Carboxytherapy, acne and surgical scars

Scars protocol

Principle

Same effect as needle subcision. Improve blood flow, vascularization and collagen synthesis.

Indications

Recent scars treated during the healing phase, atrophic scars, white scars. Thyroidectomy scars, caesarean scars, post-traumatic scars and postsurgical scars. Narrow atrophic scars.

Protocol

It is important to evaluate the scar hardness. The harder the scar is, the higher the required CO2 flow.

Depressed scars

• Combined subcutaneous and intradermal injection
• One session per week
• Flow: 80 cc/min
• Punctures inside the scar
• Number of sessions: four to six
• Deeper injections are more painful for patients with adhesions
• Multiple injections in deep layers as CO2 does not diffuse well

Narrow scars, non depressed scars

• Intradermal injection only
• One session per week
• Flow: 30–40 cc/min for soft scars
• Punctures inside the scar (as per stretch marks)
• Number of sessions:four to six

Acne scars (face)

• Combined subcutaneous and intradermal injection
• One session per week
• Flow: 30–40{ts}cc/min for minor scars (soft), >80–90{ts}cc/min (subcutaneous) to get a subcision-like effect on retracted acne scars and hard scars.
• Punctures inside the scar
• Number of sessions: four to six
• Deeper injections are more painful for patients with adhesions
• If adhesions are suspected: multiple injections in the deep layers as CO2 does not diffuse well

Technique

Hand movement should target both the subcutaneous layer and the intradermal layer for depressed scars. If adhesions are suspected, multiple subcutaneous injections are required. The dermal plane is usually injected first and then the needle is pushed further, into the subcutaneous plane, in a second movement. For small scars or scars that are not depressed, only intradermal injections should be necessary.

Injection points

Directly into the scar.

Endpoints

Erythema (subcutaneous injections); popcorn effect or fast inflation (intradermal injections).

Post-treatment care

No post-treatment care is required. If treatment is to the face, a sun protection cream and a moisturizer are usually provided.

Pain management

Emla if too painful (this cream may lower the Bohr effect, because vasoconstriction may reduce blood flow); lower flow will reduce pain (but may reduce efficacy in breaking septae).
Note 1: A few physicians use CDT for the treatment of keloids, applying higher flows (first session around 50{ts}cc/min, then usually 90–100 cc/min) as scars are tough. Results are apparently very variable. We have no personal experience of treating scars.

Note 2: Patients with acne and acne scars may benefit from combined treatments:

• traditional acne drugs and carboxytherapy
• erbium–glass/Nd–YAG laser and CDT (not during the same session but 15 days apart)
• fractional laser and CDT.