240 Methods body-contouring therapy such as endermologie [5]. Con- traindications to participation in the study included phle- bitis; signiﬁcant cardiac, respiratory, renal, or hepatic impairment; uncontrolled hypertension; and pregnancy. Some patients treated for abdominal fat reduction under- went ultrasound examination to document the presence of subepidermal cellulite. Carbon dioxide was infused subcutaneously into the affected areas using the Carbomed Programmable Auto- matic Carbon Dioxide Therapy apparatus (Carbossiterapia Italiana S.R.L, Via Zanella, MI, Italy) and 30 gauge, 0.3 9 13-microlance needles (Fig. 1). The depth of infu- sion was 10 to 13 mm. The device, calibrated to measure the dosage in milliliters, regulated the ﬂow rate and the infusion pressure. The infusion was administered at a velocity of 50 to 100 ml/min, and the total quantity of CO2 infused was 500 to 1,000 ml for the abdomen and 800 to 1,000 ml for each thigh over a 20- to 30-min period. The therapy was continuously monitored by qualiﬁed medical personnel. Measurements Weight, abdominal, and thigh circumference measure- ments were recorded at baseline and after each treatment session. Abdominal circumferences were recorded at the levels of the upper abdomen (5 cm above the umbilicus), the mid abdomen (at the umbilicus), and the lower abdo- men (5 cm below the umbilicus). Ultrasound measurement of subcutaneous fat thickness was taken immediately below the umbilicus for all patients undergoing abdominal treatments. Maximum circumferences of both the right and Fig. 1 Front panel of the Carbomed Programmable (CO2) apparatus 123 Aesth Plast Surg (2010) 34:239–243 left sides of the thigh were recorded. The level of the thigh circumference measurement was recorded as the distance from the anterior superior iliac spine, and subsequent measurements were taken from the same level for each patient. Analysis Results The patients were grouped according to age (20- to 29-year-old group, 30- to 39-year-old group, and 40- to 50-year-old group), sex, and type of therapy. Measure- ments at baseline and 2 weeks after the ﬁfth carbon dioxide therapy session were compared in terms of mean ± stan- dard error of the mean (SEM) using Student’s t test. Signiﬁcance was set at a p value less than 0.05. A total of 101 women underwent abdominal therapy (Table 1). A signiﬁcant reduction in upper, mid, and lower abdomen circumference occurred in 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 the 10 men who underwent the same therapy, the fall in abdominal circumference was not signiﬁcant. For the 57 women who underwent thigh ther- apy (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 circumference was signiﬁcantly reduced respectively in the right versus left thigh 1.6 ± 0.3 versus 1.5 ± 0.2 cm, 1.1 ± 0.3 versus 1.1 ± 0.3 cm, and 1.6 ± 0.3 versus 1.5 ± 0.4 cm. Weight loss was signiﬁcant (Table 2) for the 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 1.6 ± 0.3 kg in the 40- to 50-year-old group (n = 12). Figure 2 shows the typical ultrasound evidence of decreased subepidermal thickness after ﬁve sessions of carboxytherapy. Complications The complications were minor and included pain at the injection site as well as crepitus and minor aches, which did not last more than 30 min. Some needle-entry bruising was noted, which resolved within 7 to 10 days. No other side effects were observed.