Therapeutic action of
suction and vibration equipments compared to
carboxitherapy (Carboxipen) and VCSO:
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
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.
DR. GUSTAVO LEIBASCHOFF
President of ICAM International Consultants in Aesthetic
Director of the International School of Carboxitherapy
DR. LUIS COLL
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
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
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
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
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
All patients showed different microcirculatory
pathologies, including microthrombosis and
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
Incorporates a new technology with technical properties
that render benefits for the following
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
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
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
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,
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.
ALBERGATI.F, CURRI S.B, PARASSONI.L. Effetti sulla
microcircolazione della inoculazione sottocuatnea di
CO2, XVII CONGRESSO NAZIONALE SOCIETA ITALIANA PER LO
STUDIO DELLA MICROCIRCOLAZIONE, V CONGRESSO NAZIONALE
DEL GRUPO ITALIANO SUL LAER DOPPLER, FIRENZE, OTTOBRE
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 t.de 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
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
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
Bacci P. A Il Lipolinfiedema , Flebologia Oggi,
Curri S. B.:
Lipoesclerosis y el Microcirculo. La dermoestetica,
Il linfedema, Flebologia Oggi, 1997, Minerva Medica
Albergati f, Bacci P:
Valutazione dell’attivita microcirulatoria del Lymdiaral
in pazienti affete da flobolinfedema, La Medicina
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
Las paniculopatias de estasis venosa, Ed.Hausmann,
Raison anatomo pathologique de la cellulite
J. Mal. Vasc, Paris, 9 53-54 (1984)
first session with
a device with aspiration
rollerand IR laser
Second Video -
Third Video -
- 6 sessions
Third Video - 8 sessions
Cellulite, carboxitherapy (Carboxipen) and VCSO
Dr. Gustavo Leibaschoff, MD Cosmetic
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
in one session
Group B 10 patients received 50 cc injection of
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
and after a week in the same areas, at 10 cm of the
anterior superior hip spin.
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
capillaries for mm2 (exchange)
Diameter of the horizontal
Statistic analysis using ANOVA p>
380 images were studied
Over the total amount of
15 patients treated an average increase of 35.2 +/ -3.3%
of vertical capillaries post
injection were detected in the area of treatment (right
Group A: 5 patients that received 150cc
injection, showed an increase of 38.8% on vertical
Group B: 10 patients that received 50 cc
injection, showed an increase of 33% on vertical
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
Results in the right limb
at least 20 cm from the area of
– 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