Topical Carboxytherapy for Latrogenic Skin Burns Following Liposuction

There is growing interest in the beneficial effects of carboxytherapy within several fields of medicine including dermatology. Carboxytherapy is a means for increasing available levels of oxygen (O₂) in tissues to treat various conditions. This can be achieved by the transcutaneous administration of gaseous carbon dioxide (CO₂). As CO₂ has greater affinity for hemoglobin than O₂, increasing tissue CO₂ causes a right-ward shift in the oxygen-hemoglobin dissociation curve, resulting in unloading of O₂ and making it more available in surrounding tissues. This mechanism is known as the Bohr effect.¹ Several recent reviews describe the injection of CO₂ directly into subcutaneous tissues to treat a wide range of skin-related conditions² and enhance wound healing.³

Intradermal carboxytherapy has shown clinical benefit for treating diabetic foot ulcers4 and wounds under conditions of venous insufficiency.⁵ A recent report described the successful use of carboxytherapy with transcutaneous injection of CO₂ gas to treat five cases of deep partial-thickness skin burns following circumferential and high-definition liposuction.⁶

A topical gel, it has been theorized, could offer the benefits of CO₂ injections without disadvantages, such as injection site discomfort,⁷ and it could be used at home by the patient. The amount of CO₂ delivered into tissues is like that achieved with transcutaneous injection of CO₂ gas.₈ Recent work has shown topical carboxytherapy to promote healing of diabetic foot ulcers (Dr. Lynda Khiat, Faculté de Médecine D’Oran, Oran, Algeria; oral communication).

The following case describes partial-thickness skin burns caused by a liposuction procedure that were successfully treated with a newly developed topical carboxytherapy gel.

CASE REPORT

A 52-year-old Latin woman presented to our facility following a 360-liposuction procedure using power-assistance technology. During her 24-hour post-operative follow-up appointment, acute bruising and possible burns were observed on the skin over her entire abdomen and back (Figure 1). A diagnosis of post-operative second-degree burns and cellulitis was made.

On presentation, she was alert and orientated with a BMI of 32 kg/m² and normal vital signs. Cardiovascular, respiratory, and gastrointestinal examinations were all normal. Her past medical history was notable for a 200-pack/year history of cigarette smoking, which she had quit 3 months earlier in preparation for her liposuction procedure. She consumed alcohol socially, was not receiving any medication therapy, and had no known allergies. She was started on intravenous cefepime and clindamycin, but the results of a superficial wound culture with gram staining were negative. A low-fat, low-salt, low-sugar diet with daily hydration was recommended.

Additional tissue trauma was avoided by eliminating the compression garment. Due to her recent history of heavy smoking, she was not considered to be a suitable candidate for hyperbaric oxygen therapy. Therefore, treatment with topical carboxytherapy (CO₂ Lift, Lumisque, Inc) covered in polyvinyl chloride wrap (Saran) was initiated and applied twice daily. The product was prepared by mixing a gel and activator for 30 seconds. Following activation, the gel was topically applied, where it became semi-solid. There, it released CO₂ for 45 minutes, increasing tissue oxygenation and improving microcirculation via casodilation and sustained capillary expansion.²

The treatment plan was to continue with topical carboxytherapy twice daily, and oral cephalexin and clindamycin for 1 month, with re-evaluation every 5 days. After 2 weeks, her burns showed substantial improvement and topical carboxytherapy was continued twice daily for another week. After 3 weeks, the patient showed continued improvement (Figure 2). Antibiotics were stopped and topical carboxytherapy was continued. Complete healing was achieved after 4 weeks (Figure 3).

DISCUSSION

Burns are occasionally reported as a complication of liposuction.⁹ In a previous report, percutaneous carboxytherapy with CO₂ gas was performed daily or once every 2 days for 1 or 2 weeks to treat five patients with partial thickness burns related to liposuction treatment.⁶ Those patients achieved complete healing after 2 weeks. No complications were reported, although the occurrence of treatment-related pain was not considered a complication.

In the case presented in this article, carboxytherapy was applied twice daily but did not require a daily return to the clinic as it was applied by the patient at home. Treatment progress was monitored every 5 days and was considered complete after 4 weeks. We considered this to be an excellent result. No adverse events were observed or reported, including treatment-related pain or discomfort. Although our patient was not a suitable candidate, hyperbaric oxygen may also be beneficial for treating thermal injury and decreasing healing time.

CONCLUSION

A topical carboxytherapy gel provides the same beneficial effects as percutaneous injections of CO₂ gas for the treatment of partial-thickness burns. Topical carboxytherapy gel may also be a beneficial treatment for a range of dermatologic and aesthetic conditions.

Disclosure: The author reports there are no conflicts of interest to be disclosed.

1. Bohr C, Hasselbalch K, Krogh A. Concerning a biologically important relationship - the influence of the carbon dioxide content of blood on its oxygen binding. Skand Arch Physiol. 1904;16:401-412.

2. Kim R, Zeidler KR. Expanding the role for topical carboxytherapy: An advisory board discussion. Modern Aesthetics. 2024;12(2):15-18.

3. Khiat L, Leibaschoff GH. Clinical prospective study on the use of subcutaneous carboxytherapy in the treatment of diabetic foot ulcer. Surg Technol Int. 2018;32:81-90.

4. CO2Lift Carboxy Gel. Lumiscue Skincare, 2024. Available: https://co2lift.com/. Accessed: April 23, 2023.

5. Leibaschoff GH, Coll L, Roberts WE. A prospective clinical and instrumental study on the effects of a transcutaneous cosmeceutical gel that is claimed to produce CO₂. Surg Technol Int. 2018;32:33-45.

6. Macura M, Ban Frangez H, Cankar K, Finžgar M, Frangez I. The effect of transcutaneous application of gaseous CO2 on diabetic chronic wound healing-A double-blind randomized clinical trial. Int Wound J. 2020;17:1607-1614.

7. Brochado TMM, de Carvalho Schweich L, Di Pietro Simões N, Oliveira RJ, Antoniolli-Silva ACMB. Carboxytherapy: Controls the inflammation and enhances the production of fibronectin on wound healing under venous insufficiency. Int Wound J. 2019;16:316-324.

8. Waked K KM, Aslani A,. The use of carboxytherapy for the treatment of deep partial-thickness skin burns after circumferential and high-definition liposuction: Promising clinical results in 5 consecutive cases. Aesthet Surg J Open Forum. 2023;5:1-9.

9. Levy AS, O’Sullivan G, Parizh D, Spector JA, Houng AP. 363 Full thickness burn injury following laser-assisted liposuction. J Burn Care Res. 2018;39(Suppl 1):S152.