Aesth Plast Surg (2010) 34:239–243 DOI 10.1007/s00266-009-9459-0 O R I G I N A L A R T I C L E Georgia S. K. Lee Carbon Dioxide Therapy in the Treatment of Cellulite: An Audit of Clinical Practice Received: 20 July 2008 / Accepted: 17 October 2008 / Published online: 29 January 2010 The Author(s) 2010. This article is published with open access at Springerlink.com Abstract Background The clinical practice of using carbon dioxide therapy for localized adiposities was audited over a 4-year period. Methods Patients receiving physical, dietary, or drug concurrent therapy were excluded from the audit. Original measurements in terms of mean ± standard error of the mean (SEM) were compared with those obtained after ﬁve sessions. Results This series included 101 women who underwent abdominal therapy. Signiﬁcant reduction (p \ 0.05) in mean upper, mid, and lower abdomen circumference was experienced by all three age groups: respectively, 1.8 ± 0.5, 1.6 ± 0.4, and 2.1 ± 0.3 cm in the 20- to 29- year- old group, 1.6 ± 0.4, 2.3 ± 0.3, and 2.1 ± 0.3 cm in the 30- to 39-year-old group, and 2.0 ± 0.4, 2.5 ± 0.4, and 2.6 ± 0.4 cm in the 40- to 50-year-old group. For 57 women who underwent localized thigh therapy (27 in the 20- to 29-year-old group, 18 in the 30- to 39-year-old group, and 12 in the 40- to 50-year-old group), thigh cir- cumference was signiﬁcantly reduced in the right versus left thigh: respectively, 1.6 ± 0.3 versus 1.5 ± 0.2 cm, 1.1 ± 0.3 versus 1.1 ± 0.3 cm, 1.6 ± 0.3 versus 1.5 ± 0.4. Weight loss was signiﬁcant for older women who underwent abdominal therapy: 1.3 ± 0.2 kg in the 30- to 39-year-old group (n = 43) and 1.3 ± 0.2 kg in the 40- to 50 year-old group (n = 29). Older women who underwent thigh therapy also recorded signiﬁcant weight reduction: 0.9 ± 0.4 kg in the 30- to 39-year-old group (n = 18) and G. S. K. Lee (&) TLC Medical Practice Pte Ltd, Holland Village, Singapore, Singapore e-mail: enquiries@tlclifestyle.com 1.6 ± 0.3 kg in the 40- to 50-year-old group (n = 12). The results for 10 men were not signiﬁcant. Conclusion These results agree with those reported originally and demonstrate that carboxytherapy is safe and effective. Keywords Audit Carbon dioxide Localized adiposity Cellulite Carbon dioxide (CO2) therapy or carboxytherapy is the transcutaneous administration of CO2 for therapeutic pur- poses. Since Brandi et al. [1] described the efﬁcacy of CO2 in treating localized adiposities, showing measurable reductions in maximum circumferences of the abdomen, thigh, and knee regions, there has been a worldwide interest in the treatment [2, 3]. In the same paper, Brandi et al. [1] provided histologic evidence for the effects of CO2 gas inﬁltration on subdermal adipose tissue. Brandi et al. [4] subsequently reported improved skin elasticity when carboxytherapy was performed for skin irregularity after liposuction. In this report we describe an audit of the results after carboxytherapy for the treatment of cellulite over a 4-year period (March 2004–2008) in our clinic. Patients and Methods Patients The inclusion criteria for the study speciﬁed patients undergoing a minimum of ﬁve carboxytherapy sessions at 1- to 2-week intervals who were not under special dietary restrictions, not taking diet pills, and not undergoing other 123