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#1 Therapeutic action of suction and vibration equipments compared to carboxytherapy in
edematous-fibrosclerotic panniculopathy (cellulite)

#2 Cellulite, carboxitherapy (Carboxipen) and VCSO:  Dr. Leibaschoff and Dr. Coll


Scientific information
In Cellulite Fat tissue irregularities have its origins in the microcirculatory alterations If the network of diminutive arteries, capillaries, veins and lymphatics that crosses the connective doesn’t work correctly the tissue will suffer and toxic metabolites will start to accumulate forming edemas, nodules and skin retractions.

The injection of CO2 in the affected areas produces a vasodilatation and the speed of microcirculation is improved then   the tissues will receive more oxygen helping the toxins elimination and consequently reducing the edema

It also favors the destruction of the hypertrophic fat cell with reduction of the adipose tissue.

The use of Carboxytherapy provides excellent results for patients with long time cellulite and great results also in young patients as a prevention method.



President of ICAM International Consultants in Aesthetic Medicine
Director of the International School of Carboxitherapy

Dermatologist University of Buenos Aires Argentina


The histomorphological alterations associated to the edematous-fibrosclerotic panniculopathies (EFPs), considered an aesthetic problem to date, are now considered a “pathology”, thanks to the technological advances and a continuous update in their study. Therefore, today we speak about the “Cellulite Syndrome” that includes various pathological processes which must be duly investigated, just as in any other pathology (Curri, J.Med. Esth., 1976; Curri, Flebolinfologia, 1988; Ryan, Curri, Clin. Dermatol., 1989).

It has been shown that the microcircle alteration evidenced as “Stasis Microangiopathy and Regressive trophism” plays a key role in the cellulitic syndrome, from a pathogenic standpoint (Curri y Ryan, 1989).

Based on our experience, we consider that gradual elastocompression, physical exercise, and mesotherapy are not enough to treat the cellulitic condition, characterized by lipolymphedema and lipodystrophy.


We believe that the lymphatic system and its relations with the microcirculation (histoangiopathy) play a key role, as well as the important relations observed at the interstitial level, where the inter-system exchanges occur.

The interstitial matrix is actually an active support tissue, a real exchange tissue, rather than a passive connective tissue.

If we consider the CO2 microvascular action and the  microangiopathy pathogenesis in the cellulitic syndrome, we can understand the scientific rationale of Carboxytherapy for the treatment of the condition.

Carboxytherapy means the use of carbon dioxide (CO2) for therapeutic purposes, administered both subcutaneously and percutaneously.

The subcutaneous CO2 administration is performed through a special device (Carboxipen™) that distributes gas in a controlled manner (constant pressure, defined gas volumes in a certain time, sterile CO2). The medicinal gas is conveyed directly to the equipment from steel cylinders equipped with a manometer for the monitoring of the filling and distribution pressures.

After setting the volume and time of gas distribution, the gas is introduced in the subcutaneous tissue through 30-Gauge needles placed at the exit pipe. The monitoring of gas distribution is performed through an automatic system in the device Carboxipen™.

During gas supply, there is evident subcutaneous emphysema in extended areas due to the remarkable diffusion capacity of CO2. The emphysema is then followed by erythema and heat sensation, a sign of the vascular activity of gas.

When administered subcutaneously, the CO2 causes vasodilation in the subcutaneous microcircle. This is evidenced by an increase in flow speed and the opening of “virtual” capillaries otherwise closed under paraphysiological conditions.

The mechanism of action of CO2 is visible and measurable through microangiological investigation (Videocapillaroscopy with Optical Probe and Laser Doppler Fluxometry).  The Videocapillaroscopy with Optical Probe shows an active capillary and venular vasodilation and an increase in the micro vascular tissue relationship. The Laser Doppler Fluxometry quantifies the vasodilation (perfusion units), through an increase in the arteriole sphygmity (flowmotion), speed of the blood into the microcirculation (Albergati,, Lattarulo, Curri, XVII Congr. Naz. Med. March 1997). 

The VCSO videocapillaroscopy is a non-invasive method that analyzes capillaries through static and dynamic images. In addition, digital image processing (Dr. Luis Coll -Argentina) can transform the qualitative characteristics into quantitative, and provides for temporal comparisons. Also, the VCSO allows the observation of:

  • Morphology of vascular microarchitecture

  • Morphology of capillaries

  • Degree of capillary filling

  • Type of capillary flow (color)

  • Assessment of an increase in vascularization

  • Increase in capillary density

  • Morphology of the venular system.

The intimate mechanism of CO2 could probably be explained by the stimulation of smooth muscle cells in joints: a consequence of the active vasodilation is an increase in tissue PCO2 (shown by Ambrosi, 1986 and Vacher, 1987), which remains for some time after the therapeutic cycle is completed (directly related to the CO2 volume injected).


In the "cellulite syndrome", the therapy is performed twice a week. The dose used in each limb is about 100 cc. gas, based on the dose/response curves obtained with different CO2 doses in the Cellulitic Syndrome (Albergati, Lattarulo, Parassoni, Curri, XVIII Congr. Med. Est. Roma, March 1997).  The gas is injected in the anterior and posterior thigh. These areas are subdivided into 6 quadrants, and each quadrant receives about 10 cc. gas.

Theoretically, it is possible to use fewer injections, but the method described is preferred, since it ensures a better gas distribution, although gas dissemination in tissues is well evident.

The supply time is important since in sensitive patients with low sensitive thresholds, slower flows are better tolerated. In our experience, flows of 10-50 cc/ minute/area, were well tolerated.

 Based on the concepts mentioned above, a research study is being conducted in Buenos Aires by Dr. Gustavo Leibaschoff and Dr. Luis Coll (Dermatology Specialist and Digital Image Processing Specialist).

Here, we provide the preliminary data of this research study.

Ten patients with different cellulitic syndrome (EFP) conditions were assessed through videocapillaroscopy, using the technique developed by Dr. L.Coll.

None of the patients were on medical or cosmetic treatments (at least in the 30 days prior to the procedure), and they had received no physiotherapeutic or surgical treatments.

The patients were not taking contraceptives; they were not breastfeeding nor did they have hormonal disorders (hypothyroidism).

All patients showed different microcirculatory pathologies, including microthrombosis and microaneurysms.

After 30 days, the patients received different treatments in their limbs: carboxytherapy in the right limb, and a subdermal therapy in the left limb. The last equipment was used, according to the FDA-USA (March, 1999), “IS AN EFFECTIVE TREATMENT TO REDUCE CELLULITE.”

  • The newest and most effective phisiotherapeutic method for the treatment of cellulite (efp-edematous-fibrosclerotic panniculopathy)

  • Incorporates a new technology with technical properties that render benefits for the following
    circulatory conditions

  • Reduces external appearance of cellulite

  • Increases local microcirculation

  • Contributes to edema reduction

Dr. L. Coll was blinded to this information.

The patients’ left limbs were treated with the technique (vibration, and suction).

The patients’ right limbs were treated with Carboxytherapy;  one 100 cc injection was made in the upper right thigh, for 5 minutes.

It is important to highlight that both therapies were applied twice a week (8 sessions). Then, the patients returned to Dr. Coll’s office for a videocapillaroscopy assessment. Dr. Coll was blinded to both the technique used and the areas treated in each patient. 


Dr. Coll performed the videocapillaroscopy studies and the digital image processing in each patient, post-treatment, in the same areas, at 15 cm of the anterior superior hip spin.

In the left limbs, in areas of major microcirculatory alterations, and after the first 2 sessions, the videocapillaroscopy images showed slight changes in capillary density, slight microcirculatory stimulation that was increased along sessions, reaching a 28% increase after 8 sessions.


In the right limbs treated with CO2 (programmed carboxytherapy technique), after the first session, an immediate 32% increase in capillary density was observed, reaching a 41% increase after 8 sessions (Anova Test).

The VCSO showed a clear improvement in the capillary-venular area perfusion, with an increased vascularization in all assessed areas.  Even an increase in the flow of the post-capillary venules was observed.

These changes, of varying degrees, were observed in 100% of patients, in their limbs treated with carboxytherapy.



In this initial prospective study we have observed that carboxytherapy significantly increases microcirculation in patients with aesthetic cellulite. Interestingly, carboxytherapy causes such results by its first session, whereas the subdermal therapies achieve lower results, throughout a series of sessions.

We consider that the combination of these two therapies (subdermal therapy and carboxytherapy) is very interesting since both contribute to microcirculatory stimulation. In addition, the subdermal therapy could add fibroblastic stimulation due to the suction effect.

It is important to note that studies were performed 5 hours after the carboxytherapy application, whereas in the cases treated with subdermal therapy the studies were performed 30 minutes after treatment.



CURRI.S.B. Aspects morpho histochimiques et biochimiques du tisú adipeux dans la dermo hypodermosis cellulitique, J.MED.ESTH.1976, 5.183-191


CURRI.S.B. Inquadramento nosografico e classificazione delle pannicolopatie da stasi, FLEBOLINFOLOGIA, VOL I, SALUS ED.INT, ROMA 1988, 31-41


ALBERGATI.F, PARASSONI.L., LATTARULO.P, CURRI.S.B. Carbossiterapia e vasomotion:comparazione tra immagini video capillaroscopiche e referti laser doppler flow dopo somministrazione di anhidride carbonica. SOC.IT. DI MED. ESTETIC, SCUOLA INT.DI MED.EST, ROMA, XVIII CONGR.NAZ.DI MED ESTETICA, ROMA, 21-23 MARZO 1997.




JALTEL, Royat station termale de lárterite.Impremerie nouvelle cahiers d’arteriologie de Royat: les acrosyndromes 1995 .ED SOCIETE MEDICALE ROYAT


VACHER , ulceration croniques de members inferieurs: interet des jets alternes de gaz thermale de Royat e d’oxygene .REV DE MEDICINE CLERMONT FERRAND 5-1987


AMBROSI , Variation de la pression partielle d’oxygene mesuree par voie trasncutannee che les arteriopathies soumis a des epreveus de marche au cors du Royat. SOC.FRANCAISE D’HYDROLOGIE ET CLIMATOLOGIE MEDICALES.


COLIN, Sur la actino vasodilatatrice du dioxyde de carbone injecte en forme gazeuse dans le tegument de l’homme.JOURNEE NATIONALES DU TERMALISME ET DU CLIMATISME 116 ANNEE 4-4 1979


BOUCOMONT, Influence des cures de Royat sur les troubles circulatoires periferiques: maladie de Raynaud, acrocyanose. Journees nationales du thermalisme e du climatisme 114 annee 2-2 1977


ROMEUF J. Vingt annees de pratiques de injections sous cutanees de gas thermaux de Royat. CAHIERS DE ARTERIOLOGIE DE ROYAT 1991 SOCIETE MEDICALE DE ROYAT


CURRI.S.B., ALBERGATI, F Effetti sulla microcircolazione cutanea della inoculazione sottocutanea di CO2, CENTRO DE BIOLOGIA MOLECULAR , MILAN


LEIBASCHOFF G., COLL L Estudio comparativo de la accion microcirculatario entre la aplicación subcutánea de CO2 y terapia subdermales en pacientes portadores del síndrome de la celulitis.. Control clinico, iconografico y videocapilaroscopico con procesamiento digital de imágenes. SIMPOSIO LATINOAMERICANO DE CELULITIS, BUENOS AIRES, SETIEMBRE 2000


Bacci P. A Il Lipolinfiedema , Flebologia Oggi, 1997,1:51-62


Curri S. B.: Lipoesclerosis y el Microcirculo. La dermoestetica, 1990, 1:6-7


Campisi, C: Il linfedema, Flebologia Oggi, 1997, Minerva Medica Ed,1:27-41


Albergati f, Bacci P: Valutazione dell’attivita microcirulatoria del Lymdiaral in pazienti affete da flobolinfedema, La Medicina Funzionale 1998,3:32-30

Bacci PA, Leibaschoff GH : Celulitis-El lipolinfoedema-La evolucion de la lipoesclerosis, Lipoplastia’99 Ed.El Sol, 141-181.


Curri S B: Local lipodystrophy and districtual microcirculation centre of molecular biology, Milan, Italia, 1994


Curri SB: Las paniculopatias de estasis venosa, Ed.Hausmann, Barcelona 1991


Merlen J: Raison anatomo pathologique de la cellulite 

J. Mal. Vasc, Paris, 9 53-54 (1984)



Left side

Before the treatment

After the first session with
a device with aspiration rollerand IR laser

Second Video - Post
6 session
Third Video - Post
8 session

Right side

Before treatment CO2

After CO2 5 hours

Second Video - 6 sessions
post treatment CO2
Third Video - 8 sessions  capillaroscopypost CO2

# 2 Cellulite, carboxitherapy (Carboxipen) and VCSO

Dr. Gustavo Leibaschoff, MD Cosmetic Surgeon

Dr. Luis Coll, MD (Universitary Dermatologist UBA)

15 patients with cellulite syndrome (EFP) were evaluated through a prospective study

They were divided into two groups

                        Group A 5 Patients received 150 cc injection of CO2 in one session

                        Group B 10 patients received 50 cc injection of CO2 in one session

Conditions were assessed through videocapillaroscopy, using lens 200% with oil immersion technique developed by Dr. L. Coll.

Videocapillaroscopy studies and the digital image processing in each patient were performed, pre and post-treatment (CO2), and after a week in the same areas, at 10 cm of the anterior superior hip spin.

Witness images

Same area, at 10 cm at the anterior superior hip spin of left side

Different areas at 20 cm or more from the application site

Analysis variables

Vertical capillaries for mm2 (exchange)

Diameter of the horizontal capillaries

Statistic analysis using ANOVA p> 0.05



             380 images were studied

            Over the total amount of 15 patients treated an average increase of 35.2 +/ -3.3% of vertical capillaries post CO2 injection were detected in the area of treatment (right limb)

             Immediate detection

               – Group A: 5 patients that received 150cc CO2 injection, showed an increase of 38.8% on vertical capillaries.

               – Group B: 10 patients that received 50 cc CO2 injection, showed an increase of 33% on vertical capillaries.

             One week after Injection.

               – Images showed an average decrease of 8.2% in both groups, A and B in the area of treatment (right limb)

             Result in the witness area (left Limb) without treatment.

               – One week after treatment the witness areas don’t show significant statistical variations + -2.3% comparing with initial images from the right side before the injection .

              Results in the right limb at least 20 cm from the area of CO2 injection.
– Images don’t show significant statistical variations +-3.1% comparing with initial images from right side before treatment.


In this initial prospective study of 15 patients with Aesthetic Cellulite, the images obtained by Videocapillaroscopy showed that immediately after the first session using carboxytherapy in different doses, 150 cc and 50 cc Vertical capillaries significantly increases 35.2 +/-3.3% per mm2 in the area of injection.

After a week of the Carboxitherapy session the images showed a decreased of 8.2% of vertical capillaries comparing with the previous images post injection


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