Carboxytherapy NY

Carboxytherapy (carboxyterapia, carbossiterapy) is defined as:  “the injection of carbon dioxide gas for therapeutic purposes.”

Carbon dioxide [CO2] gas is the same gas that gives soda-pop its’ fizz. Carbon dioxide [CO2] is NOT carbon monoxide [CO] that comes out of the tailpipe exhaust of an automobile.  Carbon monoxide kills people, but we need carbon

ball-and-stick model of CO2: carbon dioxide

ball-and-stick model of CO2: carbon dioxide (Photo credit: Wikipedia)

dioxide [CO2] to exist.  Carbon dioxide is not a chemical and is in fact a large part of a natural life-cycle that we animals have with plants that share the planet with us humans.  We breathe in oxygen and breath out CO2 gas.  The plants take up the CO2 and give us back our oxygen, so it is so it is a nice transaction that we have with our plant partners on this world.  This is why people say that “plants like it when you talk to them.”  No they don’t, but they DO like the CO2 that we are blowing their way.

Meanwhile, in our bodies the CO2 serves a different purpose.  Everytime that we take a breath, we inhale oxygen and we exhale CO2.  The red blood cells are the main transporters of the newly inhaled oxygen.  There is space on the red blood cell to carry four molecules of oxygen [O2].  The lungs take in a breath inhaling fresh oxygen from the surrounding air.  The red blood cells inside the lattice-like capillary network of tiny blood vessels in the lungs pick up their four molecules of oxygen, the heart beats and the oxygen rich blood is delivered throughout the body to re-supply oxygen to working tissues.  The heart beats, forcing the blood into the arteries so that the red blood cells can carry their oxygen-rich cargo to the hard working cells of the body.  When the red blood cells encounter an area that has a high level of carbon dioxide, the waste product of cellular metabolism, the red blood cells become distorted, the oxygen is released to the needy tissues and the carbon dioxide is picked up by the now empty red blood cells  [think of a subway train pulling into the station– the doors open, the passengers who have reached their destination get off the train, and the passengers who need to be transported elsewhere get on the train—all in a highly organized manner].  The carbon dioxide is carried back to the lungs, we exhale to get rid of the carbon dioxide, we inhale more oxygen, and the entire process begins again.   So, how does carboxytherapy work?  Dark under-eye circles, cellulite, and scars are believed to caused, at least in part, due to poor blood-flow to the region.   By injecting a small amount of carbon dioxide gas into the area, we are “tricking” the body into increasing the oxygen flow to the area by compelling the red blood cells to pick up all of the excess CO2 that we injected so that it can be carried back to the lungs for elimination from the body with the next exhalation.

 1. How small are the amounts of carbon dioxide injected into dark circles under each eye? Could you

A scanning electron microscope image of normal...

A scanning electron microscope image of normal circulating human blood showing red blood cells, several types of white blood cells including lymphocytes, a monocyte, a neutrophil and many small disc-shaped platelets. (Photo credit: Wikipedia)

give an idea how much that is relative to, say, the amount we blow out in a normal breath? How about for a thigh with stretch marks or cellulite? Does one require more CO2 than the other?

The amount of gas administered varies from doctor to doctor, from patient to patient, the area that is being treated, and the underlying pathology for that which the physician is treating.

I would think that the most important things for the patient to consider are the qualifications of the individual performing the treatment, and his or her experience in using carboxytherapy to treat the problem at hand.

People could have some sense of false security regarding the receiving or performing of carboxytherapy because they think that the worst thing that could happen would be temporary because our bodies just breath out the gas.  This is true to some extent.  Carboxytherapy in itself does not have any risks or side-effects from the presence of the gas in the body.  In day to day practice it is one of the safest treatments that we have to offer.  As doctors, we use carbon dioxide gas to insuflate the abdomen during endoscopic surgeries such as removal of the gallbladder or the appendix.  Carbon dioxide gas is so safe that we use it to push aside the uterus containing the developing fetus in pregnant women who require gallbladder surgery (gallbladder attacks occur more frequently in women once they become pregnant, talk about bad timing), so we just “roll” the baby out of the way, take out the gallbladder and mother and baby are just fine.  Carbon dioxide gas is even being used by interventional cardiologists, instead of using a chemical dye, they inject the carbon dioxide gas directly into the vascular tree via the arm vein to visualize the entire vascular tree including the heart.  Carboxytherapy is safe and has no known risks or side-effects other than a potential “poke-mark” at the site of where the needle entered the skin.  These little needle marks, if they occur at all, heal in the exact same manner as any other bruise by first black-and-blue, then brown, then greenish colored, then yellow and then gone.  I have never seen anybody get a true “black and blue” bad enough to look like an injury took place (no black eyes) but if one did occur it would be totally gone after two weeks tops and patients are allowed to use make-up immediately after the procedure is completed, so it truly is a “no-downtime” procedure.  The more sessions the individual has performed the lesser chance of brusing because the skin gets “tougher” as the new collagen is building in the area in response to the treatment.

As far as the volume of gas varying from area to be treated, and how much is administered is kindof like blindfolding a bunch of people and asking them to use their sense of touch only to describe an elephant.  Depending on which area the person is touching (the tail, the nose, the teeth), you will get a different answer.  The amount of gas to be used DOES change from area to area, as well as other properties of the treatment and the individual injector.  Carboxytherapy or the presence of the CO2 gas in the tissues is not dangerous, but the experience of the individual wielding the needle is paramount to safety of the treatment and a good clinical outcomes.  I am a medical doctor and surgeon that specialized in oculofacial cosmetic and reconstructive surgery.  The surgeon that trained me during my fellowship had a clinic in Brasil, so we were always ahead of the game back here in America  as far as minimally-invasive procedures that minimized the need for surgery because of the advances being made overseas in procedures such as thermage,  less aggressive laser procedures and more natural looking implants and fillers that are still trying to gain entry into the United States.  I was on the ground floor for all of these techniques including carboxytherapy.  We were the first surgical practice to use carboxytherapy in the United States and I wrote the original research paper for the use of carboxytherapy for treating dark under-eye circles.  I have been performing carboxytherapy for eight years now, but I know physicians from South America that have been doing carboxytherapy for over thirty years!

Only a handful of research articles are out there for carboxytherapy and a couple of training DVDs are also on the market that teach the viewer how to do the procedure and they give estimates as to how much gas is to be placed in each area.  I have moved beyond that point and have even changed my mind as to how much gas to infuse into each different area to be treated.

When we first started treating eyelids we essentially “pontooned” the eyelids and filled them with about 4cc of gas so the person looked like he/she was punched in the eye by Rocky Balboa!  One patient who was not fore-warned by the treating physician of this temporary swollen appearance handed her a mirror without letting at least some of the gas go down (the gas literally  shrinks back like a soufflé falling with every passing breath) and when the patient first saw herself  she let out a blood-curdling scream that could be hear throughout  the entire office!  I just never thought that it was necessary or good to put the delicate eyelid skin on stretch for even the briefest of moments, so the amount of gas that I inject into each eyelid varies from patient to patient and their anatomy.  It was my determination that this amount of stretch on the delicate eyelid skin was not overly helpful and potentially harmful because frequent (every week) stretching of the eyelid skin could mimic or approximate the end-result of skin laxity suffered by frequent allergy sufferers.

The needle is a tiny one (30G ½ inch) same size that we use when administering Botox.  I don’t use the needle to forcibly inject the substance in to the skin, but the needle is used to gently lift the skin at the outer corner of the eyelid where it attaches at the temple bone.  The gas then travels all the way from the outer corner of the eye socket to the inner corner of the eyelid where it reaches the nose.  This takes advantage of knowledge of the facial anatomy and the physics of how liquids and gases take the path of least resistance in general.  So, I can treat the entire eyelid just by gently lifting the eyelid skin with the point of the needle, and the gas travels all the way to the inner corner of the eyelid without the need for multiple injections, just one tiny little lift of the skin at the outer corner of the eyelid.  I stop injecting the gas once it reaches the inner corner of the eyelid and stopped “pontooning” the lids like we used to back in 2005.  I would estimate that about 2cc of gas is placed beneath the eyelid skin with the change in my technique.  It is about the equivalent amount of gas that is breathed out of the nostrils when the individual is seated and taking relaxed breaths .

When treating other areas of the body, more gas is used depending on the body part to be treated and the underlying problem.  There are so many variables that I can control.  Essentially, I can change the velocity or speed of the gas as it exits the needle, the angle of insertion of the needle, the frequency of delivery of the gas, and the heat of the gas. 

If I am treating eyelids I use a flow-rate of 30cc/minute – 40 cc/minute at an angle of insertion that is parallel to the cheekbone injected as a single bolus or blast of gas until it reaches the inner corner of the eyelid.  I no longer put eyelids on extreme stretch.

If I am using the gas for body shaping to contour and shrink the circumferential diameter of the arms, legs and torso, then my angle of insertion is between 45 degrees to 90 degrees of the area to be treated [while lifting the skin away from any vital organs that I don’t want to nick like the lungs or the intestines], using an automatic mode on my device that senses the resistance inside the tissues being treated.  The gas flows into the surrounding tissue to a pre-programmed radius and psi and once the circuit [between the person being treated and the ballast inside the device] is complete, the machine can sense the gas-tension in the tissues and emits a signal that the treatment is completed.  So, I do not necessarily emphasize how many milliliters of gas is administered, but rather in achieving the desired tension within the tissues and how fast the gas flows into the tissues.  [there are a couple of studies that I will dig up for you tomorrow that document the amounts, it doesn’t really matter to me as a clinician is what I am trying to say].  Carboxytherapy is very effective in reducing areas of fatty deposits because the fat cells rupture when exposed to the gas, while leaving the neighboring blood vessels and nerves undamaged.  The fat cells just pop, either because they don’t like that high amount of carbon dioxide in the neighborhood, or due to the speed of the gas going past stretches the cell membranes of the delicate fat cells and they shatter like a crack in the ice or a cracked windshield.  There have been studies of patients that had liposuction performed on the area above the knee that were left with irregular fatty deposits beneath the skin that were unsightly.  The women had the residual fatty areas injected with carbon dioxide gas and over a period of time the fatty deposits shrank back and the overlying skin was improved.  Biopsies were taken that showed that the cell membranes of the fat cells (adiposites) were shattered and their stored lipids had been released into the interstitial space (surrounding area of the cells).  The blood vessels and nerves were unharmed, and the amount of collagen in the overlying area had increased by 90% after the series of six treatment sessions!  I like to slowly inflate areas that are being treated for redundant fat by a setting on my machine that has intermittent flow so it starts and stops until the tissue tension is met, instead of rapidly pushing the gas in a single bolus of pressure.  It allows me to let the gas trickle in a bit at a time.

We take advantage of this knowledge when treating cellulite with carboxytherapy.  Cellulite is present in greater than 97 percent of women and I don’t consider it a disease state at this point.  If it is present in 97 percent of a patient population,  I would consider that to be “normal!”  Cellulite occurs mainly in women because there are underlying structural differences between men and women.  Men have only one layer of fat, men have three.  The collagen network that holds back the fat in men is more tightly interwoven like a pair of Spanx, while the collagen network that holds back the fat in women is interwoven like a cobweb.  For women, the deep layer of fat is what surrounds the organs to keep us warm and remains even in cases of extreme starvation.  The middle fat layer is what is liposuctioned to sculpt the body, and the upper fat layer is just beneath the skin surface.  This upper layer of fat is controlled by estrogen and that is why no matter how much diet or exercise is done, these areas on the stomach, upper arms, buttocks, and saddlebag region are resistant to exercise and responsive to estrogen.  These cellulite fat cells have a locked door to lipids and the key is estrogen.  Once women reach puberty, there is enough circulating estrogen in the blood that it lands on the estrogen receptors on this upper layer of fat and opens the floodgates!  Lipids rush into these cellulite fat cells and they expand rapidly like an over-inflated balloon.  The fat cells fill, giving us this hourglass figure, and the cells grow so rapidly that they begin to push up against the already defective collagen layer designed to hold them in check.  The fast growing fat cells press up against the collagen, restricting the supply of fresh oxygen, allowing the toxins to accumulate in this area due to poor bloodflow and the poor collagen becomes even further damaged as a result and frays even more and out “pook-pook-pook” are the fat cells through the cobwebbed collagen to give us the appearance of cellulite.  Carboxytherapy works against cellulite by 1). Rupturing the underlying fat cells, 2). Increasing the circulation to the underlying area by “tricking” the body to open up the capillaries to flood the area with oxygen, 3) whisking away accumulated toxins, 4). fixing the damaged collagen lattice, 5). The shear force of the gas going past the collagen rips apart any adhesions or collagen scars that pull the skin down creating dimpling, and 6) increasing the amount of collagen in the overlying skin, thickening it and making it appear more youthful.

When treating cellulite, I insert the needle directly perpendicular to the skin or sometimes at a 45 degree angle to simultaneously break up a dimple as well as filling the area with the gas until a pre-programmed tissue tension is reached via the completion of the patient-machine circuit.  I like to push the full amount of gas in to the area as quickly as the patient can tolerate it because it is my feeling that the rapid distension of the region putting the fat cells on stretch is what causes them to burst.

The most gratifying use of carboxytherapy is its use in treating stretch marks.  Strechmarks are a form of scar in that by definition a scar is damaged collagen laid down in a disorganized pattern.  Stretchmarks occur when the skin is stretched very rapidly and is unable to keep up with the underlying changes of the skin due to pregnancy, weight gain, heavy muscle mass, or a growth spurt.  Pregnancy and weight gain/loss are pretty self-explanatory.  Many former body builders or competitive athletes are left with stretch marks when they either stop training at their former competitive level.  Stretch marks from growth spurts are typically vertical and linear on the calves and hips/thighs.  Stretch marks are a special form of scar in that the collagen is stretched beyond its natural limits and the collagen actually is frayed like the end of a piece of rope or a shoelace that has lost its protective plastic tip.  It is this collagen rupture that makes the skin thinner, almost see-through, adhesions form that pull the damaged collagen downward like a puckered sheet causing the scars to look “depressed” when compared to the surrounding unaffected skin.  Stretch marks like other scars have lousy circulation and the pigment forming melanocytes stop working and may potentially leave the damaged area, sort of packing their bags and leaving home so that stretch marks are lighter than the surrounding skin, and when the individual tries to sunbathe, the surrounding skin darkens and the stretchmarks do not tan, making them even more obvious.

Treatments for stretchmarks up until the last decade have been lacking at best.  Some people dismissed the patients with Retin A cream to try to build more collagen.  Laser resurfacing has been attempted, but it is not safe for all skin types and I have seen tanned or darker complected individuals come to me after having had laser treatments to stretch marks only to be left with “stripes” from the thermal damage caused by the laser worse than the initial stretch mark.  Up until now, there has been no good therapy that addresses all of the problems that result in the formation of a stretchmark.  Personally, I don’t think that lasers go deep enough to the deep dermal layer to cure a stretchmark.  Carboxytherapy, however handles every single aspect of the  circumstances that cause stretchmarks.  Carboxytherapy increases the circulation in an area of scar where circulation is poor to non-existent, the shear force of the gas rips apart any adhesions or scar-bands that pull the stretch marks downwards that makes them look depressed in comparison to the surrounding skin. Carboxytherapy stimulates the formation of pigment in an area where the pigment cells have stopped working, and it builds new collagen where the ruptured collagen was left behind.  So, carboxytherapy eliminates the depressed appearance of the skin, increased the skin-thickness (up to 90 percent more collagen in the stretch mark after 6 treatment sessions), and re-pigments the skin.  It is SAFE for all skin-types and it works on every single person that I have treated.  It is the only thing that I really guarantee in my practice.

When I am treating stretch marks– depending on the area of the body, I fill the entire area to be treated with the gas (kindof like a Macy’s Day Parade balloon) because this keeps the gas inside the stretchmark s and also helps to some degree with anesthesia.  Once the area has been filled with the gas, then I change the speed to the fastest outflow and again, using the needle to just “lift” the skin surface, the gas then zooms beneath the skin surface, cutting any depressing scarbands on the way until the entire length of the stretch mark has been filled with gas. The treated stretch marks are red, raised, swollen, [ like having a case of hives]  immediately after the treatment and patients feel either that the area is warm, or even itchy until all of the gas is breathed out of the body. However, the area looks completely normal about 20 minutes after the treatment, and aside of a few “poke marks” where the needle was inserted there is not even a trace that I was there.  These little poke marks occur less frequently after a few treatments because the skin gets thicker and stronger over time so there is less bruising.   First, the stretch marks elevate, then they tighten, and then the pigment cells slowly begin to work again, usually after 4-6 sessions.


2. Which layer is it injected into—just above the dermis, or even more superficially?

Depends upon the area being treated.  Superficially for eyelids.  Deep dermis to superficial subcutaneous fat layer for body sculpting,  and both deep and superficial for stretch marks

3. How much lighter do the dark circles go? Do they disappear completely? Is it like wearing a light concealer? Do they work better on younger people?

It depends on the cause of the dark circles.  Most dark circles are multi-factorial and not due to circulation alone.  Dark circles are caused by one or more of the following: 1) increased pigmentation of the skin due to heredity, heavy sun exposure, or persistent “eye-rubbing” from itchy, watery eyes due to allergies, 2) a depression underneath the lower eyelid from age-related changes and volume loss due to loss of bone and fat, or genetic structure of the area called a “tear-trough deformity, 3) prolapsed fat bags beneath eyelids, and 4) poor circulation to the decreased drainage of toxins in the underye region.  This is especially common in the presence of chronic allergies and nasal congestion (see below)


One major cause of dark under eye circles is vascular pooling. The capillary network of the lower eyelids can become congested for a variety of reasons. Normally, the tears drain from the eyelids into the nose, but if there is some obstruction due to chronic nasal congestion from seasonal allergies, previous nasal fracture, or a deviated septum, the drainage doesn’t function well, and the blood flow to the lower eyelids becomes sluggish, giving rise to the boggy blue tinge known casually as “allergic shiners.” The lack of appropriate oxygenation to the lower eyelid skin allows the bluish cast to show through the thin skin of the eyelids. Carboxytherapy works to improve the capillary network of the lower eyelids, as well as to increase the dermal collagen layer in the lower eyelid skin. By injecting a small amount of carbon dioxide gas into the affected areas, blood flow is increased and improved capillary networks are formed for longer lasting circulatory benefit. The bluish cast is replaced with a healthy pink tone. Once a series of treatments is completed, the skin has a more luminous appearance that lasts approximately six months.

Carboxytherapy addresses the vascular deficiency aspect that contributes to the appearance of dark circles.  In certain circumstances, I can make an impact and shrink the fat pads that are beneath the eyelid but I only recommend that to doctors with an immense knowledge of the undereye anatomy and carboxytherapy.  Carboxytherapy does not do anything to correct for a tear trough deformity, that usually requires a filling agent such as Restylane, Selphyll, or even the patient’s own fat via a fat-transfer procedure.  Carboxytherapy is helpful in eliminating pigmenatry changes from the skin overlying the undereylid, but my main use there is either a series of chemical peels or the use of a fading cream such as Elure cream to “lift” the excess pigmentation of the skin.

The overall improvement in the appearance of the lower eyelids is different for every single person as an individual because all four causes for dark circles can exist in the same patient.  If it is primarily a vascular issue, carboxytherapy is brilliant for this, but I also check the air movement of the nasal passages and in extreme cases of dark circles to check for the presence of a deviated septum that can only be determined by ordering a CT-scan of the face and orbits.  If there is an underlying causation such as severe deviated septum, nasal polyps, or chronic swelling of the sinuses due to allergies or numerous sinus infections, I treat the allergic rhinitis with antihistamines and nasal steroids to improve the outflow track.  I won’t do carboxytherapy for somebody that has serious nasal issues because it would not work until the anatomical damage would be corrected.  I treat the skin with brightening agents and do a little filling if the tear trough is deep.  The improvement in the appearance of dark circles depends on the percentage of the contribution to the appearance is made from vascular issues. If there is no depression that needs filler and no skin pigmentation that needs to be lifted with bleaching agents, then carboxytherapy could be up to 50% improvement after a series of six sessions.  The dark circles never COMPLETELY go away, but they can be improved greatly by a variety of interventions ultimately to add up to about 70% eradication of dark circles.  However, most people with dark circles are very sensitive to them and people essentially “grew-up” using concealers and will likely never stop using them.  I can tell you that the carboxytherapy makes for a nice improvement and during the initial studies that I conducted the patients came once a week for eight weeks for the treatment and then we dismissed them and waited to see how long until they returned asking for another treatment and the average duration of effect was about six months to eight months.  Even then, patients would just look in the mirror, decide that they were due for a “touch-up” and they came in for one or two “boosters” and felt better enough to not have to return for a complete six session series.  All who underwent the studies were happy with the procedure.  Today, I have many people using the carboxytherapy to the eyelids to make the eye area “more open” and brighter.  It is VERY effective in tightening up the skin of the upper eyelid that can tend to get hooded and saggy and drags beneath the eyeshadow.  People also like it for preventative purposes, I have people who are following a very organic diet and lifestyle and they do not want foreign substances injected in to their skin.  I have younger patients and especially European, Russian, and Chinese young ladies and gentleman that know all about carboxytherapy and its anti-aging effects.  They are either naturopaths or work with nutrition and other healing therapies that quite literally saved their lives.  I also use carboxytherapy to eliminate fluid accumulation beneath the lower eyelids.  These fluids generally fluctuate from day to day and can be the result of former eyelid or facial surgery, to extreme allergies.  It is the only therapy for these “water bags” or more technically “malar festoons” that form beneath the eyes and give the appearance of puffieness.  It is brilliant for healing this and I have seen TREMENDOUS improvement in this fluid retention problem in high stress Wall Street traders to homemakers and moms.  Carboxytherapy is good for all eyelid problems because it increases the circulation and builds more collagen, therefore diminishing the blue-tinge to the skin and the little fine lines and overhanging skin on the upper eyelids.


4.. How is it injected—with a needle attached to a gas tank of some sort, or perhaps a cannula? How big is the container and what does it look like? How big and how long are the needles.

Terrific question.  Most apparatus are the same set-up (kind of like a ‘still’)-  The carbon dioxide is a compressed gas.  You can put any gas into a gas cylinder under the proper circumstances.  So, we have medical grade carbon dioxide tank that is hooked up to the unit that acts as a flow-regulator.  Different models have different bells and whistles.  I have 2 of the best machines in the world.  The gas flows from the cylinder into the machine that acts as a flow regulator, it slows down the speed of the gas and in some of the more advanced units (such as mine) the gas is warmed to body temperature [ to make the procedure more comfortable- compressed gas is very cold, but it feels hot to the body, like letting a big ice cube melt in your hand it’s icy-hot] once the gas is slowed and gently warmed by the flow-regulator, it exits the device via a sterile tube with a bacteriostatic filter on the end where the individual use 30 gauge needle is placed.  That’s it!  Every gas tube, filter, and needle is single-use only and is NEVER used from patient to patient.  The needles are teeny-tiny 30 Gauge ½ inch needles like we use for Botox.

Advanced machines have continuous flow and the unit will drain itself of outside room air, forming a closed circuit. [Entry of room air into the system is not harmful, but it did lead to one or two cases of persistent puffy eyelid for 1-3 days as it happened to ME when I was treated by a new physician.  This isn’t the case anymore, no harm, no foul].  The speed that the gas exits the machine can be adjusted, as well as it has a continuous filling mechanism that senses the resistence in the patient’s tissues to let the operator know when the appropriate end tension has been reached.  I can let the gas go in fast and in one single big bolus of force (good for scars), or fill the area up gently a little gas at a time with alternating rest periods (for body sculpting).

The size of the CO2 tank is the exact same size as an oxygen tank.


5. How is it useful for the neck, arms and stomach, other than cellulite or stretch marks?

I think that I explained cellulite, arms, and stomach above for you.  Some people in France and Brasil in particular use the superficial injection of small amounts of gas just beneath the skin surface to raise small bumps all over the face, eyes, neck, and décolleté for anti-aging purposes.  I think that it works very well because it really does build the collagen in these area and makes the skin more smooth and supple.  It is also more cost friendly because the only other methods of rejuvenating these areas is either mesotherapy (injection of vitamins beneath the skin surface) or dermarolling (microneedling of the skin using tiny needles on a roller drum that is rolled over the skin surface to create multiple micro-punctures of the skin), or platelet-rich-protein therapy (PRP) where the patient donates two to four vials of their own blood and this is spun down in the centrigue and the nutrient-rich plasma is then re-introduced into the dermal layer by multiple small injections by the physician.  I do offer all of the above therapies, so I have seen differing results.  I spoke with a brilliant colleague from Mexico who does stem-cell work and he came to my office to see how carboxytherapy worked.  I told him that I thought that the combination of carboxytherapy to increase the bloodflow to the skin combined with the power of stemcells could have far-reaching effects on anti-aging.  He told me he uses CO2 to grow his stem-cell samples!

The mesotherapy with me uses vitamins that I import from Paris so this can be costly to the patient.  The PRP plasma treatment yields very nice results to the décolleté because it has all of the hormones and growth factors the skin needs and puts it directly in the collagen layer, by-passing the need for oral ingestion of nutrients and hoping that some of the vitamins make it to the skin.  The Dermaroller is something that I import from Germany directly and is a medical device, it is faster and can therefore be used to treat larger areas such as the neck/décolleté  more quickly.  My IDEAL treatment for the neck, décolleté would be the PRP blood fillers to treat the overall face/neck/décolleté hand-injected by me and then the surrounding areas injected with the carboxytherapy because it is fast, painless, and would open up the capillaries of the treated areas to accept the living nutrients from the blood.  Plus, the blood can be transferred to another test-tube containing a salt solution that transforms the blood into a smooth dermal filler [Selphyll, – ‘the Vampire Facelift’] procedure to fill necklace lines on the neck and linear lines between the breasts that can look kindof crinkly.  There is another incidence in the literature of an Italian doctor that was using “no-needle” botox to this area by transdermal pushing of the molecule + nutrients into the region between the breasts to diminish the puckering.  The photos looked nice, but Botox is a BIG molecule so it may be awhile until we get a “no-needle” form of that.

Other uses of carboxytherapy is to improve or even prevent scar formation after a trauma.  Some bacteria LOVE an oxygen free environment.  They thrive and multiply and these “anaerobic” bacteria can fester and prolong the inflammatory phase of healing making the likelihood of bad scarring a greater possibility.  Many of my colleagues and I have used the carboxytherapy to treat open wounds that have passed the 24 hour time limit and cannot be sutured closed and the residual scar is barely visible.  


6. How much does it cost for under eye circles? For cellulite or stretch marks? How long does it take for cellulite and stretch marks?

Cost is determined by the region where the practioner works (going rate), it will be less expensive in a smaller town than in a bustling practice on Park Avenue.  It also can be based upon who is doing the treatment, is it the actual doctor, or is a nurse doing the procedure.  I base my costs upon how much actual physician “labor” is involved.

Eyelids generally are $250.00 per treatment session and require at least 6 sessions to see some improvement.  If more than one series of 6 sessions is required, then we lower the price for the next set and so on.  Eyelid treatment takes about 5 minutes after a 15 minute numbing period.

Body treatments go by “areas” so an “area” can be the stomach, or the flanks, or the inner thighs, or the outer thighs, or the buttocks, or the arms.  Body treatments are a little bit more expensive and depend upon again the actual labor required.  If it is only one or two itty-bitty areas I treat is like an eyelid and charge $250/session.  If it is for cellulite all around the leg it can be usually $400/per session/area for 6 sessions.  If a second set of 6 sessions is required, we will give a discount on the next set of 6 sessions.

Stretch mark treatment also goes by area and labor required.  If it is only a few little lines I price it like an eyelid at $250/session/area.  If there are multiple stretchmarks that are reticulated and lace-like it could take a very long time to do both sides of the body (up to one hour treatment time) and therefore the price goes up to  $500/per session/area for 6 treament sessions.

Most patients have multiple areas that they someday would like to treat.  I encourage them to pick one area that bothers them and to treat it first to see how they respond.  Invariably, I have never had anybody not respond, and everybody adds on a second or third treatment area, so I know very well that this treatment is a home run for everybody.  They all love the results so much that by the 3rd or 4th session, they add the next body area to be treated.  It’s really a 100% satisfaction rate for the stretch marks!  Safe for all skin tones!

Results for eyelids/cellulite/fat sculpting last about 6 months to a year based on patient re-presenting to the clinic for a “booster.”  A new series is not always required and one or two “touch-up” treatments is all that is required.  Results for stretch marks are final and only change really if the patient has a dramatic weight change (pregnancy or weight-lifting) since the “’scars” of the stretch marks are essentially healed by collagen remodeling, once the results are obtained, they are yours to keep!



7. Who is the ideal candidate?

Everybody is a candidate for Carboxytherapy.  It works better on new (red) stretch marks so the sooner the patient comes to have them treated, the better.  However, the carboxytherapy is really the only thing that works well on both new (red) and old (white) stretch marks.

For under eye circles, the best results will be in a candidate who doesn’t have a depression beneath the eyelids and has corrected any nasal outflow blockages such as a deviated nasal septum, nasal polyp, or allergy control via allergy detection and altering the behavior to minimize exposure to allergans.  I usually have patients start with a prescription for nasal steroids and one carboxytherapy treatment in my office on the day of their first visit.  When they come for their second session, they are generally amazed at what it is like to be able to breathe freely for the first time in their lives.  That then becomes the crux where the carboxytherapy is used more for “healing” purposes once the nasal blockage is cleared.

Carboxytherapy works best for people that do not smoke.  Studies have shown that the blood supply to a smoker’s skin is 60% diminished even when not taking a drag from a cigarette.   Smoking also increases the appearance of dark circles not only by diminishing circulation to the region, but also from the chemical irritants having direct contact to the sensitive cornea and conjunctiva.  That being said, carboxytherapy can help to restore the vitality of the skin despite a person’s smoking status because it increases blood flow wherever the gas is injected.

Age has nothing to do with it.  I have patients aged 18 years old to 83 years old that do carboxytherapy for one reason or another.  They love it!

8. How do you help minimize pain?

Numbing cream is placed on the area to be treated and allowed 15 minutes or more depending on the individual.  Most people don’t need numbing cream for the eyelids because it is only one needle stick.  My colleagues in Europe do not use any numbing cream at all.  However, I find that it does help to diminish the pinch of the needle quite a bit.  So, numbing cream for 15 minutes or so before the treatment, ice prior to injection, some people like a little glass of wine or something while they are numbing to relax a little.  My device warms the gas to body temperature.  I have different ways of manipulating the skin so that the needle isn’t even felt, sometimes I squeeze the area to be treated and filling the area with the gas prior to treating each individual stretch mark can be anesthetic enough and keeps the gas inside each of the little lines.  I control the flow rate and turn it down to “low flow” to slow the rate that the gas inflates the skin and my device can deliver a little gas at a sputtering rate on and off.  Most of the discomfort felt is derived from rapid expansion of the tissues from a fast gas flow, so turning down the flow rate and intermittent flow helps a lot.  It is a sensation just like anything else, and usually by the second treatment the patient is watching me do the procedure and making sure that I get every last little line.  It becomes addictive in a way.

I am a strong believer in “talk-aesthesia” we just chit-chat and I do my thing and it’s over before the patient knows it, we are done, they are usually surprised and said they didn’t feel hardly anything.  We all just have fun at it, that’s all.


9. How did you discover carboxytherapy?

There were several academic meetings and lectures during my residency and fellowship training and I heard about it from a colleague who is a doctor in Brasil.  He spoke amazing things about the use of CO2.  I tried it, did the original eyelid studies here in New York, and it has been forward moving ever since!


10. How long have you been doing it? Why do you suppose it is so popular in Brazil, and why is it less so in the U.S.? Is it as popular in Europe

I have been performing carboxytherapy for about eight years now.  It makes me feel old to think that I have been doing anything for eight years, but that is when it all started.  I have met colleagues one from Argentina who has been doing carboxytherapy for over thirty-years now!

So far I have personally met doctors from Brasil, Argentina, England, France, Korea, Spain, Switzerland, Turkey, and on and on.  Carboxytherapy spas are to Brasil as Starbucks are to the United States.  There is one on every corner!

I think that it will someday be as popular in the United States, but it is correct to assume that it is more available outside the United States because first of all, financial purposes.  One cannot patent a natural component, so there is no money in it for anybody.

Not many American physicians go abroad specifically for training in a single technique.  They are usually abroad providing self-less procedures and teaching other doctors how to save lives.  There is only one direct flight to Nice and when I first went to the Anti-aging conference in Monte Carlo, there were only two or three American doctors (not including myself) on their way to the biggest Aesthetic and Anti-aging medical conference in the Western world (Singapore is #1).  That has changed, and now I am pleased to see about 10 of my colleagues every year adding to the 5,000 physician, 129 country represented meeting in Monte Carlo every year.

Interest in carboxytherapy is increasing year by year.  For more information about the procedure readers can visit for carboxytherapy in the USA and to learn about world-wide carboxytherapy.

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