of a frog They

showed a strong vasodilatation associated with the creation of new capillaries

Mechanism of action Effects of CO2

bull Vasodilatation

bull The first effects following CO2 injection is a strong vasodilatation a blood flow increase and a higher pO2 in the treated area

bull The Bohr effect bull Local oxygen release is improved because of the Bohr effect The

Bohr effect describes the tendency of haemoglobin to have less affinity for oxygen when the blood concentration of CO2 is increased This lower affinity leads the haemoglobin to release the oxygen better in superficial tissues and muscles CO2 is quickly converted to bicarbonates and H+ acid in presence of the carbonic anhydrase enzyme

bull CO2 + H2O 1048774 H+ + HCO3

Bohr Effect

bull This reaction causes the tissuersquos pH to become acidic with even more dissociation of O2 from haemoglobin allowing the tissue to become even more oxygenated

Stimulation of collagen synthesis

bull A 2008 Brazilian study showed a reorganization of collagen fibres following intradermal injections of carbon dioxide and demonstrated that the CO2 is capable of increasing the collagen turnover a trauma to the dermis launches a healing process with collagen synthesis

bull CO2 improves the process by first increasing neovascularization with more healing substances and factors to be on site In second it releases more oxygen around and in the healing area improving the recovery phase

Stretch marksPrinciple

Improve neovascularization and blood flow (red color seen via skin transparency will appear pink close to the natural skin color) improve melanocyte pigment production to darken white stretch marks Improve collagen synthesis to reduce the wave appearance of old stretch marks

Indications

Old white stretch marks deep depressed stretch marks irregular old stretch marks are the main indications Young pinkred stretch marks should preferably have laser treatment (KTP or pulsed dye laser)

Protocol Combined intradermal and subcutaneous injections One session per month Flow 80ndash150 ccmin Puncture inside the mark Number of sessions four to ten

Technique Start injecting the dermis and when done push the needle further to inject the subcutaneous layers Endpoints Popcorn appearance (inflated stretch marks) for 1 or 2 minutes then erythema Injection points Follow each stretch mark and inject each 1ndash2 cm Post-treatment care No post injection care is required Pain management Injecting stretch marks is often painful Patients describe a burning sensation Although flow greater than 100 ccmin is recommended it is sometimes impossible to maintain these values because of the pain Lowering flows to 70ndash80 ccmin may make the patient more comfortable

Periorbital AreaPrinciple

Increase blood flow stimulate collagen production reduce fatty prolapse in some cases

Indications

Fatty prolapse eye wrinkles under-eye dark circles Smoker female with dark circle are good indications

Protocols

Eye wrinkles Combined intradermal and subcutaneous injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six

Under-eye dark circles Intradermal injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six Fatty prolapse Subcutaneous and intradermal injections One session per month Flow 20ndash40 ccmin Puncture in the fatty area Number of sessions three to six

Technique Injection points Fatty prolapse will receive two to four quick punctures in the area where the fat

resides Eye wrinkles and dark circles require from 2 to 3 punctures 1 or 2 cm spaced 1 or 2 seconds each made all along the external inferior border of the eye orbit next to the orbit bones (zygomatic bone)

Endpoints Eye lid becomes distended and inflated Upper eye lid distension may be important

Fatty prolapses are inflated and red The eye returns to normal appearance within 2 or 3 minutes

Post-treatment care No post-treatment care is required Sun protection may be used in the next 2 weeks

Pain management Emlareg if treatment is too painful (This cream lowers the Bohr effect vasoconstriction

reduces blood flow) To reduce pain lower the flow and increase the number of punctures

Caution

One of the major CO2 side effects and complication is pertinent to the eyelid procedure It is important to purge and remove any trace of oxygenair in the tubes and needle O2 injection into the eye lid leads to a strong inflammatory reaction which lasts 4 or 5 days with redness edema closed eye and pain

Celluliteorange peel skin

Principle Stimulate blood flow and activate receptors involved in the natural lipolysis of the body Improve skin tightening to reduce orange peel skin Fibrous cellulite treatments will require mechanical disruption of fibrous septae with higher CO2 flows Indication All types of cellulite from grade IndashII to grade IIIndashIV Subcutaneous irregularities after liposuction Complementary treatment to liposuction which does not have any efficacy on cellulite

Protocol

Cellulite grade I or II

Combination of subcutaneous and intradermal injections One session per day to one per week Flow 1ndash2 cckgmin ndash approximately 2 minutes per injection Punctures 15ndash20 cm spaced no overlapping - Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Cellulite grade III or IV Combination of subcutaneous and intradermal injection One session per day to one per week Flow gt2 cckgmin Punctures 15ndash20 cm spaced no overlapping Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Technique The operatorrsquos hand movement should target both the subcutaneous layer and the intradermal layer as

both lipolysis and collagen synthesis need to be activated

Injection points Injections points should be made in the area where cellulite resides hips and thighs

Endpoint Subcutaneous injection will let the gas diffuse and create a 15ndash20 cm diameter granite-like appearance

disk After several sessions the skin offers less resistance to the gas diffusion so a few injections point may then be enough to treat the all cellulite area

Post-treatment care No post-injection care is necessary

Pain management Pain is more frequent in the first sessions CO2 can be reduced in the first sessions and progressively

increased from session to session If too much pain is reported change the injection point and reduce the treatment time giving more shorter injections

Maximizing results CDT may benefit from combination with such treatments as RF Cellu-M6 Velasmooth and manual

lymphatic massage Dietetic advice should be given to help the patient maintain a stable weight

Reinforcement sessions Patients are usually advised to renew the treatment at least once a year in order to maintain the

Localized fat

Indication Any kind of localized fat or skin irregularity after liposuction Can also be a complementary treatment to liposuction to treat the remaining fat Protocol Subcutaneous layer 1 session per day to 1 per week Flow 1ndash2 cckgmin (50ndash80 ccmin) approximately 2 minutes per injection point Punctures spaced 15ndash20 cm apart Number of sessions 10ndash20 ndash First results usually seen after session 4~6 Progressive flow (automatic mode) available with some machines Submentonian area deep dermis (andor subcutaneous) Flow 1ndash2 cckgmin (50ndash80 ccmin) Approximately 30ndash60 seconds per area injected (until onset of erythema or pain) - Usually three punctures (one in the center one left side one right side) May trigger a tempo-mandibular articulation pain (lasts 1 or 2 minutes)

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 5: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

Carboxytherapy has been widely used in the last 10 years in South America in Brazil for cosmetic purposes stretch marks cellulite localized adiposities and under-eye dark circles in combination with other minimally invasive procedures

Carboxytherapy can be performed at the office with no down time It requires the physician to get a CO2 insufflator equipment tubing bacterial filters and small needles

Where does the CO2 story start

Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could

continue his experiments was cut short by the judge La Reacutepublique na pas besoin de

savants ni de chimistes le cours de la justice ne peut ecirctre suspendu

The Republic needs neither scientists nor chemists the course of justice cannot be

delayed

Lalouette (1777 )

bull Joseph Black isolated carbon dioxide in 1757bull Henry Cavendish isolated hydrogen in 1766 bull Daniel Rutherford isolated nitrogen in 1772 bull Joseph Priestly isolated oxygen in 1772

bull Lalouette showed in 1777 that carbon dioxide improved chronic and inveterate skin problems especially in foot ulcers not response to convention treatments such as daily dressings and debridement

bull Carbon dioxide water bath therapy (carbothera) springsrdquo or (artificial) therapeutic CO2 officially recognized in France as medications

bull

Scientific Publications

Carbotherapy continued to be used in France and publications begin to appear in the early 1930sDoctors in the medical spa of Royat found that transdermal use of CO2 in enriched warm baths improved vascular ischemia symptoms because of a strong direct vasodilator effect a neo-angiogenesis effect and better oxygen release in superficial tissues

Neo-angiogenesis effect

The first experiments in the 1930s consistedof injecting CO2 into the leg of a frog They

showed a strong vasodilatation associated with the creation of new capillaries

Mechanism of action Effects of CO2

bull Vasodilatation

bull The first effects following CO2 injection is a strong vasodilatation a blood flow increase and a higher pO2 in the treated area

bull The Bohr effect bull Local oxygen release is improved because of the Bohr effect The

Bohr effect describes the tendency of haemoglobin to have less affinity for oxygen when the blood concentration of CO2 is increased This lower affinity leads the haemoglobin to release the oxygen better in superficial tissues and muscles CO2 is quickly converted to bicarbonates and H+ acid in presence of the carbonic anhydrase enzyme

bull CO2 + H2O 1048774 H+ + HCO3

Bohr Effect

bull This reaction causes the tissuersquos pH to become acidic with even more dissociation of O2 from haemoglobin allowing the tissue to become even more oxygenated

Stimulation of collagen synthesis

bull A 2008 Brazilian study showed a reorganization of collagen fibres following intradermal injections of carbon dioxide and demonstrated that the CO2 is capable of increasing the collagen turnover a trauma to the dermis launches a healing process with collagen synthesis

bull CO2 improves the process by first increasing neovascularization with more healing substances and factors to be on site In second it releases more oxygen around and in the healing area improving the recovery phase

Stretch marksPrinciple

Improve neovascularization and blood flow (red color seen via skin transparency will appear pink close to the natural skin color) improve melanocyte pigment production to darken white stretch marks Improve collagen synthesis to reduce the wave appearance of old stretch marks

Indications

Old white stretch marks deep depressed stretch marks irregular old stretch marks are the main indications Young pinkred stretch marks should preferably have laser treatment (KTP or pulsed dye laser)

Protocol Combined intradermal and subcutaneous injections One session per month Flow 80ndash150 ccmin Puncture inside the mark Number of sessions four to ten

Technique Start injecting the dermis and when done push the needle further to inject the subcutaneous layers Endpoints Popcorn appearance (inflated stretch marks) for 1 or 2 minutes then erythema Injection points Follow each stretch mark and inject each 1ndash2 cm Post-treatment care No post injection care is required Pain management Injecting stretch marks is often painful Patients describe a burning sensation Although flow greater than 100 ccmin is recommended it is sometimes impossible to maintain these values because of the pain Lowering flows to 70ndash80 ccmin may make the patient more comfortable

Periorbital AreaPrinciple

Increase blood flow stimulate collagen production reduce fatty prolapse in some cases

Indications

Fatty prolapse eye wrinkles under-eye dark circles Smoker female with dark circle are good indications

Protocols

Eye wrinkles Combined intradermal and subcutaneous injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six

Under-eye dark circles Intradermal injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six Fatty prolapse Subcutaneous and intradermal injections One session per month Flow 20ndash40 ccmin Puncture in the fatty area Number of sessions three to six

Technique Injection points Fatty prolapse will receive two to four quick punctures in the area where the fat

resides Eye wrinkles and dark circles require from 2 to 3 punctures 1 or 2 cm spaced 1 or 2 seconds each made all along the external inferior border of the eye orbit next to the orbit bones (zygomatic bone)

Endpoints Eye lid becomes distended and inflated Upper eye lid distension may be important

Fatty prolapses are inflated and red The eye returns to normal appearance within 2 or 3 minutes

Post-treatment care No post-treatment care is required Sun protection may be used in the next 2 weeks

Pain management Emlareg if treatment is too painful (This cream lowers the Bohr effect vasoconstriction

reduces blood flow) To reduce pain lower the flow and increase the number of punctures

Caution

One of the major CO2 side effects and complication is pertinent to the eyelid procedure It is important to purge and remove any trace of oxygenair in the tubes and needle O2 injection into the eye lid leads to a strong inflammatory reaction which lasts 4 or 5 days with redness edema closed eye and pain

Celluliteorange peel skin

Principle Stimulate blood flow and activate receptors involved in the natural lipolysis of the body Improve skin tightening to reduce orange peel skin Fibrous cellulite treatments will require mechanical disruption of fibrous septae with higher CO2 flows Indication All types of cellulite from grade IndashII to grade IIIndashIV Subcutaneous irregularities after liposuction Complementary treatment to liposuction which does not have any efficacy on cellulite

Protocol

Cellulite grade I or II

Combination of subcutaneous and intradermal injections One session per day to one per week Flow 1ndash2 cckgmin ndash approximately 2 minutes per injection Punctures 15ndash20 cm spaced no overlapping - Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Cellulite grade III or IV Combination of subcutaneous and intradermal injection One session per day to one per week Flow gt2 cckgmin Punctures 15ndash20 cm spaced no overlapping Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Technique The operatorrsquos hand movement should target both the subcutaneous layer and the intradermal layer as

both lipolysis and collagen synthesis need to be activated

Injection points Injections points should be made in the area where cellulite resides hips and thighs

Endpoint Subcutaneous injection will let the gas diffuse and create a 15ndash20 cm diameter granite-like appearance

disk After several sessions the skin offers less resistance to the gas diffusion so a few injections point may then be enough to treat the all cellulite area

Post-treatment care No post-injection care is necessary

Pain management Pain is more frequent in the first sessions CO2 can be reduced in the first sessions and progressively

increased from session to session If too much pain is reported change the injection point and reduce the treatment time giving more shorter injections

Maximizing results CDT may benefit from combination with such treatments as RF Cellu-M6 Velasmooth and manual

lymphatic massage Dietetic advice should be given to help the patient maintain a stable weight

Reinforcement sessions Patients are usually advised to renew the treatment at least once a year in order to maintain the

Localized fat

Indication Any kind of localized fat or skin irregularity after liposuction Can also be a complementary treatment to liposuction to treat the remaining fat Protocol Subcutaneous layer 1 session per day to 1 per week Flow 1ndash2 cckgmin (50ndash80 ccmin) approximately 2 minutes per injection point Punctures spaced 15ndash20 cm apart Number of sessions 10ndash20 ndash First results usually seen after session 4~6 Progressive flow (automatic mode) available with some machines Submentonian area deep dermis (andor subcutaneous) Flow 1ndash2 cckgmin (50ndash80 ccmin) Approximately 30ndash60 seconds per area injected (until onset of erythema or pain) - Usually three punctures (one in the center one left side one right side) May trigger a tempo-mandibular articulation pain (lasts 1 or 2 minutes)

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 6: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

Carboxytherapy can be performed at the office with no down time It requires the physician to get a CO2 insufflator equipment tubing bacterial filters and small needles

Where does the CO2 story start

Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could

continue his experiments was cut short by the judge La Reacutepublique na pas besoin de

savants ni de chimistes le cours de la justice ne peut ecirctre suspendu

The Republic needs neither scientists nor chemists the course of justice cannot be

delayed

Lalouette (1777 )

bull Joseph Black isolated carbon dioxide in 1757bull Henry Cavendish isolated hydrogen in 1766 bull Daniel Rutherford isolated nitrogen in 1772 bull Joseph Priestly isolated oxygen in 1772

bull Lalouette showed in 1777 that carbon dioxide improved chronic and inveterate skin problems especially in foot ulcers not response to convention treatments such as daily dressings and debridement

bull Carbon dioxide water bath therapy (carbothera) springsrdquo or (artificial) therapeutic CO2 officially recognized in France as medications

bull

Scientific Publications

Carbotherapy continued to be used in France and publications begin to appear in the early 1930sDoctors in the medical spa of Royat found that transdermal use of CO2 in enriched warm baths improved vascular ischemia symptoms because of a strong direct vasodilator effect a neo-angiogenesis effect and better oxygen release in superficial tissues

Neo-angiogenesis effect

The first experiments in the 1930s consistedof injecting CO2 into the leg of a frog They

showed a strong vasodilatation associated with the creation of new capillaries

Mechanism of action Effects of CO2

bull Vasodilatation

bull The first effects following CO2 injection is a strong vasodilatation a blood flow increase and a higher pO2 in the treated area

bull The Bohr effect bull Local oxygen release is improved because of the Bohr effect The

Bohr effect describes the tendency of haemoglobin to have less affinity for oxygen when the blood concentration of CO2 is increased This lower affinity leads the haemoglobin to release the oxygen better in superficial tissues and muscles CO2 is quickly converted to bicarbonates and H+ acid in presence of the carbonic anhydrase enzyme

bull CO2 + H2O 1048774 H+ + HCO3

Bohr Effect

bull This reaction causes the tissuersquos pH to become acidic with even more dissociation of O2 from haemoglobin allowing the tissue to become even more oxygenated

Stimulation of collagen synthesis

bull A 2008 Brazilian study showed a reorganization of collagen fibres following intradermal injections of carbon dioxide and demonstrated that the CO2 is capable of increasing the collagen turnover a trauma to the dermis launches a healing process with collagen synthesis

bull CO2 improves the process by first increasing neovascularization with more healing substances and factors to be on site In second it releases more oxygen around and in the healing area improving the recovery phase

Stretch marksPrinciple

Improve neovascularization and blood flow (red color seen via skin transparency will appear pink close to the natural skin color) improve melanocyte pigment production to darken white stretch marks Improve collagen synthesis to reduce the wave appearance of old stretch marks

Indications

Old white stretch marks deep depressed stretch marks irregular old stretch marks are the main indications Young pinkred stretch marks should preferably have laser treatment (KTP or pulsed dye laser)

Protocol Combined intradermal and subcutaneous injections One session per month Flow 80ndash150 ccmin Puncture inside the mark Number of sessions four to ten

Technique Start injecting the dermis and when done push the needle further to inject the subcutaneous layers Endpoints Popcorn appearance (inflated stretch marks) for 1 or 2 minutes then erythema Injection points Follow each stretch mark and inject each 1ndash2 cm Post-treatment care No post injection care is required Pain management Injecting stretch marks is often painful Patients describe a burning sensation Although flow greater than 100 ccmin is recommended it is sometimes impossible to maintain these values because of the pain Lowering flows to 70ndash80 ccmin may make the patient more comfortable

Periorbital AreaPrinciple

Increase blood flow stimulate collagen production reduce fatty prolapse in some cases

Indications

Fatty prolapse eye wrinkles under-eye dark circles Smoker female with dark circle are good indications

Protocols

Eye wrinkles Combined intradermal and subcutaneous injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six

Under-eye dark circles Intradermal injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six Fatty prolapse Subcutaneous and intradermal injections One session per month Flow 20ndash40 ccmin Puncture in the fatty area Number of sessions three to six

Technique Injection points Fatty prolapse will receive two to four quick punctures in the area where the fat

resides Eye wrinkles and dark circles require from 2 to 3 punctures 1 or 2 cm spaced 1 or 2 seconds each made all along the external inferior border of the eye orbit next to the orbit bones (zygomatic bone)

Endpoints Eye lid becomes distended and inflated Upper eye lid distension may be important

Fatty prolapses are inflated and red The eye returns to normal appearance within 2 or 3 minutes

Post-treatment care No post-treatment care is required Sun protection may be used in the next 2 weeks

Pain management Emlareg if treatment is too painful (This cream lowers the Bohr effect vasoconstriction

reduces blood flow) To reduce pain lower the flow and increase the number of punctures

Caution

One of the major CO2 side effects and complication is pertinent to the eyelid procedure It is important to purge and remove any trace of oxygenair in the tubes and needle O2 injection into the eye lid leads to a strong inflammatory reaction which lasts 4 or 5 days with redness edema closed eye and pain

Celluliteorange peel skin

Principle Stimulate blood flow and activate receptors involved in the natural lipolysis of the body Improve skin tightening to reduce orange peel skin Fibrous cellulite treatments will require mechanical disruption of fibrous septae with higher CO2 flows Indication All types of cellulite from grade IndashII to grade IIIndashIV Subcutaneous irregularities after liposuction Complementary treatment to liposuction which does not have any efficacy on cellulite

Protocol

Cellulite grade I or II

Combination of subcutaneous and intradermal injections One session per day to one per week Flow 1ndash2 cckgmin ndash approximately 2 minutes per injection Punctures 15ndash20 cm spaced no overlapping - Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Cellulite grade III or IV Combination of subcutaneous and intradermal injection One session per day to one per week Flow gt2 cckgmin Punctures 15ndash20 cm spaced no overlapping Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Technique The operatorrsquos hand movement should target both the subcutaneous layer and the intradermal layer as

both lipolysis and collagen synthesis need to be activated

Injection points Injections points should be made in the area where cellulite resides hips and thighs

Endpoint Subcutaneous injection will let the gas diffuse and create a 15ndash20 cm diameter granite-like appearance

disk After several sessions the skin offers less resistance to the gas diffusion so a few injections point may then be enough to treat the all cellulite area

Post-treatment care No post-injection care is necessary

Pain management Pain is more frequent in the first sessions CO2 can be reduced in the first sessions and progressively

increased from session to session If too much pain is reported change the injection point and reduce the treatment time giving more shorter injections

Maximizing results CDT may benefit from combination with such treatments as RF Cellu-M6 Velasmooth and manual

lymphatic massage Dietetic advice should be given to help the patient maintain a stable weight

Reinforcement sessions Patients are usually advised to renew the treatment at least once a year in order to maintain the

Localized fat

Indication Any kind of localized fat or skin irregularity after liposuction Can also be a complementary treatment to liposuction to treat the remaining fat Protocol Subcutaneous layer 1 session per day to 1 per week Flow 1ndash2 cckgmin (50ndash80 ccmin) approximately 2 minutes per injection point Punctures spaced 15ndash20 cm apart Number of sessions 10ndash20 ndash First results usually seen after session 4~6 Progressive flow (automatic mode) available with some machines Submentonian area deep dermis (andor subcutaneous) Flow 1ndash2 cckgmin (50ndash80 ccmin) Approximately 30ndash60 seconds per area injected (until onset of erythema or pain) - Usually three punctures (one in the center one left side one right side) May trigger a tempo-mandibular articulation pain (lasts 1 or 2 minutes)

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 7: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

Where does the CO2 story start

Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could

continue his experiments was cut short by the judge La Reacutepublique na pas besoin de

savants ni de chimistes le cours de la justice ne peut ecirctre suspendu

The Republic needs neither scientists nor chemists the course of justice cannot be

delayed

Lalouette (1777 )

bull Joseph Black isolated carbon dioxide in 1757bull Henry Cavendish isolated hydrogen in 1766 bull Daniel Rutherford isolated nitrogen in 1772 bull Joseph Priestly isolated oxygen in 1772

bull Lalouette showed in 1777 that carbon dioxide improved chronic and inveterate skin problems especially in foot ulcers not response to convention treatments such as daily dressings and debridement

bull Carbon dioxide water bath therapy (carbothera) springsrdquo or (artificial) therapeutic CO2 officially recognized in France as medications

bull

Scientific Publications

Carbotherapy continued to be used in France and publications begin to appear in the early 1930sDoctors in the medical spa of Royat found that transdermal use of CO2 in enriched warm baths improved vascular ischemia symptoms because of a strong direct vasodilator effect a neo-angiogenesis effect and better oxygen release in superficial tissues

Neo-angiogenesis effect

The first experiments in the 1930s consistedof injecting CO2 into the leg of a frog They

showed a strong vasodilatation associated with the creation of new capillaries

Mechanism of action Effects of CO2

bull Vasodilatation

bull The first effects following CO2 injection is a strong vasodilatation a blood flow increase and a higher pO2 in the treated area

bull The Bohr effect bull Local oxygen release is improved because of the Bohr effect The

Bohr effect describes the tendency of haemoglobin to have less affinity for oxygen when the blood concentration of CO2 is increased This lower affinity leads the haemoglobin to release the oxygen better in superficial tissues and muscles CO2 is quickly converted to bicarbonates and H+ acid in presence of the carbonic anhydrase enzyme

bull CO2 + H2O 1048774 H+ + HCO3

Bohr Effect

bull This reaction causes the tissuersquos pH to become acidic with even more dissociation of O2 from haemoglobin allowing the tissue to become even more oxygenated

Stimulation of collagen synthesis

bull A 2008 Brazilian study showed a reorganization of collagen fibres following intradermal injections of carbon dioxide and demonstrated that the CO2 is capable of increasing the collagen turnover a trauma to the dermis launches a healing process with collagen synthesis

bull CO2 improves the process by first increasing neovascularization with more healing substances and factors to be on site In second it releases more oxygen around and in the healing area improving the recovery phase

Stretch marksPrinciple

Improve neovascularization and blood flow (red color seen via skin transparency will appear pink close to the natural skin color) improve melanocyte pigment production to darken white stretch marks Improve collagen synthesis to reduce the wave appearance of old stretch marks

Indications

Old white stretch marks deep depressed stretch marks irregular old stretch marks are the main indications Young pinkred stretch marks should preferably have laser treatment (KTP or pulsed dye laser)

Protocol Combined intradermal and subcutaneous injections One session per month Flow 80ndash150 ccmin Puncture inside the mark Number of sessions four to ten

Technique Start injecting the dermis and when done push the needle further to inject the subcutaneous layers Endpoints Popcorn appearance (inflated stretch marks) for 1 or 2 minutes then erythema Injection points Follow each stretch mark and inject each 1ndash2 cm Post-treatment care No post injection care is required Pain management Injecting stretch marks is often painful Patients describe a burning sensation Although flow greater than 100 ccmin is recommended it is sometimes impossible to maintain these values because of the pain Lowering flows to 70ndash80 ccmin may make the patient more comfortable

Periorbital AreaPrinciple

Increase blood flow stimulate collagen production reduce fatty prolapse in some cases

Indications

Fatty prolapse eye wrinkles under-eye dark circles Smoker female with dark circle are good indications

Protocols

Eye wrinkles Combined intradermal and subcutaneous injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six

Under-eye dark circles Intradermal injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six Fatty prolapse Subcutaneous and intradermal injections One session per month Flow 20ndash40 ccmin Puncture in the fatty area Number of sessions three to six

Technique Injection points Fatty prolapse will receive two to four quick punctures in the area where the fat

resides Eye wrinkles and dark circles require from 2 to 3 punctures 1 or 2 cm spaced 1 or 2 seconds each made all along the external inferior border of the eye orbit next to the orbit bones (zygomatic bone)

Endpoints Eye lid becomes distended and inflated Upper eye lid distension may be important

Fatty prolapses are inflated and red The eye returns to normal appearance within 2 or 3 minutes

Post-treatment care No post-treatment care is required Sun protection may be used in the next 2 weeks

Pain management Emlareg if treatment is too painful (This cream lowers the Bohr effect vasoconstriction

reduces blood flow) To reduce pain lower the flow and increase the number of punctures

Caution

One of the major CO2 side effects and complication is pertinent to the eyelid procedure It is important to purge and remove any trace of oxygenair in the tubes and needle O2 injection into the eye lid leads to a strong inflammatory reaction which lasts 4 or 5 days with redness edema closed eye and pain

Celluliteorange peel skin

Principle Stimulate blood flow and activate receptors involved in the natural lipolysis of the body Improve skin tightening to reduce orange peel skin Fibrous cellulite treatments will require mechanical disruption of fibrous septae with higher CO2 flows Indication All types of cellulite from grade IndashII to grade IIIndashIV Subcutaneous irregularities after liposuction Complementary treatment to liposuction which does not have any efficacy on cellulite

Protocol

Cellulite grade I or II

Combination of subcutaneous and intradermal injections One session per day to one per week Flow 1ndash2 cckgmin ndash approximately 2 minutes per injection Punctures 15ndash20 cm spaced no overlapping - Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Cellulite grade III or IV Combination of subcutaneous and intradermal injection One session per day to one per week Flow gt2 cckgmin Punctures 15ndash20 cm spaced no overlapping Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Technique The operatorrsquos hand movement should target both the subcutaneous layer and the intradermal layer as

both lipolysis and collagen synthesis need to be activated

Injection points Injections points should be made in the area where cellulite resides hips and thighs

Endpoint Subcutaneous injection will let the gas diffuse and create a 15ndash20 cm diameter granite-like appearance

disk After several sessions the skin offers less resistance to the gas diffusion so a few injections point may then be enough to treat the all cellulite area

Post-treatment care No post-injection care is necessary

Pain management Pain is more frequent in the first sessions CO2 can be reduced in the first sessions and progressively

increased from session to session If too much pain is reported change the injection point and reduce the treatment time giving more shorter injections

Maximizing results CDT may benefit from combination with such treatments as RF Cellu-M6 Velasmooth and manual

lymphatic massage Dietetic advice should be given to help the patient maintain a stable weight

Reinforcement sessions Patients are usually advised to renew the treatment at least once a year in order to maintain the

Localized fat

Indication Any kind of localized fat or skin irregularity after liposuction Can also be a complementary treatment to liposuction to treat the remaining fat Protocol Subcutaneous layer 1 session per day to 1 per week Flow 1ndash2 cckgmin (50ndash80 ccmin) approximately 2 minutes per injection point Punctures spaced 15ndash20 cm apart Number of sessions 10ndash20 ndash First results usually seen after session 4~6 Progressive flow (automatic mode) available with some machines Submentonian area deep dermis (andor subcutaneous) Flow 1ndash2 cckgmin (50ndash80 ccmin) Approximately 30ndash60 seconds per area injected (until onset of erythema or pain) - Usually three punctures (one in the center one left side one right side) May trigger a tempo-mandibular articulation pain (lasts 1 or 2 minutes)

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 8: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could

continue his experiments was cut short by the judge La Reacutepublique na pas besoin de

savants ni de chimistes le cours de la justice ne peut ecirctre suspendu

The Republic needs neither scientists nor chemists the course of justice cannot be

delayed

Lalouette (1777 )

bull Joseph Black isolated carbon dioxide in 1757bull Henry Cavendish isolated hydrogen in 1766 bull Daniel Rutherford isolated nitrogen in 1772 bull Joseph Priestly isolated oxygen in 1772

bull Lalouette showed in 1777 that carbon dioxide improved chronic and inveterate skin problems especially in foot ulcers not response to convention treatments such as daily dressings and debridement

bull Carbon dioxide water bath therapy (carbothera) springsrdquo or (artificial) therapeutic CO2 officially recognized in France as medications

bull

Scientific Publications

Carbotherapy continued to be used in France and publications begin to appear in the early 1930sDoctors in the medical spa of Royat found that transdermal use of CO2 in enriched warm baths improved vascular ischemia symptoms because of a strong direct vasodilator effect a neo-angiogenesis effect and better oxygen release in superficial tissues

Neo-angiogenesis effect

The first experiments in the 1930s consistedof injecting CO2 into the leg of a frog They

showed a strong vasodilatation associated with the creation of new capillaries

Mechanism of action Effects of CO2

bull Vasodilatation

bull The first effects following CO2 injection is a strong vasodilatation a blood flow increase and a higher pO2 in the treated area

bull The Bohr effect bull Local oxygen release is improved because of the Bohr effect The

Bohr effect describes the tendency of haemoglobin to have less affinity for oxygen when the blood concentration of CO2 is increased This lower affinity leads the haemoglobin to release the oxygen better in superficial tissues and muscles CO2 is quickly converted to bicarbonates and H+ acid in presence of the carbonic anhydrase enzyme

bull CO2 + H2O 1048774 H+ + HCO3

Bohr Effect

bull This reaction causes the tissuersquos pH to become acidic with even more dissociation of O2 from haemoglobin allowing the tissue to become even more oxygenated

Stimulation of collagen synthesis

bull A 2008 Brazilian study showed a reorganization of collagen fibres following intradermal injections of carbon dioxide and demonstrated that the CO2 is capable of increasing the collagen turnover a trauma to the dermis launches a healing process with collagen synthesis

bull CO2 improves the process by first increasing neovascularization with more healing substances and factors to be on site In second it releases more oxygen around and in the healing area improving the recovery phase

Stretch marksPrinciple

Improve neovascularization and blood flow (red color seen via skin transparency will appear pink close to the natural skin color) improve melanocyte pigment production to darken white stretch marks Improve collagen synthesis to reduce the wave appearance of old stretch marks

Indications

Old white stretch marks deep depressed stretch marks irregular old stretch marks are the main indications Young pinkred stretch marks should preferably have laser treatment (KTP or pulsed dye laser)

Protocol Combined intradermal and subcutaneous injections One session per month Flow 80ndash150 ccmin Puncture inside the mark Number of sessions four to ten

Technique Start injecting the dermis and when done push the needle further to inject the subcutaneous layers Endpoints Popcorn appearance (inflated stretch marks) for 1 or 2 minutes then erythema Injection points Follow each stretch mark and inject each 1ndash2 cm Post-treatment care No post injection care is required Pain management Injecting stretch marks is often painful Patients describe a burning sensation Although flow greater than 100 ccmin is recommended it is sometimes impossible to maintain these values because of the pain Lowering flows to 70ndash80 ccmin may make the patient more comfortable

Periorbital AreaPrinciple

Increase blood flow stimulate collagen production reduce fatty prolapse in some cases

Indications

Fatty prolapse eye wrinkles under-eye dark circles Smoker female with dark circle are good indications

Protocols

Eye wrinkles Combined intradermal and subcutaneous injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six

Under-eye dark circles Intradermal injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six Fatty prolapse Subcutaneous and intradermal injections One session per month Flow 20ndash40 ccmin Puncture in the fatty area Number of sessions three to six

Technique Injection points Fatty prolapse will receive two to four quick punctures in the area where the fat

resides Eye wrinkles and dark circles require from 2 to 3 punctures 1 or 2 cm spaced 1 or 2 seconds each made all along the external inferior border of the eye orbit next to the orbit bones (zygomatic bone)

Endpoints Eye lid becomes distended and inflated Upper eye lid distension may be important

Fatty prolapses are inflated and red The eye returns to normal appearance within 2 or 3 minutes

Post-treatment care No post-treatment care is required Sun protection may be used in the next 2 weeks

Pain management Emlareg if treatment is too painful (This cream lowers the Bohr effect vasoconstriction

reduces blood flow) To reduce pain lower the flow and increase the number of punctures

Caution

One of the major CO2 side effects and complication is pertinent to the eyelid procedure It is important to purge and remove any trace of oxygenair in the tubes and needle O2 injection into the eye lid leads to a strong inflammatory reaction which lasts 4 or 5 days with redness edema closed eye and pain

Celluliteorange peel skin

Principle Stimulate blood flow and activate receptors involved in the natural lipolysis of the body Improve skin tightening to reduce orange peel skin Fibrous cellulite treatments will require mechanical disruption of fibrous septae with higher CO2 flows Indication All types of cellulite from grade IndashII to grade IIIndashIV Subcutaneous irregularities after liposuction Complementary treatment to liposuction which does not have any efficacy on cellulite

Protocol

Cellulite grade I or II

Combination of subcutaneous and intradermal injections One session per day to one per week Flow 1ndash2 cckgmin ndash approximately 2 minutes per injection Punctures 15ndash20 cm spaced no overlapping - Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Cellulite grade III or IV Combination of subcutaneous and intradermal injection One session per day to one per week Flow gt2 cckgmin Punctures 15ndash20 cm spaced no overlapping Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Technique The operatorrsquos hand movement should target both the subcutaneous layer and the intradermal layer as

both lipolysis and collagen synthesis need to be activated

Injection points Injections points should be made in the area where cellulite resides hips and thighs

Endpoint Subcutaneous injection will let the gas diffuse and create a 15ndash20 cm diameter granite-like appearance

disk After several sessions the skin offers less resistance to the gas diffusion so a few injections point may then be enough to treat the all cellulite area

Post-treatment care No post-injection care is necessary

Pain management Pain is more frequent in the first sessions CO2 can be reduced in the first sessions and progressively

increased from session to session If too much pain is reported change the injection point and reduce the treatment time giving more shorter injections

Maximizing results CDT may benefit from combination with such treatments as RF Cellu-M6 Velasmooth and manual

lymphatic massage Dietetic advice should be given to help the patient maintain a stable weight

Reinforcement sessions Patients are usually advised to renew the treatment at least once a year in order to maintain the

Localized fat

Indication Any kind of localized fat or skin irregularity after liposuction Can also be a complementary treatment to liposuction to treat the remaining fat Protocol Subcutaneous layer 1 session per day to 1 per week Flow 1ndash2 cckgmin (50ndash80 ccmin) approximately 2 minutes per injection point Punctures spaced 15ndash20 cm apart Number of sessions 10ndash20 ndash First results usually seen after session 4~6 Progressive flow (automatic mode) available with some machines Submentonian area deep dermis (andor subcutaneous) Flow 1ndash2 cckgmin (50ndash80 ccmin) Approximately 30ndash60 seconds per area injected (until onset of erythema or pain) - Usually three punctures (one in the center one left side one right side) May trigger a tempo-mandibular articulation pain (lasts 1 or 2 minutes)

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 9: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

Lalouette (1777 )

bull Joseph Black isolated carbon dioxide in 1757bull Henry Cavendish isolated hydrogen in 1766 bull Daniel Rutherford isolated nitrogen in 1772 bull Joseph Priestly isolated oxygen in 1772

bull Lalouette showed in 1777 that carbon dioxide improved chronic and inveterate skin problems especially in foot ulcers not response to convention treatments such as daily dressings and debridement

bull Carbon dioxide water bath therapy (carbothera) springsrdquo or (artificial) therapeutic CO2 officially recognized in France as medications

bull

Scientific Publications

Carbotherapy continued to be used in France and publications begin to appear in the early 1930sDoctors in the medical spa of Royat found that transdermal use of CO2 in enriched warm baths improved vascular ischemia symptoms because of a strong direct vasodilator effect a neo-angiogenesis effect and better oxygen release in superficial tissues

Neo-angiogenesis effect

The first experiments in the 1930s consistedof injecting CO2 into the leg of a frog They

showed a strong vasodilatation associated with the creation of new capillaries

Mechanism of action Effects of CO2

bull Vasodilatation

bull The first effects following CO2 injection is a strong vasodilatation a blood flow increase and a higher pO2 in the treated area

bull The Bohr effect bull Local oxygen release is improved because of the Bohr effect The

Bohr effect describes the tendency of haemoglobin to have less affinity for oxygen when the blood concentration of CO2 is increased This lower affinity leads the haemoglobin to release the oxygen better in superficial tissues and muscles CO2 is quickly converted to bicarbonates and H+ acid in presence of the carbonic anhydrase enzyme

bull CO2 + H2O 1048774 H+ + HCO3

Bohr Effect

bull This reaction causes the tissuersquos pH to become acidic with even more dissociation of O2 from haemoglobin allowing the tissue to become even more oxygenated

Stimulation of collagen synthesis

bull A 2008 Brazilian study showed a reorganization of collagen fibres following intradermal injections of carbon dioxide and demonstrated that the CO2 is capable of increasing the collagen turnover a trauma to the dermis launches a healing process with collagen synthesis

bull CO2 improves the process by first increasing neovascularization with more healing substances and factors to be on site In second it releases more oxygen around and in the healing area improving the recovery phase

Stretch marksPrinciple

Improve neovascularization and blood flow (red color seen via skin transparency will appear pink close to the natural skin color) improve melanocyte pigment production to darken white stretch marks Improve collagen synthesis to reduce the wave appearance of old stretch marks

Indications

Old white stretch marks deep depressed stretch marks irregular old stretch marks are the main indications Young pinkred stretch marks should preferably have laser treatment (KTP or pulsed dye laser)

Protocol Combined intradermal and subcutaneous injections One session per month Flow 80ndash150 ccmin Puncture inside the mark Number of sessions four to ten

Technique Start injecting the dermis and when done push the needle further to inject the subcutaneous layers Endpoints Popcorn appearance (inflated stretch marks) for 1 or 2 minutes then erythema Injection points Follow each stretch mark and inject each 1ndash2 cm Post-treatment care No post injection care is required Pain management Injecting stretch marks is often painful Patients describe a burning sensation Although flow greater than 100 ccmin is recommended it is sometimes impossible to maintain these values because of the pain Lowering flows to 70ndash80 ccmin may make the patient more comfortable

Periorbital AreaPrinciple

Increase blood flow stimulate collagen production reduce fatty prolapse in some cases

Indications

Fatty prolapse eye wrinkles under-eye dark circles Smoker female with dark circle are good indications

Protocols

Eye wrinkles Combined intradermal and subcutaneous injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six

Under-eye dark circles Intradermal injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six Fatty prolapse Subcutaneous and intradermal injections One session per month Flow 20ndash40 ccmin Puncture in the fatty area Number of sessions three to six

Technique Injection points Fatty prolapse will receive two to four quick punctures in the area where the fat

resides Eye wrinkles and dark circles require from 2 to 3 punctures 1 or 2 cm spaced 1 or 2 seconds each made all along the external inferior border of the eye orbit next to the orbit bones (zygomatic bone)

Endpoints Eye lid becomes distended and inflated Upper eye lid distension may be important

Fatty prolapses are inflated and red The eye returns to normal appearance within 2 or 3 minutes

Post-treatment care No post-treatment care is required Sun protection may be used in the next 2 weeks

Pain management Emlareg if treatment is too painful (This cream lowers the Bohr effect vasoconstriction

reduces blood flow) To reduce pain lower the flow and increase the number of punctures

Caution

One of the major CO2 side effects and complication is pertinent to the eyelid procedure It is important to purge and remove any trace of oxygenair in the tubes and needle O2 injection into the eye lid leads to a strong inflammatory reaction which lasts 4 or 5 days with redness edema closed eye and pain

Celluliteorange peel skin

Principle Stimulate blood flow and activate receptors involved in the natural lipolysis of the body Improve skin tightening to reduce orange peel skin Fibrous cellulite treatments will require mechanical disruption of fibrous septae with higher CO2 flows Indication All types of cellulite from grade IndashII to grade IIIndashIV Subcutaneous irregularities after liposuction Complementary treatment to liposuction which does not have any efficacy on cellulite

Protocol

Cellulite grade I or II

Combination of subcutaneous and intradermal injections One session per day to one per week Flow 1ndash2 cckgmin ndash approximately 2 minutes per injection Punctures 15ndash20 cm spaced no overlapping - Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Cellulite grade III or IV Combination of subcutaneous and intradermal injection One session per day to one per week Flow gt2 cckgmin Punctures 15ndash20 cm spaced no overlapping Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Technique The operatorrsquos hand movement should target both the subcutaneous layer and the intradermal layer as

both lipolysis and collagen synthesis need to be activated

Injection points Injections points should be made in the area where cellulite resides hips and thighs

Endpoint Subcutaneous injection will let the gas diffuse and create a 15ndash20 cm diameter granite-like appearance

disk After several sessions the skin offers less resistance to the gas diffusion so a few injections point may then be enough to treat the all cellulite area

Post-treatment care No post-injection care is necessary

Pain management Pain is more frequent in the first sessions CO2 can be reduced in the first sessions and progressively

increased from session to session If too much pain is reported change the injection point and reduce the treatment time giving more shorter injections

Maximizing results CDT may benefit from combination with such treatments as RF Cellu-M6 Velasmooth and manual

lymphatic massage Dietetic advice should be given to help the patient maintain a stable weight

Reinforcement sessions Patients are usually advised to renew the treatment at least once a year in order to maintain the

Localized fat

Indication Any kind of localized fat or skin irregularity after liposuction Can also be a complementary treatment to liposuction to treat the remaining fat Protocol Subcutaneous layer 1 session per day to 1 per week Flow 1ndash2 cckgmin (50ndash80 ccmin) approximately 2 minutes per injection point Punctures spaced 15ndash20 cm apart Number of sessions 10ndash20 ndash First results usually seen after session 4~6 Progressive flow (automatic mode) available with some machines Submentonian area deep dermis (andor subcutaneous) Flow 1ndash2 cckgmin (50ndash80 ccmin) Approximately 30ndash60 seconds per area injected (until onset of erythema or pain) - Usually three punctures (one in the center one left side one right side) May trigger a tempo-mandibular articulation pain (lasts 1 or 2 minutes)

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 10: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

Scientific Publications

Carbotherapy continued to be used in France and publications begin to appear in the early 1930sDoctors in the medical spa of Royat found that transdermal use of CO2 in enriched warm baths improved vascular ischemia symptoms because of a strong direct vasodilator effect a neo-angiogenesis effect and better oxygen release in superficial tissues

Neo-angiogenesis effect

The first experiments in the 1930s consistedof injecting CO2 into the leg of a frog They

showed a strong vasodilatation associated with the creation of new capillaries

Mechanism of action Effects of CO2

bull Vasodilatation

bull The first effects following CO2 injection is a strong vasodilatation a blood flow increase and a higher pO2 in the treated area

bull The Bohr effect bull Local oxygen release is improved because of the Bohr effect The

Bohr effect describes the tendency of haemoglobin to have less affinity for oxygen when the blood concentration of CO2 is increased This lower affinity leads the haemoglobin to release the oxygen better in superficial tissues and muscles CO2 is quickly converted to bicarbonates and H+ acid in presence of the carbonic anhydrase enzyme

bull CO2 + H2O 1048774 H+ + HCO3

Bohr Effect

bull This reaction causes the tissuersquos pH to become acidic with even more dissociation of O2 from haemoglobin allowing the tissue to become even more oxygenated

Stimulation of collagen synthesis

bull A 2008 Brazilian study showed a reorganization of collagen fibres following intradermal injections of carbon dioxide and demonstrated that the CO2 is capable of increasing the collagen turnover a trauma to the dermis launches a healing process with collagen synthesis

bull CO2 improves the process by first increasing neovascularization with more healing substances and factors to be on site In second it releases more oxygen around and in the healing area improving the recovery phase

Stretch marksPrinciple

Improve neovascularization and blood flow (red color seen via skin transparency will appear pink close to the natural skin color) improve melanocyte pigment production to darken white stretch marks Improve collagen synthesis to reduce the wave appearance of old stretch marks

Indications

Old white stretch marks deep depressed stretch marks irregular old stretch marks are the main indications Young pinkred stretch marks should preferably have laser treatment (KTP or pulsed dye laser)

Protocol Combined intradermal and subcutaneous injections One session per month Flow 80ndash150 ccmin Puncture inside the mark Number of sessions four to ten

Technique Start injecting the dermis and when done push the needle further to inject the subcutaneous layers Endpoints Popcorn appearance (inflated stretch marks) for 1 or 2 minutes then erythema Injection points Follow each stretch mark and inject each 1ndash2 cm Post-treatment care No post injection care is required Pain management Injecting stretch marks is often painful Patients describe a burning sensation Although flow greater than 100 ccmin is recommended it is sometimes impossible to maintain these values because of the pain Lowering flows to 70ndash80 ccmin may make the patient more comfortable

Periorbital AreaPrinciple

Increase blood flow stimulate collagen production reduce fatty prolapse in some cases

Indications

Fatty prolapse eye wrinkles under-eye dark circles Smoker female with dark circle are good indications

Protocols

Eye wrinkles Combined intradermal and subcutaneous injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six

Under-eye dark circles Intradermal injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six Fatty prolapse Subcutaneous and intradermal injections One session per month Flow 20ndash40 ccmin Puncture in the fatty area Number of sessions three to six

Technique Injection points Fatty prolapse will receive two to four quick punctures in the area where the fat

resides Eye wrinkles and dark circles require from 2 to 3 punctures 1 or 2 cm spaced 1 or 2 seconds each made all along the external inferior border of the eye orbit next to the orbit bones (zygomatic bone)

Endpoints Eye lid becomes distended and inflated Upper eye lid distension may be important

Fatty prolapses are inflated and red The eye returns to normal appearance within 2 or 3 minutes

Post-treatment care No post-treatment care is required Sun protection may be used in the next 2 weeks

Pain management Emlareg if treatment is too painful (This cream lowers the Bohr effect vasoconstriction

reduces blood flow) To reduce pain lower the flow and increase the number of punctures

Caution

One of the major CO2 side effects and complication is pertinent to the eyelid procedure It is important to purge and remove any trace of oxygenair in the tubes and needle O2 injection into the eye lid leads to a strong inflammatory reaction which lasts 4 or 5 days with redness edema closed eye and pain

Celluliteorange peel skin

Principle Stimulate blood flow and activate receptors involved in the natural lipolysis of the body Improve skin tightening to reduce orange peel skin Fibrous cellulite treatments will require mechanical disruption of fibrous septae with higher CO2 flows Indication All types of cellulite from grade IndashII to grade IIIndashIV Subcutaneous irregularities after liposuction Complementary treatment to liposuction which does not have any efficacy on cellulite

Protocol

Cellulite grade I or II

Combination of subcutaneous and intradermal injections One session per day to one per week Flow 1ndash2 cckgmin ndash approximately 2 minutes per injection Punctures 15ndash20 cm spaced no overlapping - Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Cellulite grade III or IV Combination of subcutaneous and intradermal injection One session per day to one per week Flow gt2 cckgmin Punctures 15ndash20 cm spaced no overlapping Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Technique The operatorrsquos hand movement should target both the subcutaneous layer and the intradermal layer as

both lipolysis and collagen synthesis need to be activated

Injection points Injections points should be made in the area where cellulite resides hips and thighs

Endpoint Subcutaneous injection will let the gas diffuse and create a 15ndash20 cm diameter granite-like appearance

disk After several sessions the skin offers less resistance to the gas diffusion so a few injections point may then be enough to treat the all cellulite area

Post-treatment care No post-injection care is necessary

Pain management Pain is more frequent in the first sessions CO2 can be reduced in the first sessions and progressively

increased from session to session If too much pain is reported change the injection point and reduce the treatment time giving more shorter injections

Maximizing results CDT may benefit from combination with such treatments as RF Cellu-M6 Velasmooth and manual

lymphatic massage Dietetic advice should be given to help the patient maintain a stable weight

Reinforcement sessions Patients are usually advised to renew the treatment at least once a year in order to maintain the

Localized fat

Indication Any kind of localized fat or skin irregularity after liposuction Can also be a complementary treatment to liposuction to treat the remaining fat Protocol Subcutaneous layer 1 session per day to 1 per week Flow 1ndash2 cckgmin (50ndash80 ccmin) approximately 2 minutes per injection point Punctures spaced 15ndash20 cm apart Number of sessions 10ndash20 ndash First results usually seen after session 4~6 Progressive flow (automatic mode) available with some machines Submentonian area deep dermis (andor subcutaneous) Flow 1ndash2 cckgmin (50ndash80 ccmin) Approximately 30ndash60 seconds per area injected (until onset of erythema or pain) - Usually three punctures (one in the center one left side one right side) May trigger a tempo-mandibular articulation pain (lasts 1 or 2 minutes)

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 11: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

Neo-angiogenesis effect

The first experiments in the 1930s consistedof injecting CO2 into the leg of a frog They

showed a strong vasodilatation associated with the creation of new capillaries

Mechanism of action Effects of CO2

bull Vasodilatation

bull The first effects following CO2 injection is a strong vasodilatation a blood flow increase and a higher pO2 in the treated area

bull The Bohr effect bull Local oxygen release is improved because of the Bohr effect The

Bohr effect describes the tendency of haemoglobin to have less affinity for oxygen when the blood concentration of CO2 is increased This lower affinity leads the haemoglobin to release the oxygen better in superficial tissues and muscles CO2 is quickly converted to bicarbonates and H+ acid in presence of the carbonic anhydrase enzyme

bull CO2 + H2O 1048774 H+ + HCO3

Bohr Effect

bull This reaction causes the tissuersquos pH to become acidic with even more dissociation of O2 from haemoglobin allowing the tissue to become even more oxygenated

Stimulation of collagen synthesis

bull A 2008 Brazilian study showed a reorganization of collagen fibres following intradermal injections of carbon dioxide and demonstrated that the CO2 is capable of increasing the collagen turnover a trauma to the dermis launches a healing process with collagen synthesis

bull CO2 improves the process by first increasing neovascularization with more healing substances and factors to be on site In second it releases more oxygen around and in the healing area improving the recovery phase

Stretch marksPrinciple

Improve neovascularization and blood flow (red color seen via skin transparency will appear pink close to the natural skin color) improve melanocyte pigment production to darken white stretch marks Improve collagen synthesis to reduce the wave appearance of old stretch marks

Indications

Old white stretch marks deep depressed stretch marks irregular old stretch marks are the main indications Young pinkred stretch marks should preferably have laser treatment (KTP or pulsed dye laser)

Protocol Combined intradermal and subcutaneous injections One session per month Flow 80ndash150 ccmin Puncture inside the mark Number of sessions four to ten

Technique Start injecting the dermis and when done push the needle further to inject the subcutaneous layers Endpoints Popcorn appearance (inflated stretch marks) for 1 or 2 minutes then erythema Injection points Follow each stretch mark and inject each 1ndash2 cm Post-treatment care No post injection care is required Pain management Injecting stretch marks is often painful Patients describe a burning sensation Although flow greater than 100 ccmin is recommended it is sometimes impossible to maintain these values because of the pain Lowering flows to 70ndash80 ccmin may make the patient more comfortable

Periorbital AreaPrinciple

Increase blood flow stimulate collagen production reduce fatty prolapse in some cases

Indications

Fatty prolapse eye wrinkles under-eye dark circles Smoker female with dark circle are good indications

Protocols

Eye wrinkles Combined intradermal and subcutaneous injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six

Under-eye dark circles Intradermal injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six Fatty prolapse Subcutaneous and intradermal injections One session per month Flow 20ndash40 ccmin Puncture in the fatty area Number of sessions three to six

Technique Injection points Fatty prolapse will receive two to four quick punctures in the area where the fat

resides Eye wrinkles and dark circles require from 2 to 3 punctures 1 or 2 cm spaced 1 or 2 seconds each made all along the external inferior border of the eye orbit next to the orbit bones (zygomatic bone)

Endpoints Eye lid becomes distended and inflated Upper eye lid distension may be important

Fatty prolapses are inflated and red The eye returns to normal appearance within 2 or 3 minutes

Post-treatment care No post-treatment care is required Sun protection may be used in the next 2 weeks

Pain management Emlareg if treatment is too painful (This cream lowers the Bohr effect vasoconstriction

reduces blood flow) To reduce pain lower the flow and increase the number of punctures

Caution

One of the major CO2 side effects and complication is pertinent to the eyelid procedure It is important to purge and remove any trace of oxygenair in the tubes and needle O2 injection into the eye lid leads to a strong inflammatory reaction which lasts 4 or 5 days with redness edema closed eye and pain

Celluliteorange peel skin

Principle Stimulate blood flow and activate receptors involved in the natural lipolysis of the body Improve skin tightening to reduce orange peel skin Fibrous cellulite treatments will require mechanical disruption of fibrous septae with higher CO2 flows Indication All types of cellulite from grade IndashII to grade IIIndashIV Subcutaneous irregularities after liposuction Complementary treatment to liposuction which does not have any efficacy on cellulite

Protocol

Cellulite grade I or II

Combination of subcutaneous and intradermal injections One session per day to one per week Flow 1ndash2 cckgmin ndash approximately 2 minutes per injection Punctures 15ndash20 cm spaced no overlapping - Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Cellulite grade III or IV Combination of subcutaneous and intradermal injection One session per day to one per week Flow gt2 cckgmin Punctures 15ndash20 cm spaced no overlapping Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Technique The operatorrsquos hand movement should target both the subcutaneous layer and the intradermal layer as

both lipolysis and collagen synthesis need to be activated

Injection points Injections points should be made in the area where cellulite resides hips and thighs

Endpoint Subcutaneous injection will let the gas diffuse and create a 15ndash20 cm diameter granite-like appearance

disk After several sessions the skin offers less resistance to the gas diffusion so a few injections point may then be enough to treat the all cellulite area

Post-treatment care No post-injection care is necessary

Pain management Pain is more frequent in the first sessions CO2 can be reduced in the first sessions and progressively

increased from session to session If too much pain is reported change the injection point and reduce the treatment time giving more shorter injections

Maximizing results CDT may benefit from combination with such treatments as RF Cellu-M6 Velasmooth and manual

lymphatic massage Dietetic advice should be given to help the patient maintain a stable weight

Reinforcement sessions Patients are usually advised to renew the treatment at least once a year in order to maintain the

Localized fat

Indication Any kind of localized fat or skin irregularity after liposuction Can also be a complementary treatment to liposuction to treat the remaining fat Protocol Subcutaneous layer 1 session per day to 1 per week Flow 1ndash2 cckgmin (50ndash80 ccmin) approximately 2 minutes per injection point Punctures spaced 15ndash20 cm apart Number of sessions 10ndash20 ndash First results usually seen after session 4~6 Progressive flow (automatic mode) available with some machines Submentonian area deep dermis (andor subcutaneous) Flow 1ndash2 cckgmin (50ndash80 ccmin) Approximately 30ndash60 seconds per area injected (until onset of erythema or pain) - Usually three punctures (one in the center one left side one right side) May trigger a tempo-mandibular articulation pain (lasts 1 or 2 minutes)

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 12: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

Mechanism of action Effects of CO2

bull Vasodilatation

bull The first effects following CO2 injection is a strong vasodilatation a blood flow increase and a higher pO2 in the treated area

bull The Bohr effect bull Local oxygen release is improved because of the Bohr effect The

Bohr effect describes the tendency of haemoglobin to have less affinity for oxygen when the blood concentration of CO2 is increased This lower affinity leads the haemoglobin to release the oxygen better in superficial tissues and muscles CO2 is quickly converted to bicarbonates and H+ acid in presence of the carbonic anhydrase enzyme

bull CO2 + H2O 1048774 H+ + HCO3

Bohr Effect

bull This reaction causes the tissuersquos pH to become acidic with even more dissociation of O2 from haemoglobin allowing the tissue to become even more oxygenated

Stimulation of collagen synthesis

bull A 2008 Brazilian study showed a reorganization of collagen fibres following intradermal injections of carbon dioxide and demonstrated that the CO2 is capable of increasing the collagen turnover a trauma to the dermis launches a healing process with collagen synthesis

bull CO2 improves the process by first increasing neovascularization with more healing substances and factors to be on site In second it releases more oxygen around and in the healing area improving the recovery phase

Stretch marksPrinciple

Improve neovascularization and blood flow (red color seen via skin transparency will appear pink close to the natural skin color) improve melanocyte pigment production to darken white stretch marks Improve collagen synthesis to reduce the wave appearance of old stretch marks

Indications

Old white stretch marks deep depressed stretch marks irregular old stretch marks are the main indications Young pinkred stretch marks should preferably have laser treatment (KTP or pulsed dye laser)

Protocol Combined intradermal and subcutaneous injections One session per month Flow 80ndash150 ccmin Puncture inside the mark Number of sessions four to ten

Technique Start injecting the dermis and when done push the needle further to inject the subcutaneous layers Endpoints Popcorn appearance (inflated stretch marks) for 1 or 2 minutes then erythema Injection points Follow each stretch mark and inject each 1ndash2 cm Post-treatment care No post injection care is required Pain management Injecting stretch marks is often painful Patients describe a burning sensation Although flow greater than 100 ccmin is recommended it is sometimes impossible to maintain these values because of the pain Lowering flows to 70ndash80 ccmin may make the patient more comfortable

Periorbital AreaPrinciple

Increase blood flow stimulate collagen production reduce fatty prolapse in some cases

Indications

Fatty prolapse eye wrinkles under-eye dark circles Smoker female with dark circle are good indications

Protocols

Eye wrinkles Combined intradermal and subcutaneous injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six

Under-eye dark circles Intradermal injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six Fatty prolapse Subcutaneous and intradermal injections One session per month Flow 20ndash40 ccmin Puncture in the fatty area Number of sessions three to six

Technique Injection points Fatty prolapse will receive two to four quick punctures in the area where the fat

resides Eye wrinkles and dark circles require from 2 to 3 punctures 1 or 2 cm spaced 1 or 2 seconds each made all along the external inferior border of the eye orbit next to the orbit bones (zygomatic bone)

Endpoints Eye lid becomes distended and inflated Upper eye lid distension may be important

Fatty prolapses are inflated and red The eye returns to normal appearance within 2 or 3 minutes

Post-treatment care No post-treatment care is required Sun protection may be used in the next 2 weeks

Pain management Emlareg if treatment is too painful (This cream lowers the Bohr effect vasoconstriction

reduces blood flow) To reduce pain lower the flow and increase the number of punctures

Caution

One of the major CO2 side effects and complication is pertinent to the eyelid procedure It is important to purge and remove any trace of oxygenair in the tubes and needle O2 injection into the eye lid leads to a strong inflammatory reaction which lasts 4 or 5 days with redness edema closed eye and pain

Celluliteorange peel skin

Principle Stimulate blood flow and activate receptors involved in the natural lipolysis of the body Improve skin tightening to reduce orange peel skin Fibrous cellulite treatments will require mechanical disruption of fibrous septae with higher CO2 flows Indication All types of cellulite from grade IndashII to grade IIIndashIV Subcutaneous irregularities after liposuction Complementary treatment to liposuction which does not have any efficacy on cellulite

Protocol

Cellulite grade I or II

Combination of subcutaneous and intradermal injections One session per day to one per week Flow 1ndash2 cckgmin ndash approximately 2 minutes per injection Punctures 15ndash20 cm spaced no overlapping - Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Cellulite grade III or IV Combination of subcutaneous and intradermal injection One session per day to one per week Flow gt2 cckgmin Punctures 15ndash20 cm spaced no overlapping Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Technique The operatorrsquos hand movement should target both the subcutaneous layer and the intradermal layer as

both lipolysis and collagen synthesis need to be activated

Injection points Injections points should be made in the area where cellulite resides hips and thighs

Endpoint Subcutaneous injection will let the gas diffuse and create a 15ndash20 cm diameter granite-like appearance

disk After several sessions the skin offers less resistance to the gas diffusion so a few injections point may then be enough to treat the all cellulite area

Post-treatment care No post-injection care is necessary

Pain management Pain is more frequent in the first sessions CO2 can be reduced in the first sessions and progressively

increased from session to session If too much pain is reported change the injection point and reduce the treatment time giving more shorter injections

Maximizing results CDT may benefit from combination with such treatments as RF Cellu-M6 Velasmooth and manual

lymphatic massage Dietetic advice should be given to help the patient maintain a stable weight

Reinforcement sessions Patients are usually advised to renew the treatment at least once a year in order to maintain the

Localized fat

Indication Any kind of localized fat or skin irregularity after liposuction Can also be a complementary treatment to liposuction to treat the remaining fat Protocol Subcutaneous layer 1 session per day to 1 per week Flow 1ndash2 cckgmin (50ndash80 ccmin) approximately 2 minutes per injection point Punctures spaced 15ndash20 cm apart Number of sessions 10ndash20 ndash First results usually seen after session 4~6 Progressive flow (automatic mode) available with some machines Submentonian area deep dermis (andor subcutaneous) Flow 1ndash2 cckgmin (50ndash80 ccmin) Approximately 30ndash60 seconds per area injected (until onset of erythema or pain) - Usually three punctures (one in the center one left side one right side) May trigger a tempo-mandibular articulation pain (lasts 1 or 2 minutes)

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 13: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

Bohr Effect

bull This reaction causes the tissuersquos pH to become acidic with even more dissociation of O2 from haemoglobin allowing the tissue to become even more oxygenated

Stimulation of collagen synthesis

bull A 2008 Brazilian study showed a reorganization of collagen fibres following intradermal injections of carbon dioxide and demonstrated that the CO2 is capable of increasing the collagen turnover a trauma to the dermis launches a healing process with collagen synthesis

bull CO2 improves the process by first increasing neovascularization with more healing substances and factors to be on site In second it releases more oxygen around and in the healing area improving the recovery phase

Stretch marksPrinciple

Improve neovascularization and blood flow (red color seen via skin transparency will appear pink close to the natural skin color) improve melanocyte pigment production to darken white stretch marks Improve collagen synthesis to reduce the wave appearance of old stretch marks

Indications

Old white stretch marks deep depressed stretch marks irregular old stretch marks are the main indications Young pinkred stretch marks should preferably have laser treatment (KTP or pulsed dye laser)

Protocol Combined intradermal and subcutaneous injections One session per month Flow 80ndash150 ccmin Puncture inside the mark Number of sessions four to ten

Technique Start injecting the dermis and when done push the needle further to inject the subcutaneous layers Endpoints Popcorn appearance (inflated stretch marks) for 1 or 2 minutes then erythema Injection points Follow each stretch mark and inject each 1ndash2 cm Post-treatment care No post injection care is required Pain management Injecting stretch marks is often painful Patients describe a burning sensation Although flow greater than 100 ccmin is recommended it is sometimes impossible to maintain these values because of the pain Lowering flows to 70ndash80 ccmin may make the patient more comfortable

Periorbital AreaPrinciple

Increase blood flow stimulate collagen production reduce fatty prolapse in some cases

Indications

Fatty prolapse eye wrinkles under-eye dark circles Smoker female with dark circle are good indications

Protocols

Eye wrinkles Combined intradermal and subcutaneous injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six

Under-eye dark circles Intradermal injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six Fatty prolapse Subcutaneous and intradermal injections One session per month Flow 20ndash40 ccmin Puncture in the fatty area Number of sessions three to six

Technique Injection points Fatty prolapse will receive two to four quick punctures in the area where the fat

resides Eye wrinkles and dark circles require from 2 to 3 punctures 1 or 2 cm spaced 1 or 2 seconds each made all along the external inferior border of the eye orbit next to the orbit bones (zygomatic bone)

Endpoints Eye lid becomes distended and inflated Upper eye lid distension may be important

Fatty prolapses are inflated and red The eye returns to normal appearance within 2 or 3 minutes

Post-treatment care No post-treatment care is required Sun protection may be used in the next 2 weeks

Pain management Emlareg if treatment is too painful (This cream lowers the Bohr effect vasoconstriction

reduces blood flow) To reduce pain lower the flow and increase the number of punctures

Caution

One of the major CO2 side effects and complication is pertinent to the eyelid procedure It is important to purge and remove any trace of oxygenair in the tubes and needle O2 injection into the eye lid leads to a strong inflammatory reaction which lasts 4 or 5 days with redness edema closed eye and pain

Celluliteorange peel skin

Principle Stimulate blood flow and activate receptors involved in the natural lipolysis of the body Improve skin tightening to reduce orange peel skin Fibrous cellulite treatments will require mechanical disruption of fibrous septae with higher CO2 flows Indication All types of cellulite from grade IndashII to grade IIIndashIV Subcutaneous irregularities after liposuction Complementary treatment to liposuction which does not have any efficacy on cellulite

Protocol

Cellulite grade I or II

Combination of subcutaneous and intradermal injections One session per day to one per week Flow 1ndash2 cckgmin ndash approximately 2 minutes per injection Punctures 15ndash20 cm spaced no overlapping - Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Cellulite grade III or IV Combination of subcutaneous and intradermal injection One session per day to one per week Flow gt2 cckgmin Punctures 15ndash20 cm spaced no overlapping Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Technique The operatorrsquos hand movement should target both the subcutaneous layer and the intradermal layer as

both lipolysis and collagen synthesis need to be activated

Injection points Injections points should be made in the area where cellulite resides hips and thighs

Endpoint Subcutaneous injection will let the gas diffuse and create a 15ndash20 cm diameter granite-like appearance

disk After several sessions the skin offers less resistance to the gas diffusion so a few injections point may then be enough to treat the all cellulite area

Post-treatment care No post-injection care is necessary

Pain management Pain is more frequent in the first sessions CO2 can be reduced in the first sessions and progressively

increased from session to session If too much pain is reported change the injection point and reduce the treatment time giving more shorter injections

Maximizing results CDT may benefit from combination with such treatments as RF Cellu-M6 Velasmooth and manual

lymphatic massage Dietetic advice should be given to help the patient maintain a stable weight

Reinforcement sessions Patients are usually advised to renew the treatment at least once a year in order to maintain the

Localized fat

Indication Any kind of localized fat or skin irregularity after liposuction Can also be a complementary treatment to liposuction to treat the remaining fat Protocol Subcutaneous layer 1 session per day to 1 per week Flow 1ndash2 cckgmin (50ndash80 ccmin) approximately 2 minutes per injection point Punctures spaced 15ndash20 cm apart Number of sessions 10ndash20 ndash First results usually seen after session 4~6 Progressive flow (automatic mode) available with some machines Submentonian area deep dermis (andor subcutaneous) Flow 1ndash2 cckgmin (50ndash80 ccmin) Approximately 30ndash60 seconds per area injected (until onset of erythema or pain) - Usually three punctures (one in the center one left side one right side) May trigger a tempo-mandibular articulation pain (lasts 1 or 2 minutes)

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 14: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

Stimulation of collagen synthesis

bull A 2008 Brazilian study showed a reorganization of collagen fibres following intradermal injections of carbon dioxide and demonstrated that the CO2 is capable of increasing the collagen turnover a trauma to the dermis launches a healing process with collagen synthesis

bull CO2 improves the process by first increasing neovascularization with more healing substances and factors to be on site In second it releases more oxygen around and in the healing area improving the recovery phase

Stretch marksPrinciple

Improve neovascularization and blood flow (red color seen via skin transparency will appear pink close to the natural skin color) improve melanocyte pigment production to darken white stretch marks Improve collagen synthesis to reduce the wave appearance of old stretch marks

Indications

Old white stretch marks deep depressed stretch marks irregular old stretch marks are the main indications Young pinkred stretch marks should preferably have laser treatment (KTP or pulsed dye laser)

Protocol Combined intradermal and subcutaneous injections One session per month Flow 80ndash150 ccmin Puncture inside the mark Number of sessions four to ten

Technique Start injecting the dermis and when done push the needle further to inject the subcutaneous layers Endpoints Popcorn appearance (inflated stretch marks) for 1 or 2 minutes then erythema Injection points Follow each stretch mark and inject each 1ndash2 cm Post-treatment care No post injection care is required Pain management Injecting stretch marks is often painful Patients describe a burning sensation Although flow greater than 100 ccmin is recommended it is sometimes impossible to maintain these values because of the pain Lowering flows to 70ndash80 ccmin may make the patient more comfortable

Periorbital AreaPrinciple

Increase blood flow stimulate collagen production reduce fatty prolapse in some cases

Indications

Fatty prolapse eye wrinkles under-eye dark circles Smoker female with dark circle are good indications

Protocols

Eye wrinkles Combined intradermal and subcutaneous injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six

Under-eye dark circles Intradermal injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six Fatty prolapse Subcutaneous and intradermal injections One session per month Flow 20ndash40 ccmin Puncture in the fatty area Number of sessions three to six

Technique Injection points Fatty prolapse will receive two to four quick punctures in the area where the fat

resides Eye wrinkles and dark circles require from 2 to 3 punctures 1 or 2 cm spaced 1 or 2 seconds each made all along the external inferior border of the eye orbit next to the orbit bones (zygomatic bone)

Endpoints Eye lid becomes distended and inflated Upper eye lid distension may be important

Fatty prolapses are inflated and red The eye returns to normal appearance within 2 or 3 minutes

Post-treatment care No post-treatment care is required Sun protection may be used in the next 2 weeks

Pain management Emlareg if treatment is too painful (This cream lowers the Bohr effect vasoconstriction

reduces blood flow) To reduce pain lower the flow and increase the number of punctures

Caution

One of the major CO2 side effects and complication is pertinent to the eyelid procedure It is important to purge and remove any trace of oxygenair in the tubes and needle O2 injection into the eye lid leads to a strong inflammatory reaction which lasts 4 or 5 days with redness edema closed eye and pain

Celluliteorange peel skin

Principle Stimulate blood flow and activate receptors involved in the natural lipolysis of the body Improve skin tightening to reduce orange peel skin Fibrous cellulite treatments will require mechanical disruption of fibrous septae with higher CO2 flows Indication All types of cellulite from grade IndashII to grade IIIndashIV Subcutaneous irregularities after liposuction Complementary treatment to liposuction which does not have any efficacy on cellulite

Protocol

Cellulite grade I or II

Combination of subcutaneous and intradermal injections One session per day to one per week Flow 1ndash2 cckgmin ndash approximately 2 minutes per injection Punctures 15ndash20 cm spaced no overlapping - Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Cellulite grade III or IV Combination of subcutaneous and intradermal injection One session per day to one per week Flow gt2 cckgmin Punctures 15ndash20 cm spaced no overlapping Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Technique The operatorrsquos hand movement should target both the subcutaneous layer and the intradermal layer as

both lipolysis and collagen synthesis need to be activated

Injection points Injections points should be made in the area where cellulite resides hips and thighs

Endpoint Subcutaneous injection will let the gas diffuse and create a 15ndash20 cm diameter granite-like appearance

disk After several sessions the skin offers less resistance to the gas diffusion so a few injections point may then be enough to treat the all cellulite area

Post-treatment care No post-injection care is necessary

Pain management Pain is more frequent in the first sessions CO2 can be reduced in the first sessions and progressively

increased from session to session If too much pain is reported change the injection point and reduce the treatment time giving more shorter injections

Maximizing results CDT may benefit from combination with such treatments as RF Cellu-M6 Velasmooth and manual

lymphatic massage Dietetic advice should be given to help the patient maintain a stable weight

Reinforcement sessions Patients are usually advised to renew the treatment at least once a year in order to maintain the

Localized fat

Indication Any kind of localized fat or skin irregularity after liposuction Can also be a complementary treatment to liposuction to treat the remaining fat Protocol Subcutaneous layer 1 session per day to 1 per week Flow 1ndash2 cckgmin (50ndash80 ccmin) approximately 2 minutes per injection point Punctures spaced 15ndash20 cm apart Number of sessions 10ndash20 ndash First results usually seen after session 4~6 Progressive flow (automatic mode) available with some machines Submentonian area deep dermis (andor subcutaneous) Flow 1ndash2 cckgmin (50ndash80 ccmin) Approximately 30ndash60 seconds per area injected (until onset of erythema or pain) - Usually three punctures (one in the center one left side one right side) May trigger a tempo-mandibular articulation pain (lasts 1 or 2 minutes)

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 15: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

Stretch marksPrinciple

Improve neovascularization and blood flow (red color seen via skin transparency will appear pink close to the natural skin color) improve melanocyte pigment production to darken white stretch marks Improve collagen synthesis to reduce the wave appearance of old stretch marks

Indications

Old white stretch marks deep depressed stretch marks irregular old stretch marks are the main indications Young pinkred stretch marks should preferably have laser treatment (KTP or pulsed dye laser)

Protocol Combined intradermal and subcutaneous injections One session per month Flow 80ndash150 ccmin Puncture inside the mark Number of sessions four to ten

Technique Start injecting the dermis and when done push the needle further to inject the subcutaneous layers Endpoints Popcorn appearance (inflated stretch marks) for 1 or 2 minutes then erythema Injection points Follow each stretch mark and inject each 1ndash2 cm Post-treatment care No post injection care is required Pain management Injecting stretch marks is often painful Patients describe a burning sensation Although flow greater than 100 ccmin is recommended it is sometimes impossible to maintain these values because of the pain Lowering flows to 70ndash80 ccmin may make the patient more comfortable

Periorbital AreaPrinciple

Increase blood flow stimulate collagen production reduce fatty prolapse in some cases

Indications

Fatty prolapse eye wrinkles under-eye dark circles Smoker female with dark circle are good indications

Protocols

Eye wrinkles Combined intradermal and subcutaneous injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six

Under-eye dark circles Intradermal injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six Fatty prolapse Subcutaneous and intradermal injections One session per month Flow 20ndash40 ccmin Puncture in the fatty area Number of sessions three to six

Technique Injection points Fatty prolapse will receive two to four quick punctures in the area where the fat

resides Eye wrinkles and dark circles require from 2 to 3 punctures 1 or 2 cm spaced 1 or 2 seconds each made all along the external inferior border of the eye orbit next to the orbit bones (zygomatic bone)

Endpoints Eye lid becomes distended and inflated Upper eye lid distension may be important

Fatty prolapses are inflated and red The eye returns to normal appearance within 2 or 3 minutes

Post-treatment care No post-treatment care is required Sun protection may be used in the next 2 weeks

Pain management Emlareg if treatment is too painful (This cream lowers the Bohr effect vasoconstriction

reduces blood flow) To reduce pain lower the flow and increase the number of punctures

Caution

One of the major CO2 side effects and complication is pertinent to the eyelid procedure It is important to purge and remove any trace of oxygenair in the tubes and needle O2 injection into the eye lid leads to a strong inflammatory reaction which lasts 4 or 5 days with redness edema closed eye and pain

Celluliteorange peel skin

Principle Stimulate blood flow and activate receptors involved in the natural lipolysis of the body Improve skin tightening to reduce orange peel skin Fibrous cellulite treatments will require mechanical disruption of fibrous septae with higher CO2 flows Indication All types of cellulite from grade IndashII to grade IIIndashIV Subcutaneous irregularities after liposuction Complementary treatment to liposuction which does not have any efficacy on cellulite

Protocol

Cellulite grade I or II

Combination of subcutaneous and intradermal injections One session per day to one per week Flow 1ndash2 cckgmin ndash approximately 2 minutes per injection Punctures 15ndash20 cm spaced no overlapping - Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Cellulite grade III or IV Combination of subcutaneous and intradermal injection One session per day to one per week Flow gt2 cckgmin Punctures 15ndash20 cm spaced no overlapping Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Technique The operatorrsquos hand movement should target both the subcutaneous layer and the intradermal layer as

both lipolysis and collagen synthesis need to be activated

Injection points Injections points should be made in the area where cellulite resides hips and thighs

Endpoint Subcutaneous injection will let the gas diffuse and create a 15ndash20 cm diameter granite-like appearance

disk After several sessions the skin offers less resistance to the gas diffusion so a few injections point may then be enough to treat the all cellulite area

Post-treatment care No post-injection care is necessary

Pain management Pain is more frequent in the first sessions CO2 can be reduced in the first sessions and progressively

increased from session to session If too much pain is reported change the injection point and reduce the treatment time giving more shorter injections

Maximizing results CDT may benefit from combination with such treatments as RF Cellu-M6 Velasmooth and manual

lymphatic massage Dietetic advice should be given to help the patient maintain a stable weight

Reinforcement sessions Patients are usually advised to renew the treatment at least once a year in order to maintain the

Localized fat

Indication Any kind of localized fat or skin irregularity after liposuction Can also be a complementary treatment to liposuction to treat the remaining fat Protocol Subcutaneous layer 1 session per day to 1 per week Flow 1ndash2 cckgmin (50ndash80 ccmin) approximately 2 minutes per injection point Punctures spaced 15ndash20 cm apart Number of sessions 10ndash20 ndash First results usually seen after session 4~6 Progressive flow (automatic mode) available with some machines Submentonian area deep dermis (andor subcutaneous) Flow 1ndash2 cckgmin (50ndash80 ccmin) Approximately 30ndash60 seconds per area injected (until onset of erythema or pain) - Usually three punctures (one in the center one left side one right side) May trigger a tempo-mandibular articulation pain (lasts 1 or 2 minutes)

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 16: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

Technique Start injecting the dermis and when done push the needle further to inject the subcutaneous layers Endpoints Popcorn appearance (inflated stretch marks) for 1 or 2 minutes then erythema Injection points Follow each stretch mark and inject each 1ndash2 cm Post-treatment care No post injection care is required Pain management Injecting stretch marks is often painful Patients describe a burning sensation Although flow greater than 100 ccmin is recommended it is sometimes impossible to maintain these values because of the pain Lowering flows to 70ndash80 ccmin may make the patient more comfortable

Periorbital AreaPrinciple

Increase blood flow stimulate collagen production reduce fatty prolapse in some cases

Indications

Fatty prolapse eye wrinkles under-eye dark circles Smoker female with dark circle are good indications

Protocols

Eye wrinkles Combined intradermal and subcutaneous injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six

Under-eye dark circles Intradermal injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six Fatty prolapse Subcutaneous and intradermal injections One session per month Flow 20ndash40 ccmin Puncture in the fatty area Number of sessions three to six

Technique Injection points Fatty prolapse will receive two to four quick punctures in the area where the fat

resides Eye wrinkles and dark circles require from 2 to 3 punctures 1 or 2 cm spaced 1 or 2 seconds each made all along the external inferior border of the eye orbit next to the orbit bones (zygomatic bone)

Endpoints Eye lid becomes distended and inflated Upper eye lid distension may be important

Fatty prolapses are inflated and red The eye returns to normal appearance within 2 or 3 minutes

Post-treatment care No post-treatment care is required Sun protection may be used in the next 2 weeks

Pain management Emlareg if treatment is too painful (This cream lowers the Bohr effect vasoconstriction

reduces blood flow) To reduce pain lower the flow and increase the number of punctures

Caution

One of the major CO2 side effects and complication is pertinent to the eyelid procedure It is important to purge and remove any trace of oxygenair in the tubes and needle O2 injection into the eye lid leads to a strong inflammatory reaction which lasts 4 or 5 days with redness edema closed eye and pain

Celluliteorange peel skin

Principle Stimulate blood flow and activate receptors involved in the natural lipolysis of the body Improve skin tightening to reduce orange peel skin Fibrous cellulite treatments will require mechanical disruption of fibrous septae with higher CO2 flows Indication All types of cellulite from grade IndashII to grade IIIndashIV Subcutaneous irregularities after liposuction Complementary treatment to liposuction which does not have any efficacy on cellulite

Protocol

Cellulite grade I or II

Combination of subcutaneous and intradermal injections One session per day to one per week Flow 1ndash2 cckgmin ndash approximately 2 minutes per injection Punctures 15ndash20 cm spaced no overlapping - Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Cellulite grade III or IV Combination of subcutaneous and intradermal injection One session per day to one per week Flow gt2 cckgmin Punctures 15ndash20 cm spaced no overlapping Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Technique The operatorrsquos hand movement should target both the subcutaneous layer and the intradermal layer as

both lipolysis and collagen synthesis need to be activated

Injection points Injections points should be made in the area where cellulite resides hips and thighs

Endpoint Subcutaneous injection will let the gas diffuse and create a 15ndash20 cm diameter granite-like appearance

disk After several sessions the skin offers less resistance to the gas diffusion so a few injections point may then be enough to treat the all cellulite area

Post-treatment care No post-injection care is necessary

Pain management Pain is more frequent in the first sessions CO2 can be reduced in the first sessions and progressively

increased from session to session If too much pain is reported change the injection point and reduce the treatment time giving more shorter injections

Maximizing results CDT may benefit from combination with such treatments as RF Cellu-M6 Velasmooth and manual

lymphatic massage Dietetic advice should be given to help the patient maintain a stable weight

Reinforcement sessions Patients are usually advised to renew the treatment at least once a year in order to maintain the

Localized fat

Indication Any kind of localized fat or skin irregularity after liposuction Can also be a complementary treatment to liposuction to treat the remaining fat Protocol Subcutaneous layer 1 session per day to 1 per week Flow 1ndash2 cckgmin (50ndash80 ccmin) approximately 2 minutes per injection point Punctures spaced 15ndash20 cm apart Number of sessions 10ndash20 ndash First results usually seen after session 4~6 Progressive flow (automatic mode) available with some machines Submentonian area deep dermis (andor subcutaneous) Flow 1ndash2 cckgmin (50ndash80 ccmin) Approximately 30ndash60 seconds per area injected (until onset of erythema or pain) - Usually three punctures (one in the center one left side one right side) May trigger a tempo-mandibular articulation pain (lasts 1 or 2 minutes)

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 17: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

Periorbital AreaPrinciple

Increase blood flow stimulate collagen production reduce fatty prolapse in some cases

Indications

Fatty prolapse eye wrinkles under-eye dark circles Smoker female with dark circle are good indications

Protocols

Eye wrinkles Combined intradermal and subcutaneous injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six

Under-eye dark circles Intradermal injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six Fatty prolapse Subcutaneous and intradermal injections One session per month Flow 20ndash40 ccmin Puncture in the fatty area Number of sessions three to six

Technique Injection points Fatty prolapse will receive two to four quick punctures in the area where the fat

resides Eye wrinkles and dark circles require from 2 to 3 punctures 1 or 2 cm spaced 1 or 2 seconds each made all along the external inferior border of the eye orbit next to the orbit bones (zygomatic bone)

Endpoints Eye lid becomes distended and inflated Upper eye lid distension may be important

Fatty prolapses are inflated and red The eye returns to normal appearance within 2 or 3 minutes

Post-treatment care No post-treatment care is required Sun protection may be used in the next 2 weeks

Pain management Emlareg if treatment is too painful (This cream lowers the Bohr effect vasoconstriction

reduces blood flow) To reduce pain lower the flow and increase the number of punctures

Caution

One of the major CO2 side effects and complication is pertinent to the eyelid procedure It is important to purge and remove any trace of oxygenair in the tubes and needle O2 injection into the eye lid leads to a strong inflammatory reaction which lasts 4 or 5 days with redness edema closed eye and pain

Celluliteorange peel skin

Principle Stimulate blood flow and activate receptors involved in the natural lipolysis of the body Improve skin tightening to reduce orange peel skin Fibrous cellulite treatments will require mechanical disruption of fibrous septae with higher CO2 flows Indication All types of cellulite from grade IndashII to grade IIIndashIV Subcutaneous irregularities after liposuction Complementary treatment to liposuction which does not have any efficacy on cellulite

Protocol

Cellulite grade I or II

Combination of subcutaneous and intradermal injections One session per day to one per week Flow 1ndash2 cckgmin ndash approximately 2 minutes per injection Punctures 15ndash20 cm spaced no overlapping - Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Cellulite grade III or IV Combination of subcutaneous and intradermal injection One session per day to one per week Flow gt2 cckgmin Punctures 15ndash20 cm spaced no overlapping Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Technique The operatorrsquos hand movement should target both the subcutaneous layer and the intradermal layer as

both lipolysis and collagen synthesis need to be activated

Injection points Injections points should be made in the area where cellulite resides hips and thighs

Endpoint Subcutaneous injection will let the gas diffuse and create a 15ndash20 cm diameter granite-like appearance

disk After several sessions the skin offers less resistance to the gas diffusion so a few injections point may then be enough to treat the all cellulite area

Post-treatment care No post-injection care is necessary

Pain management Pain is more frequent in the first sessions CO2 can be reduced in the first sessions and progressively

increased from session to session If too much pain is reported change the injection point and reduce the treatment time giving more shorter injections

Maximizing results CDT may benefit from combination with such treatments as RF Cellu-M6 Velasmooth and manual

lymphatic massage Dietetic advice should be given to help the patient maintain a stable weight

Reinforcement sessions Patients are usually advised to renew the treatment at least once a year in order to maintain the

Localized fat

Indication Any kind of localized fat or skin irregularity after liposuction Can also be a complementary treatment to liposuction to treat the remaining fat Protocol Subcutaneous layer 1 session per day to 1 per week Flow 1ndash2 cckgmin (50ndash80 ccmin) approximately 2 minutes per injection point Punctures spaced 15ndash20 cm apart Number of sessions 10ndash20 ndash First results usually seen after session 4~6 Progressive flow (automatic mode) available with some machines Submentonian area deep dermis (andor subcutaneous) Flow 1ndash2 cckgmin (50ndash80 ccmin) Approximately 30ndash60 seconds per area injected (until onset of erythema or pain) - Usually three punctures (one in the center one left side one right side) May trigger a tempo-mandibular articulation pain (lasts 1 or 2 minutes)

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 18: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

Under-eye dark circles Intradermal injections One session per month Flow 20ndash40 ccmin Four to five punctures around the lower orbit bones Number of sessions three to six Fatty prolapse Subcutaneous and intradermal injections One session per month Flow 20ndash40 ccmin Puncture in the fatty area Number of sessions three to six

Technique Injection points Fatty prolapse will receive two to four quick punctures in the area where the fat

resides Eye wrinkles and dark circles require from 2 to 3 punctures 1 or 2 cm spaced 1 or 2 seconds each made all along the external inferior border of the eye orbit next to the orbit bones (zygomatic bone)

Endpoints Eye lid becomes distended and inflated Upper eye lid distension may be important

Fatty prolapses are inflated and red The eye returns to normal appearance within 2 or 3 minutes

Post-treatment care No post-treatment care is required Sun protection may be used in the next 2 weeks

Pain management Emlareg if treatment is too painful (This cream lowers the Bohr effect vasoconstriction

reduces blood flow) To reduce pain lower the flow and increase the number of punctures

Caution

One of the major CO2 side effects and complication is pertinent to the eyelid procedure It is important to purge and remove any trace of oxygenair in the tubes and needle O2 injection into the eye lid leads to a strong inflammatory reaction which lasts 4 or 5 days with redness edema closed eye and pain

Celluliteorange peel skin

Principle Stimulate blood flow and activate receptors involved in the natural lipolysis of the body Improve skin tightening to reduce orange peel skin Fibrous cellulite treatments will require mechanical disruption of fibrous septae with higher CO2 flows Indication All types of cellulite from grade IndashII to grade IIIndashIV Subcutaneous irregularities after liposuction Complementary treatment to liposuction which does not have any efficacy on cellulite

Protocol

Cellulite grade I or II

Combination of subcutaneous and intradermal injections One session per day to one per week Flow 1ndash2 cckgmin ndash approximately 2 minutes per injection Punctures 15ndash20 cm spaced no overlapping - Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Cellulite grade III or IV Combination of subcutaneous and intradermal injection One session per day to one per week Flow gt2 cckgmin Punctures 15ndash20 cm spaced no overlapping Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Technique The operatorrsquos hand movement should target both the subcutaneous layer and the intradermal layer as

both lipolysis and collagen synthesis need to be activated

Injection points Injections points should be made in the area where cellulite resides hips and thighs

Endpoint Subcutaneous injection will let the gas diffuse and create a 15ndash20 cm diameter granite-like appearance

disk After several sessions the skin offers less resistance to the gas diffusion so a few injections point may then be enough to treat the all cellulite area

Post-treatment care No post-injection care is necessary

Pain management Pain is more frequent in the first sessions CO2 can be reduced in the first sessions and progressively

increased from session to session If too much pain is reported change the injection point and reduce the treatment time giving more shorter injections

Maximizing results CDT may benefit from combination with such treatments as RF Cellu-M6 Velasmooth and manual

lymphatic massage Dietetic advice should be given to help the patient maintain a stable weight

Reinforcement sessions Patients are usually advised to renew the treatment at least once a year in order to maintain the

Localized fat

Indication Any kind of localized fat or skin irregularity after liposuction Can also be a complementary treatment to liposuction to treat the remaining fat Protocol Subcutaneous layer 1 session per day to 1 per week Flow 1ndash2 cckgmin (50ndash80 ccmin) approximately 2 minutes per injection point Punctures spaced 15ndash20 cm apart Number of sessions 10ndash20 ndash First results usually seen after session 4~6 Progressive flow (automatic mode) available with some machines Submentonian area deep dermis (andor subcutaneous) Flow 1ndash2 cckgmin (50ndash80 ccmin) Approximately 30ndash60 seconds per area injected (until onset of erythema or pain) - Usually three punctures (one in the center one left side one right side) May trigger a tempo-mandibular articulation pain (lasts 1 or 2 minutes)

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 19: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

Technique Injection points Fatty prolapse will receive two to four quick punctures in the area where the fat

resides Eye wrinkles and dark circles require from 2 to 3 punctures 1 or 2 cm spaced 1 or 2 seconds each made all along the external inferior border of the eye orbit next to the orbit bones (zygomatic bone)

Endpoints Eye lid becomes distended and inflated Upper eye lid distension may be important

Fatty prolapses are inflated and red The eye returns to normal appearance within 2 or 3 minutes

Post-treatment care No post-treatment care is required Sun protection may be used in the next 2 weeks

Pain management Emlareg if treatment is too painful (This cream lowers the Bohr effect vasoconstriction

reduces blood flow) To reduce pain lower the flow and increase the number of punctures

Caution

One of the major CO2 side effects and complication is pertinent to the eyelid procedure It is important to purge and remove any trace of oxygenair in the tubes and needle O2 injection into the eye lid leads to a strong inflammatory reaction which lasts 4 or 5 days with redness edema closed eye and pain

Celluliteorange peel skin

Principle Stimulate blood flow and activate receptors involved in the natural lipolysis of the body Improve skin tightening to reduce orange peel skin Fibrous cellulite treatments will require mechanical disruption of fibrous septae with higher CO2 flows Indication All types of cellulite from grade IndashII to grade IIIndashIV Subcutaneous irregularities after liposuction Complementary treatment to liposuction which does not have any efficacy on cellulite

Protocol

Cellulite grade I or II

Combination of subcutaneous and intradermal injections One session per day to one per week Flow 1ndash2 cckgmin ndash approximately 2 minutes per injection Punctures 15ndash20 cm spaced no overlapping - Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Cellulite grade III or IV Combination of subcutaneous and intradermal injection One session per day to one per week Flow gt2 cckgmin Punctures 15ndash20 cm spaced no overlapping Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Technique The operatorrsquos hand movement should target both the subcutaneous layer and the intradermal layer as

both lipolysis and collagen synthesis need to be activated

Injection points Injections points should be made in the area where cellulite resides hips and thighs

Endpoint Subcutaneous injection will let the gas diffuse and create a 15ndash20 cm diameter granite-like appearance

disk After several sessions the skin offers less resistance to the gas diffusion so a few injections point may then be enough to treat the all cellulite area

Post-treatment care No post-injection care is necessary

Pain management Pain is more frequent in the first sessions CO2 can be reduced in the first sessions and progressively

increased from session to session If too much pain is reported change the injection point and reduce the treatment time giving more shorter injections

Maximizing results CDT may benefit from combination with such treatments as RF Cellu-M6 Velasmooth and manual

lymphatic massage Dietetic advice should be given to help the patient maintain a stable weight

Reinforcement sessions Patients are usually advised to renew the treatment at least once a year in order to maintain the

Localized fat

Indication Any kind of localized fat or skin irregularity after liposuction Can also be a complementary treatment to liposuction to treat the remaining fat Protocol Subcutaneous layer 1 session per day to 1 per week Flow 1ndash2 cckgmin (50ndash80 ccmin) approximately 2 minutes per injection point Punctures spaced 15ndash20 cm apart Number of sessions 10ndash20 ndash First results usually seen after session 4~6 Progressive flow (automatic mode) available with some machines Submentonian area deep dermis (andor subcutaneous) Flow 1ndash2 cckgmin (50ndash80 ccmin) Approximately 30ndash60 seconds per area injected (until onset of erythema or pain) - Usually three punctures (one in the center one left side one right side) May trigger a tempo-mandibular articulation pain (lasts 1 or 2 minutes)

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 20: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

Caution

One of the major CO2 side effects and complication is pertinent to the eyelid procedure It is important to purge and remove any trace of oxygenair in the tubes and needle O2 injection into the eye lid leads to a strong inflammatory reaction which lasts 4 or 5 days with redness edema closed eye and pain

Celluliteorange peel skin

Principle Stimulate blood flow and activate receptors involved in the natural lipolysis of the body Improve skin tightening to reduce orange peel skin Fibrous cellulite treatments will require mechanical disruption of fibrous septae with higher CO2 flows Indication All types of cellulite from grade IndashII to grade IIIndashIV Subcutaneous irregularities after liposuction Complementary treatment to liposuction which does not have any efficacy on cellulite

Protocol

Cellulite grade I or II

Combination of subcutaneous and intradermal injections One session per day to one per week Flow 1ndash2 cckgmin ndash approximately 2 minutes per injection Punctures 15ndash20 cm spaced no overlapping - Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Cellulite grade III or IV Combination of subcutaneous and intradermal injection One session per day to one per week Flow gt2 cckgmin Punctures 15ndash20 cm spaced no overlapping Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Technique The operatorrsquos hand movement should target both the subcutaneous layer and the intradermal layer as

both lipolysis and collagen synthesis need to be activated

Injection points Injections points should be made in the area where cellulite resides hips and thighs

Endpoint Subcutaneous injection will let the gas diffuse and create a 15ndash20 cm diameter granite-like appearance

disk After several sessions the skin offers less resistance to the gas diffusion so a few injections point may then be enough to treat the all cellulite area

Post-treatment care No post-injection care is necessary

Pain management Pain is more frequent in the first sessions CO2 can be reduced in the first sessions and progressively

increased from session to session If too much pain is reported change the injection point and reduce the treatment time giving more shorter injections

Maximizing results CDT may benefit from combination with such treatments as RF Cellu-M6 Velasmooth and manual

lymphatic massage Dietetic advice should be given to help the patient maintain a stable weight

Reinforcement sessions Patients are usually advised to renew the treatment at least once a year in order to maintain the

Localized fat

Indication Any kind of localized fat or skin irregularity after liposuction Can also be a complementary treatment to liposuction to treat the remaining fat Protocol Subcutaneous layer 1 session per day to 1 per week Flow 1ndash2 cckgmin (50ndash80 ccmin) approximately 2 minutes per injection point Punctures spaced 15ndash20 cm apart Number of sessions 10ndash20 ndash First results usually seen after session 4~6 Progressive flow (automatic mode) available with some machines Submentonian area deep dermis (andor subcutaneous) Flow 1ndash2 cckgmin (50ndash80 ccmin) Approximately 30ndash60 seconds per area injected (until onset of erythema or pain) - Usually three punctures (one in the center one left side one right side) May trigger a tempo-mandibular articulation pain (lasts 1 or 2 minutes)

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 21: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

Celluliteorange peel skin

Principle Stimulate blood flow and activate receptors involved in the natural lipolysis of the body Improve skin tightening to reduce orange peel skin Fibrous cellulite treatments will require mechanical disruption of fibrous septae with higher CO2 flows Indication All types of cellulite from grade IndashII to grade IIIndashIV Subcutaneous irregularities after liposuction Complementary treatment to liposuction which does not have any efficacy on cellulite

Protocol

Cellulite grade I or II

Combination of subcutaneous and intradermal injections One session per day to one per week Flow 1ndash2 cckgmin ndash approximately 2 minutes per injection Punctures 15ndash20 cm spaced no overlapping - Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Cellulite grade III or IV Combination of subcutaneous and intradermal injection One session per day to one per week Flow gt2 cckgmin Punctures 15ndash20 cm spaced no overlapping Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Technique The operatorrsquos hand movement should target both the subcutaneous layer and the intradermal layer as

both lipolysis and collagen synthesis need to be activated

Injection points Injections points should be made in the area where cellulite resides hips and thighs

Endpoint Subcutaneous injection will let the gas diffuse and create a 15ndash20 cm diameter granite-like appearance

disk After several sessions the skin offers less resistance to the gas diffusion so a few injections point may then be enough to treat the all cellulite area

Post-treatment care No post-injection care is necessary

Pain management Pain is more frequent in the first sessions CO2 can be reduced in the first sessions and progressively

increased from session to session If too much pain is reported change the injection point and reduce the treatment time giving more shorter injections

Maximizing results CDT may benefit from combination with such treatments as RF Cellu-M6 Velasmooth and manual

lymphatic massage Dietetic advice should be given to help the patient maintain a stable weight

Reinforcement sessions Patients are usually advised to renew the treatment at least once a year in order to maintain the

Localized fat

Indication Any kind of localized fat or skin irregularity after liposuction Can also be a complementary treatment to liposuction to treat the remaining fat Protocol Subcutaneous layer 1 session per day to 1 per week Flow 1ndash2 cckgmin (50ndash80 ccmin) approximately 2 minutes per injection point Punctures spaced 15ndash20 cm apart Number of sessions 10ndash20 ndash First results usually seen after session 4~6 Progressive flow (automatic mode) available with some machines Submentonian area deep dermis (andor subcutaneous) Flow 1ndash2 cckgmin (50ndash80 ccmin) Approximately 30ndash60 seconds per area injected (until onset of erythema or pain) - Usually three punctures (one in the center one left side one right side) May trigger a tempo-mandibular articulation pain (lasts 1 or 2 minutes)

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 22: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

Protocol

Cellulite grade I or II

Combination of subcutaneous and intradermal injections One session per day to one per week Flow 1ndash2 cckgmin ndash approximately 2 minutes per injection Punctures 15ndash20 cm spaced no overlapping - Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Cellulite grade III or IV Combination of subcutaneous and intradermal injection One session per day to one per week Flow gt2 cckgmin Punctures 15ndash20 cm spaced no overlapping Number of sessions 10ndash20 Progressive flow (automatic mode) available with some machines

Technique The operatorrsquos hand movement should target both the subcutaneous layer and the intradermal layer as

both lipolysis and collagen synthesis need to be activated

Injection points Injections points should be made in the area where cellulite resides hips and thighs

Endpoint Subcutaneous injection will let the gas diffuse and create a 15ndash20 cm diameter granite-like appearance

disk After several sessions the skin offers less resistance to the gas diffusion so a few injections point may then be enough to treat the all cellulite area

Post-treatment care No post-injection care is necessary

Pain management Pain is more frequent in the first sessions CO2 can be reduced in the first sessions and progressively

increased from session to session If too much pain is reported change the injection point and reduce the treatment time giving more shorter injections

Maximizing results CDT may benefit from combination with such treatments as RF Cellu-M6 Velasmooth and manual

lymphatic massage Dietetic advice should be given to help the patient maintain a stable weight

Reinforcement sessions Patients are usually advised to renew the treatment at least once a year in order to maintain the

Localized fat

Indication Any kind of localized fat or skin irregularity after liposuction Can also be a complementary treatment to liposuction to treat the remaining fat Protocol Subcutaneous layer 1 session per day to 1 per week Flow 1ndash2 cckgmin (50ndash80 ccmin) approximately 2 minutes per injection point Punctures spaced 15ndash20 cm apart Number of sessions 10ndash20 ndash First results usually seen after session 4~6 Progressive flow (automatic mode) available with some machines Submentonian area deep dermis (andor subcutaneous) Flow 1ndash2 cckgmin (50ndash80 ccmin) Approximately 30ndash60 seconds per area injected (until onset of erythema or pain) - Usually three punctures (one in the center one left side one right side) May trigger a tempo-mandibular articulation pain (lasts 1 or 2 minutes)

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 23: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

Technique The operatorrsquos hand movement should target both the subcutaneous layer and the intradermal layer as

both lipolysis and collagen synthesis need to be activated

Injection points Injections points should be made in the area where cellulite resides hips and thighs

Endpoint Subcutaneous injection will let the gas diffuse and create a 15ndash20 cm diameter granite-like appearance

disk After several sessions the skin offers less resistance to the gas diffusion so a few injections point may then be enough to treat the all cellulite area

Post-treatment care No post-injection care is necessary

Pain management Pain is more frequent in the first sessions CO2 can be reduced in the first sessions and progressively

increased from session to session If too much pain is reported change the injection point and reduce the treatment time giving more shorter injections

Maximizing results CDT may benefit from combination with such treatments as RF Cellu-M6 Velasmooth and manual

lymphatic massage Dietetic advice should be given to help the patient maintain a stable weight

Reinforcement sessions Patients are usually advised to renew the treatment at least once a year in order to maintain the

Localized fat

Indication Any kind of localized fat or skin irregularity after liposuction Can also be a complementary treatment to liposuction to treat the remaining fat Protocol Subcutaneous layer 1 session per day to 1 per week Flow 1ndash2 cckgmin (50ndash80 ccmin) approximately 2 minutes per injection point Punctures spaced 15ndash20 cm apart Number of sessions 10ndash20 ndash First results usually seen after session 4~6 Progressive flow (automatic mode) available with some machines Submentonian area deep dermis (andor subcutaneous) Flow 1ndash2 cckgmin (50ndash80 ccmin) Approximately 30ndash60 seconds per area injected (until onset of erythema or pain) - Usually three punctures (one in the center one left side one right side) May trigger a tempo-mandibular articulation pain (lasts 1 or 2 minutes)

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 24: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

Localized fat

Indication Any kind of localized fat or skin irregularity after liposuction Can also be a complementary treatment to liposuction to treat the remaining fat Protocol Subcutaneous layer 1 session per day to 1 per week Flow 1ndash2 cckgmin (50ndash80 ccmin) approximately 2 minutes per injection point Punctures spaced 15ndash20 cm apart Number of sessions 10ndash20 ndash First results usually seen after session 4~6 Progressive flow (automatic mode) available with some machines Submentonian area deep dermis (andor subcutaneous) Flow 1ndash2 cckgmin (50ndash80 ccmin) Approximately 30ndash60 seconds per area injected (until onset of erythema or pain) - Usually three punctures (one in the center one left side one right side) May trigger a tempo-mandibular articulation pain (lasts 1 or 2 minutes)

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 25: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

General CO2 contraindicationsbullbull needle phobia bull stress with history of vagal unconsciousness event bull severe heart failure congestive heart disease bull recent heart infarction or instable angina pectoris bull restrictive pulmonary disease chronic obstructive lung diseases bull sleep apnea bull renal failure dialysis bull recent cerebrovascular accident bull uncontrolled blood pressure bull epilepsy bull recent phlebitis or pulmonary embolism bull uncontrolled diabetes bull immunosupression or deficiency bull chemotherapy cancer (healing disorders) bull patients with impaired healing bull connective tissue disorders or diseases bull bleeding diseases Willebrandrsquos disorder hemophilia

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 26: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

Local contraindicationsbull bacterial infection dermatitis cellulites bull foreign body in the area to be treated bull herpes simplex in acute phase and other acute skin viral infection bull skin disease with abnormally increased local circulation bull facial rosacea bull poikiloderma of Civatte bull red necks and red deacutecolletage

bull Temporary contraindications bull pregnancy (precautionary principle) bull lactation (precautionary principle) bull anticoagulation recent aspirin or antiinflammatory drugs intake bull acute skin infection (wait until it is cured) bull other aesthetic procedure or skin traumatism less than 15 days prior to CDT

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Periorbital Area
  • Slide 50
  • Slide 51
  • Slide 52
  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You
Page 27: Dr. Patrick Treacy lectures on Carboxytherapy to the Royal Society of Medicine (London) 2013

Thank You

  • PowerPoint Presentation
  • RioBlush
  • Slide 3
  • Slide 4
  • So where are we
  • What is Carboxytherapy
  • Slide 7
  • Slide 8
  • Slide 9
  • Where does the CO2 story start
  • Slide 11
  • Slide 12
  • Lavoisier was brought to trial on 8 May 1794 According to a (probably apocryphal) story the appeal to spare his life so that he could continue his experiments was cut short by the judge La Reacutepublique na pas besoin de savants ni de chimistes le cours de la justice ne peut ecirctre suspendu The Republic needs neither scientists nor chemists the course of justice cannot be delayed
  • Lalouette (1777 )
  • Slide 15
  • Scientific Publications
  • Slide 17
  • Slide 18
  • Slide 19
  • Neo-angiogenesis effect
  • Slide 21
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  • Mechanism of action Effects of CO2
  • Slide 31
  • Bohr Effect
  • Slide 33
  • Stimulation of collagen synthesis
  • Slide 35
  • Slide 36
  • Stretch marks
  • Slide 38
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  • Periorbital Area
  • Slide 50
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  • Technique
  • Slide 54
  • Caution
  • Slide 56
  • Slide 57
  • Celluliteorange peel skin
  • Protocol
  • Slide 60
  • Localized fat
  • General CO2 contraindications
  • Local contraindications
  • Thank You