Combined benefits: The use of Carbon Dioxide and Oxygen in aesthetics

By Dr Domenico Amuso / 01 Nov 2014

Dr Domenico Amuso explores the individual and combined uses of Carboxytherapy and Oxygen Infusion to achieve optimal aesthetic results

The use of Carbon Dioxide and Oxygen to achieve skin rejuvenation is a tale of two methodologies that work very successfully individually, but add another dimension when combined. This article describes uses of carboxytherapy and oxygen in skin rejuvenation and how the therapies can be combined to enhance results.


Images courtesy of MBE Medical Division

Carboxytherapy is defined as the use of medical carbon dioxide (CO2) administered with intradermal and subcutaneous inoculations by medical professionals, typically using a device connected to a cylinder of medical CO2 which enables the gas to be supplied in a controlled way, and programmable according to the resistance encountered in the patients’ tissues. The first effects following CO2 injection is a strong vasodilatation, a blood flow increase and a higher pO2 in the treated area. The Bohr effect describes the tendency of haemoglobin to have less affinity for oxygen when the blood concentration of CO2 is increased.1 This lower affinity leads the haemoglobin to better release the oxygen in superficial tissues and muscles. The presence of CO2 also promotes collagen remodelling as well as thickening and smoothing the overlying skin. Relating to blood circulation, Carboxytherapy causes active arteriolar vasodilation, increasing the blood flow to the treated area. This also effectively eliminates the build-up of fluids and toxins between the cells causing lymphatic drainage.2 The treatment is safe for all kinds of patients, and for face and body therapies. Carbon Dioxide is non-toxic, does not cause embolisms and is compatible with the human body that produces it constantly and eliminates it through the lungs via the venous system.


‘Oxygen Infusion’ is a technique where oxygen with a purity of between 94-98% is ejected onto the skin through proprietary hand pieces fitted with shaped ‘oxygen caps’ at a pressure two or three times higher than normal atmospheric pressure. Fick’s first law of diffusion, modified by Higuchi,3 states that the capacity to carry a substance through the epidermis is directly proportional to the solubility and the ability of the applied substance to diffuse. The cutaneous barrier function resides in the corneal layer. During the infusion process, the oxygen, when it comes into contact with the skin, has a latent period in which the gas reaches a state of balance with the skin. Once the point of balance is reached, a constant flow of penetration begins, the scale of which is proportional to the concentration and to the pressure of the gas. This methodology enables the gas to pass transcutaneously. This occurs to a small extent through glandular annexes (pilosebaceous apparatus and eccrine glands) and through intercellular and/or transcellular paths. The therapeutic action of Oxygen Infusion is characterized by the angiogenetic properties typical of oxygen. It is also believed that Oxygen Infusion influences the long-term regulation of tissue ematic flux, delivering an increase in the entity of the vascular bed of tissue microcirculation, causing a true angiogenesis.4 Oxygen Infusion acts on the three primary components of the connective dermal tissue, keeping up an adequate production for quantity and quality of glycosaminoglycans (hyaluronic acid), elastic and collagen fibres. When infused, Oxygen can be effective in the treatment of P.E.F.S. (Fibro Sclerotic Edematous Panniculitis), wrinkles, stretch marks, lax skin, localized adiposity and dyschromia.4

Combined Therapies

Gas Contouring is a technique consisting of localized injections of carbon dioxide followed by localized infusions of pure oxygen pressurized at more than two atmospheres. Compared with Carboxytherapy, a therapy that has been in use since the thirties, this new technique has shown considerable benefits. To evaluate the clinical action of the two when used together, a clinical study5 was conducted using sixty Caucasian female patients aged between 21 and 56 years of age. Of the sixty participants, 20 were treated solely with oxygen infusion, 20 with carbon dioxide and 20 with a combination of oxygen and carbon dioxide. The areas that underwent treatment were the ‘saddle bags’ and the abdomen. All the patients were evaluated clinically and particular attention was paid to the measurements, in centimetres, of the abdomen and thighs and to the measurement of skin elasticity and hydration. There were 12 sessions in the treatment and patients’ levels were recorded at the beginning, at the sixth session and at the twelfth. With Oxygen Infusion, the result was an improvement of 35.3% in skin elasticity and 19.9% in skin hydration. With Carboxytherapy, an improvement of 41.8% in skin elasticity and 15.6% in skin hydration was seen. With the combined action of Oxygen Infusion and Carboxytherapy, an improvement of 53.6% in skin elasticity and 27.9% in skin hydration was observed. There was also a clear reduction of localized fat deposits on the abdomen and thighs of the third category of patients. A further study6 was undertaken to investigate the effects of Carboxytherapy and Oxygen Infusion when used together for Fibro Sclerotic Edematous Panniculitis treatment. Improvements in skin texture in terms of grain, lines and depth of wrinkles and an effective lipolytic action in specific areas were noted.

Images courtesy of MBE Medical Division


From my own experience in this field, and that of my colleagues, I am convinced that the synergic action of Carboxytherapy and Oxygen Infusion:

  • enables synthesis of dermal fibres having a filling effect (collagen I and III)
  • intensifies the synthesis of fibres having a supporting effect (collagen IV and VII)
  • tones the skin and fills the micro-grooves to give the surface density and volume to the skin
  • stimulates the synthesis of GAGs (glycosaminoglycans) collagen type I, III, IV, VII to restore the density and cohesion of the skin
  • promotes the synthesis of amino acids that make up the NMF to moisturize the skin
  • acts on cellular oxidation (cellular ageing) and tissue glycation or caramelization (ageing tissue)
  • counteracts the loss of elasticity and tonicity of the dermis and the consequential formation of FEF and stretch-marks
  • affects adipose tissue: carbon dioxide breaks down the membranes of the fat cells and oxygen infusion promotes the splitting up of the triglycerides into fat acids, reducing fat accumulation.

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