Carboxy Therapy
Subcutaneous CO2 injections to improve circulation, reduce dark circles, cellulite, and stretch marks via the Bohr effect
Bottom Line
Carboxytherapy has limited but promising evidence for aesthetic applications. Best evidence is for dark under-eye circles and stretch marks, where multiple small studies show improvements. For localized fat reduction, effects appear transient - a rigorous RCT showed benefits at 1 week but not at 6 months.
The mechanism is well-understood (Bohr effect enhancing oxygen delivery), but the procedure is painful and not FDA-approved. Consider if you have specific aesthetic concerns that haven't responded to other treatments.
Science
Mechanism of action:
- Based on the Bohr effect: increased CO2 causes hemoglobin to release more oxygen
- CO2 injection causes local vasodilation and increased blood flow
- Enhanced oxygenation stimulates collagen and elastin synthesis
- May trigger VEGF-mediated angiogenesis (new blood vessel formation)
- For fat reduction: may cause temporary adipocyte shrinkage (not cell death)
Key studies:
- Costa et al. (2023): Systematic review of 27 studies on cellulite and striae
- Tabaie et al. (2024): Clinical trial showing significant reduction in periorbital hyperpigmentation
- Lee et al. (2018): RCT showing fat reduction at 1 week but not sustained at 6 months
- Saleh et al. (2020): 8-session protocol improved stretch marks with collagen remodeling
Applications with evidence:
- Dark circles (periorbital hyperpigmentation) - moderate evidence
- Stretch marks (striae distensae) - moderate evidence
- Cellulite - limited evidence
- Localized fat reduction - transient effects only
- Wound healing - emerging evidence
Limitations:
- Most studies are small (10-30 participants)
- Not FDA-approved (as of 2018)
- Long-term durability of results unclear
- Mechanism for fat reduction appears temporary
Supporting Studies
4 peer-reviewed studies
View all studies & compare research →Practical Protocol
Standard treatment protocol:
- Sessions: 6-10 sessions typical course
- Frequency: Weekly sessions
- CO2 volume: 10-100 mL per area depending on treatment
- Flow rate: 20-80 mL/min
- Temperature: Often cooled (15°C) for comfort
For dark circles:
- Intradermal injection around orbital area
- 10-20 mL CO2 at 20 mL/min
- 4-6 weekly sessions
- Results visible after 3rd session typically
For stretch marks:
- Subcutaneous injection along striae
- Higher volumes (50-150 mL per area)
- 6-8 sessions at 1-2 week intervals
- Combine with topical treatments for enhanced results
For cellulite:
- Subcutaneous injection in affected areas
- 100-200 mL per treatment area
- 8-10 weekly sessions
- Maintenance sessions may be needed
Post-treatment:
- Avoid strenuous exercise for 24 hours
- Mild bruising and swelling normal for 2-5 days
- Results typically assessed 1-2 weeks after final session
Risks & Side Effects
Common side effects (expected):
- Pain during injection (main limiting factor)
- Bruising at injection sites (30-45% of patients)
- Temporary swelling/oedema
- Erythema (redness) lasting 1-3 days
- Crackling sensation under skin (resolves in hours)
- Heavy legs sensation (due to vasodilation)
Rare complications:
- Air embolism (if improperly performed)
- Tissue emphysema
- Inadvertent lipolysis in unintended areas
- Infection at injection sites
Contraindications:
- Cardiovascular disease (heart failure, recent MI, unstable angina)
- Respiratory conditions (COPD, sleep apnea)
- Recent thrombosis, phlebitis, or pulmonary embolism
- Pregnancy
- Active cancer or post-cancer (growth-promoting effects)
- Epilepsy
- Severe anemia or bleeding disorders
- Uncontrolled diabetes
- Active skin infection
- Glaucoma (risk of increased intraocular pressure)
Important notes:
- Not FDA-approved
- Must be performed by qualified professional
- Pain is significant - discuss with practitioner beforehand
Who It's For
Ideal candidates:
- Those with stubborn dark under-eye circles
- People with stretch marks (especially striae alba)
- Those seeking non-surgical cellulite treatment
- Patients who haven't responded to topical treatments
- Those willing to commit to multiple sessions
Should skip:
- Anyone with cardiovascular or respiratory conditions
- Those seeking permanent fat reduction (effects are transient)
- People with low pain tolerance (procedure is uncomfortable)
- Those expecting dramatic results
- Anyone unwilling to commit to 6-10 session course
Better alternatives:
- For fat reduction: diet/exercise, or proven procedures like cryolipolysis
- For dark circles: address root cause (sleep, allergies, sun protection)
- For stretch marks: microneedling or laser may have better evidence
How to Track Results
What to measure:
- Photography: Same lighting, angle, and distance before each session
- Circumference measurements (if treating cellulite/fat)
- Subjective satisfaction ratings
- Side effect diary
Timeline:
- Initial assessment: Before first session
- Progress photos: Before each session
- Interim assessment: After 4-5 sessions
- Final assessment: 2-4 weeks after last session
Signs it's working:
- Dark circles: Visible lightening after 3+ sessions
- Stretch marks: Improved texture, reduced visibility
- Cellulite: Smoother skin surface
- Skin: Improved texture and elasticity
Red flags:
- Excessive bruising lasting >1 week
- Signs of infection (increasing redness, warmth, pus)
- Persistent numbness or nerve symptoms
- No visible improvement after 6 sessions
Cost Breakdown
Per session costs:
- Small area (eyes): $75-150
- Medium area (face/neck): $100-200
- Large area (abdomen/thighs): $150-300
Full treatment course:
- Dark circles (6 sessions): $450-900
- Stretch marks (8 sessions): $800-1,600
- Cellulite (10 sessions): $1,000-2,500
Cost considerations:
- Usually not covered by insurance (cosmetic)
- Package deals often available (10-20% discount)
- Maintenance sessions may be needed
- Compare to alternatives:
- Laser treatments: $200-500/session
- Microneedling: $200-700/session
- Topical retinoids: $20-100/month
Podcasts
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The Science of Carboxy Therapy: Healing, Anti-Aging and Sexual Health with Lana Kerr
Lana Kerr, founder and CEO of Lumis, discusses the science behind carboxytherapy and her CO2...
Discussed in Podcasts
8 curated moments from top health podcasts. Click any timestamp to play.
Double-blind studies support CO2 Lift for vaginal rejuvenation
The host discusses being impressed by the double-blind studies supporting CO2 Lift V for vaginal rejuvenation applications.
"But when I heard about CO2 lift, A, for the skin, but also looked at the double-blind studies that they had done for vaginal rejuvenation, that is what just blew me away. Okay? So..."
CO2 Lift as a medical grade carbon dioxide treatment
The host describes CO2 Lift as a medical grade treatment that uses carbon dioxide to lift, tighten, and regenerate skin across multiple body areas.
"this product, CO2 Lift. It is a medical grade treatment that uses carbon dioxide to lift, tighten, and regenerate your skin. It can be applied to your face, your eyes, your neck, and your body. And it is also used as a vaginal rejuvenation gel. Okay. So..."
How Lana Kerr discovered carboxytherapy
Kerr shares how she discovered carboxytherapy through a practitioner with great skin and developed a gel delivery system as a first-of-its-kind product.
"In 2015, she discovered a new way to deliver carbon dioxide through the skin by using a gel, CO2 Lift. That's what it's called that she uses in her company, CO2 Lift for fast skin regeneration. And she's going to be talking all about exactly what it is, why it's so effective, and the results that she has seen on herself and within some of her clientele."
Carbon dioxide gel for skin regeneration explained
The host introduces Lana Kerr's discovery of a new way to deliver carbon dioxide through the skin using a gel for fast skin regeneration.
"In 2015, she discovered a new way to deliver carbon dioxide through the skin by using a gel, CO2 Lift. That's what it's called that she uses in her company, CO2 Lift for fast skin regeneration. And she's going to be talking all about exactly what it is, why it's so effective, and the results that she has seen on herself and within some of her clientele."
Lana Kerr introduces CO2 Lift carboxy technology
Kerr explains how she pioneered CO2 Lift in 2015, a gel that delivers carbon dioxide for rapid skin regeneration and anti-aging effects.
"Hey, y'all. Welcome back to Hope Unwholesome. Today, I have on the show Lana Kerr. She is the founder and CEO of Lumis, providing skincare products to medical providers and through e-commerce. In 2015, she pioneered a skin rejuvenation method called CO2 Lift, a gel that delivers carbon dioxide for rapid regeneration and anti-aging effects. She also delivered CO2 Lift V for vulval vaginal rejuvenation, enhancing lubrication and sensitivity."
Carboxy therapy applications for skin and sexual health
The discussion covers how carboxy technology is used in products for skin rejuvenation and vaginal and sexual health.
"skin and that's what we want to achieve right and that's what would you kind of see when you use just even one application with CO2 left anywhere on the body do you want to wake up feeling like you're stepping into who you're meant to be it's the best possible version of you what if I told you that the key to your best life health and happiness are all around you you just have to find what works for you"
CO2 carboxy mask creates hyperbaric-like effect on skin
The hosts discuss how the CO2 Lift carboxy mask uses carbon dioxide to increase blood vessel formation and moisture, similar to a hyperbaric chamber effect.
"never puts castor oil in their products. You'd be surprised. I just purchased, you know, one of the new Bobbi Brown products. And it had castor oil? Absolutely. So it's a hot new oil on the market right now. I think it's in a lot of products that we don't even realize. But when you see it and feel it, it is the stickiest, gooiest. Yeah, I don't know anyone who works with it. It's really not sticky as much as it's just very thick. No, it's not sticky because I have been using it on my brows for,"
Carboxy mask for vaginal and post-procedure use
Discussion of using the carboxy mask for vaginal rejuvenation with benefits similar to the Mona Lisa laser, and for post-procedure skin calming.
"lift, carboxy mask, whatever. And it's an at-home treatment. It's not something that somebody does for you. What's the benefit of that? The benefits sound a lot like the benefits of the Mona Lisa laser. So it's a lifting, regenerating. The Mona Lisa brings more blood vessel, which brings moisture, which is exactly what the oxygen of this mask is supposed to do vaginally. Wow, that's brilliant."
Who to Follow
Researchers:
- Dr. Luigi Parassoni - Italian pioneer who developed carboxytherapy in the 1990s
- Dr. Nadia Afsar Kazerooni - Research on periorbital applications
Note: Carboxytherapy is more established in Europe and South America than in the US, where it remains off-label.
Synergies & Conflicts
Often combined with:
- Topical retinoids - Enhanced penetration after carboxytherapy
- Microneedling - Complementary collagen stimulation
- PRP (platelet-rich plasma) - Combined protocols studied for stretch marks
- Fractional CO2 laser - Studies show combination more effective than either alone
Timing considerations:
- Space carboxytherapy 1-2 weeks from other procedures
- Avoid same-day combination treatments
- Complete carboxytherapy course before adding other modalities
What People Say
Common positive reports:
Common complaints:
Reddit/forum sentiment: