Effectiveness of carboxytherapy in the treatment of cellulite in healthy women: a pilot study
Carbon dioxide therapy, better known as carboxytherapy, relates to percutaneous infusion of medical carbon dioxide with therapeutic approaches, and its use in the treatment of localized fat has demonstrated good results. Gynoid lipodystrophy, also known as cellulite, affects 80%–90% of women after puberty, especially in the buttocks and thighs. Its etiology is complex and involves multifactorial aspects. Its treatment and evaluation require the use of new technologies (more effective and low-cost approaches). The objective was to investigate the effectiveness of carboxytherapy in the treatment of cellulite in the areas of buttocks and posterior thigh. Patients and methods: Ten women, 29±6.1 years, were selected and all of them received eight treatment sessions, with an interval of 7 days between sessions. Standardized digital photographs were used to assess the severity of cellulite, and panoramic images were collected by ultrasound diagnosis. The evaluations were performed before the first treatment (baseline) and 7 days after the last treatment session of carboxytherapy. Results: After the treatment, there was a significant reduction (P=0.0025) of the cellulite from degree III to degree II, and this improvement had correlation with the improvement in the organization of the fibrous lines and the disposal of adipose tissue lines of the treated regions observed through the panoramic ultrasound images diagnosis. Conclusion: Carboxytherapy is an effective technique of treatment of cellulite in the buttocks region and posterior thighs of healthy women. Keywords: carbon dioxide, cellulite, localized fat, gynoid lipodystrophy, skin, panoramic ultrasound Introduction Cellulite refers to a change that gives the skin a wavy and irregular appearance, and it affects 80%–90% of women after puberty. Numerous treatments have been proposed such as balanced diet, physical activity, massage, topical products, radiofrequency, therapeutic ultrasound, and light emitting diode therapy, among others.1 Carbon dioxide (CO2) therapy, commonly known as carboxytherapy, refers to the administration of CO2 with therapeutic proposals. The technique originated in France in 1932, and originally the treatment was carried out percutaneously (through the skin) by the so-called heated carbonated water baths or the application of water-saturated CO2 directly to the skin of patients. The technique was used for arteriopathy and ulcer treatments. The results encouraged further studies, leading to the expansion of indications of new treatments. After the development of new technologies, the application was no longer topical and involved passing the CO2 to be infused directly into the subcutaneous tissue, ensuring faster and better results. Sequential studies described the effectiveness of the carboxytherapy treatment of localized adiposities; demonstrated measurable reductions in circumference regions of the abdomen, thigh, and/or knee; and showed histological evidence of the effect of gas leakage, showing its possible lipolytic effects Ferreira et al5 described the increase in collagen remodeling induced by intradermal injections of CO2. In another study, Abramo et al6 showed that after the controlled infusion of CO2, vasodilation of the microcirculation skin was observed, accompanied by an increase of peripheral blood flow and an increase in skin temperature at the injection site (on average 3.48°C). Cellulite affects, especially, the buttocks and thighs; its etiology is multifactorial and involves complex issues, and its treatment and evaluation require the use of new methodologies. The lipolysis caused by carboxytherapy seems to be caused by temperature increase and local blood flow and have been demonstrated in previous studies; however, clinical studies are still required, with good analysis techniques that prioritize their effects on cellulite. This study aimed to verify the effectiveness of controlled infusion of CO2 in the treatment of cellulite in gluteal and posterior thigh bilaterally. Materials and methods This study began with a sample of 12 candidates and finished with ten of them with an average age of 29±6.1 years and body mass index (BMI) of 25.5±3.3 kg/m2. Inclusion criteria were healthy women, aged 20–35 years, BMI <29.9 kg/m2, with regular menstrual cycle, and presence of cellulite of gluteal and posterior thigh bilaterally as classified in degrees of severity II and III as in the current classification of cellulite2. This study was approved by the Research Ethics Committee: União das Instituições de Serviço, Ensino e Pesquisa – and all subjects signed informed consent forms. The treatment was performed in the Clinical Laboratory of the Center for Education and Advanced Training CEFAI (Amparo, SP, Brazil). Volunteers were excluded if they were in aesthetic treatment; had had some kind of treatment in the gluteal region and thighs for a period leading up to 6 months before the start of this study; if they were pregnant or had had a recent pregnancy (<6 months); if they had cardiovascular problems, metabolic disorders, respiratory disorders, immunosuppression, kidney and liver failure, and skin lesions at the treatment site; or if they had diabetes mellitus. In assessing weight and height, the volunteers wore only underwear without shoes. A classical mechanical stadiometer (model 110 CH; Welmy, SP, Brazil) was used. The BMI was evaluated by applying the formula BMI = weight in kilograms divided by the square of the height in meters (kg/m2).Body fat percentage of each volunteer was measured with Biodynamics (Model 310E; TBW, SP, Brazil). All volunteers received directions about the treatment steps and procedures to be performed. The treatment protocol consisted of eight sessions with an interval of 7 days. The evaluations were performed before the first treatment (baseline) and 7 days after the last treatment session. The total time between the baseline and the posttreatment reevaluation was ~2.5 months. After analysis of the area, ten points were selected for the infusion of CO2 (four in the gluteal area and six in the posterior thigh) as shown in Figure 1A. The treated areas were inspected and constantly monitored during all sessions. With a proper pen, points equidistant from each other were marked, 12 cm apart from each other, in places where the infiltration of CO2 was held. The antisepsis was performed with alcoholic chlorhexidine at 0.5%. At each selected points, 80 mL of gas with a flow rate of 80 mL/min was infused. The needle was positioned at 45° (inferior angle), and a subcutaneous puncture was made with a depth of ~10 mm (Figure 1B). Figure 1 (A) Points of CO2 infusion; (B) position and angulation of needle
