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Despite the wide variety of indications which carboxytherapy is able to turn its hand to, it seems that the vast majority of data collected and treatments performed are for the reduction in the appearance of cellulite and fatty tissue.   Clinical data on the use of carbon dioxide for aesthetic indications is currently quite limited, although there are some key studies emanating from Europe and South America which shed significant light on its efficacy in the treatment of fatty tissue.   In 2001, a study from the University of Siena in Italy looked into the treatment of localised fat deposits on the thighs, knees and/or abdomen in 48 women using carbon dioxide therapy. The CO2 was administered subcutaneously twice weekly for 3 consecutive weeks, i.e. a total of 6 treatment sessions.   Results showed that on average the women lost 2cms of circumference from their thighs, 1cm from the knees and almost 3cms from the abdomen. The skin in the treated areas also presented a thicker appearance than before treatment, with cellulite appearing smoother. Few side effects were observed; although of those noted, such as the presence of a crackling sensation under the skin (reported by all patients), pain at the injection site (reported by 70% of patients) and slight haematomas (reported by 30% of patients), all resolved very quickly.   A later study from the same University published in 2004 looked at the effects of carbon dioxide on skin irregularity and its use as a complement to liposuction. It evaluated the treatment of 42 patients treated for fatty tissue accumulations on the thighs and knees. The group of patients were divided into three groups, in one group only liposuction was performed, in the second carbon dioxide therapy was administered 3 weeks after liposuction was performed in twice weekly applications for 10 consecutive weeks, and in the third group carbon dioxide therapy alone was administered, again twice weekly for 10 consecutive weeks.   The results were then analysed by reporting on variations in circumference measurements and skin elasticity after 2 months. The authors noted that liposuction alone did not generally have a positive enough effect on skin irregularity and could in fact cause uneven areas, however the addition of carbon dioxide therapy provided an improvement in skin smoothness and elasticity, meaning that in their opinion it offers a good complement to liposuction procedures. CO2 therapy also showed positive results in reducing fat accumulation as the circumferential measurement results of those treated with liposuction and carbon dioxide were better than for those treated with liposuction alone. A study from Brazil published in March 2008 looked at whether the intradermal and subcutaneous injection of carbon dioxide into the skin of rats would increase the turnover of collagen. 
Following biopsies it was noted that collagen turnover had indeed increased as compared to the control animals (which were injected with saline) and that the collagen formations were more pronounced in the areas where the gas was injected intradermally as compared to where it was injected subcutaneously.   The authors noted that the results obtained corroborated clinical observations of aesthetic improvements in human facial skin injected with carbon dioxide but that future clinical studies were needed to address the comparison between intradermal and subcutaneous injection methods as well as the volume of gas to be used and the frequency of treatment sessions.   As this treatment becomes more popular in the UK, and perhaps the USA, it is hoped that more studies of this kind will be done on the various potential aesthetic indications for carboxytherapy.

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