Aesth Plast Surg (2010) 34:239–243 patients who enroll in wellness programs receive thorough counseling. In our practice, patients undergo basic health screening, and most patients receive concurrent dietary, lifestyle, and exercise therapies. As part of a holistic approach, CO2 and drug treatment may be added. An audit of CO2 therapy should exclude the majority of patients who enroll in a holistic program. Difﬁculty restricting mono- therapy in clinical practice probably explains why pub- lished audits of this popular treatment are few. Conversely, it is likely that this audit may underestimate the results because physical, drug, or dietary methods are excluded. Conclusion Acknowledgment retrieving the data. The results of this audit agree with those reported in smaller prospective series, conﬁrming that carboxytherapy is safe and effective. We are grateful to the clinic staff for their help in Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which per- mits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. References 1. Brandi C, D’Aniello C, Grimaldi L, Bosi B, Dei I, Lattarulo P, Alessandrini C (2001) Carbon dioxide therapy in the treatment of localized adiposities: clinical study and histopathological corre- lations. Aesth Plast Surg 25:170–174 243 2. Campos V, Bloch L, Cordeiro T (2007) Carboxytherapy for gy- noid lipodystrophy treatment: the Brazilian experience. J Am Acad Dermatol 56:AB196 3. Koutna N (2006) Carboxytherapy: a new noninvasive method in aesthetic medicine. Cas Lek Cesk 145:841–843 4. Brandi C, D’Aniello, Grimaldi L, Caiazzo E, Stranghellini E (2004) Carbon dioxide therapy: effects on skin irregulatiry and its use as a complement to liposuction. Aesth Plast Surg 28:222–225 5. Chang P, Wiseman J, Jacoby T, Salisbury AV, Ersek RA (1998) Noninvasive mechanical body contouring: (endermologie) a one- year clinical outcome study update. Aesth Plast Surg 22:145–153 6. Ferreira JCT, Haddad A, Tavares SAN (2008) Increase in col- lagen turnover induced by intradermal injection of carbon dioxide in rats. J Drugs Dermatol 7:25–30 7. Ochiai R, Takeda J, Noguchi J, Ohgami M, Ishii S (2000) Sub- cutaneous carbon dioxide insufﬂation does not cause hypercarbia during endoscopic thyroidectomy. Anesth Analg 90:760–762 8. Lee CM, Huxley RR, Wildman RP, Woodward M (2008) Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis. J Clin Epidemiol 61:648– 653 9. Ballou SP, Mackiewicz A, Lysikiewicz A, Neuman MR (1990) Direct quantiﬁcation of skin elasticity in systemic sclerosis. J Rheumatol 17:790–794 10. Bartell TH, Monafo WW, Mustoe TA (1988) A new instrument for serial measurements of elasticity in hypertrophic scar. J Burn Care Rehabil 9:657–660 11. Fong SS, Hung LK, Cheng JC (1997) The Cutometer and ultra- sonography in the assessment of postburn hypertrophic scar: a preliminary study. Burns 23:12–18 12. Draelos ZD, Marenus KD (1997) Cellulite: etiology and pur- ported treatment. Dermatol Surg 23:1177–1181 13. Numberger F, Muller G (1978) So-called cellulite: an invented disease. J Dermatol Surg Oncol 4:221–229 14. Rosenbaum M, Priedo V, Hellmer J, Boschmann M, Krueger J, Leibel RL, Ship AG (1998) An exploratory investigation of the morphology and biochemistry of cellulite. Plast Reconstr Surg 101:1934–1939 123