The American Journal of Medical Sciences and Pharmaceutical Research
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TYPE
Original Research
PAGE NO.
44-50
10.37547/tajmspr/Volume07Issue08-07
OPEN ACCESS
SUBMITED
17 July 2025
ACCEPTED
08 August 2025
PUBLISHED
23
August 2025
VOLUME
Vol.07 Issue 08 2025
CITATION
Pieieva Irina. (2025). Prospects for the Use of Carboxytherapy in
Comprehensive Care for Problematic Skin. The American Journal of
Medical Sciences and Pharmaceutical Research, 7(8), 44
–
50.
https://doi.org/10.37547/tajmspr/Volume07Issue08-07
COPYRIGHT
© 2025 Original content from this work may be used under the terms
of the creative commons attributes 4.0 License.
Prospects for the Use of
Carboxytherapy in
Comprehensive Care for
Problematic Skin
Pieieva Irina
Cosmetologist-esthetician in a beauty salon PUDRA Tiraspol,
Moldova
Abstract
This article presents a comprehensive analysis of the
prospects for applying non-injection carboxytherapy
within integrated care programs for problematic skin,
taking into account contemporary demands for efficacy,
safety, and physiological compatibility of interventions.
The study is grounded in an interdisciplinary framework
combining clinical dermatology, cosmetology, skin
physiology, and evidence-based medicine. Special
attention is paid to secondary analysis of scientific
literature describing the effects of transdermal and
topical CO₂ application on vascular, pigmentary, and
structural skin parameters in patients with acne, post-
acne, striae, hyperpigmentation, and early cellulite.
Both visual-instrumental and clinical outcomes are
examined
—
including
skin
hydration,
elasticity,
microcirculation, lymphatic drainage, and patient
satisfaction. Findings indicate that noninvasive CO₂
modalities
—
such as gel formulations, masks, and
device-assisted
transdermal
delivery
—
produce
significant clinical improvements, particularly in the
periorbital area and regions with compromised turgor,
while maintaining a high safety profile and requiring no
recovery time. A comparative review with alternative
approaches (PRP, fractional CO₂ laser, IPL) highlights the
superior tolerability and multifunctional benefits of
noninvasive carboxytherapy, especially for patients with
sensitive or thin skin. Limitations of the current evidence
base are also identified: variability in treatment
protocols, short observation periods, and the lack of
standardized efficacy scales. The necessity for
methodological standardization and an increase in
randomized controlled trials is substantiated. This article
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The American Journal of Medical Sciences and Pharmaceutical Research
will be of value to specialists in aesthetic medicine,
clinical dermatologists, skin physiology researchers, and
developers of personalized, multitargeted skincare
regimens.
Keywords:
non-injection carboxytherapy, problematic
skin, transdermal delivery, CO₂ gels, periorbital area,
striae,
hyperpigmentation,
microcirculation,
physiological skincare, aesthetic dermatology.
Introduction
Contemporary cosmetology
—
both within countries
boasting established dermatological care systems and in
private aesthetic medicine settings across the post-
Soviet region
—
is undergoing a significant shift driven by
a reappraisal of the balance between efficacy and
invasiveness of treatments. Increasing prevalence of
skin
sensitivity,
heightened
susceptibility
to
inflammatory reactions, and chronic dermatoses across
all age groups have prompted a move toward
physiologically gentle techniques. In this context,
interest is growing in non-injection carboxytherapy: a
modality relying on localized application of carbon
dioxide to enhance microcirculation, tissue oxygenation,
and regenerative processes without compromising skin
integrity.
Particular attention in both research and practice has
focused on transdermal CO₂ therapies—
gel applications,
masks, and device-based methods
—
that facilitate gas
exchange with the skin via pressure gradients and
physicochemical reactions at the epidermal surface.
Clinical interest in these approaches is exemplified by
multi-stage care protocols for acne, post-acne sequelae,
and chronic skin hypoxia. Because they avoid breaching
the skin barrier, non-injection carboxytherapy becomes
the method of choice when invasive procedures are
contraindicated or impractical.
These techniques establish a distinct skincare paradigm
aimed at stimulating the skin’s innate physiological
mechanisms without needles
—
an imperative given
today’s rigorous demands
for safety, patient
compliance, and minimized recovery time. Unlike
injectable carboxytherapy
—
traditionally employed for
contouring local fat deposits or treating periorbital
wrinkles
—
non-injection carboxytherapy is positioned as
a versatile maintenance tool suitable for routine use.
The aim of this study is to analyze the physiological
effects, clinical outcomes, and applications of non-
injection carboxytherapy in the management of
problematic and sensitive skin; to substantiate its
efficacy
within
comprehensive
dermocosmetic
restoration protocols; and to identify directions for
future
research
in
non-
invasive
CO₂–
based
methodologies.
Materials and Methods
The methodological framework of this study is situated
at the crossroads of clinical dermatology, aesthetic
medicine, and physiological cosmetology, reflecting the
interdisciplinary nature of analyzing non-injection
carboxytherapy’s efficacy in correcting aesthetic skin
imperfections. The principal analytical tool is a
qualitative content analysis of both scientific and
applied literature addressing the mechanisms of
transdermal CO₂ action, its effects on skin condition, and
its incorporation into non-invasive skincare regimens.
Our review draws on sources encompassing clinical
overviews and applied studies of skin hydration,
elasticity, vascular and pigmentary disorders, textural
changes, and cellulite. Particular emphasis is placed on
the work of Kołodziejczak [1], which reports changes in
hydration and viscoelasticity of the lower‐eyelid skin
following CO
₂ monotherapy and combined CO₂–
acid
treatments, and on Kołodziejczak and Rotsztejn [2], who
demonstrate carboxytherapy’s impact on the vascular
and pigmentary components of periorbital dark circles.
We also consider systematic reviews by Martignago et
al. [3], Kroumpouzos [4], and Zelenkova [5], which
synthesize clinical outcomes of CO₂ application for
striae, cellulite, and age-related skin changes.
Separate attention is given to Bagherani’s reviews [6,
10], which establish the therapeutic relevance of CO₂
interventions across various dermatological conditions,
and to Peixoto [7], who examines carboxytherapy’s role
in acne-scar management. The publications by Qoreishi
[8] and Kumar [9] are analyzed for their insights into
positioning CO₂ modalities within e
merging non-invasive
and minimally invasive skin-rejuvenation strategies,
with a focus on the interface between aesthetic
correction and dermatological care.
Thus, our methodological strategy relies on a
comparative analysis of theoretical models, clinical data,
visual-instrumental metrics, and safety parameters used
to evaluate carboxytherapy’s effectiveness. This
integrative approach has revealed a solid rationale for
viewing
non-
injection
CO₂
treatments
as
an
independent
modality
for
managing
vascular,
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pigmentary, and structural skin disturbances.
Results
Analysis
of
current
data
on
non-injection
carboxytherapy reveals consistent physiological and
visually measurable skin improvements in response to
superficial carbon dioxide exposure. Use of gel masks,
transdermal applications, and device-
assisted CO₂
delivery triggers a cascade of reactions affecting the
microcirculation, superficial capillaries, and epidermal
structures without breaching skin integrity.
One of the most reproducible findings, reported by
Kołodziejczak [1], is increased hydration and elasticity in
the periorbital region. Both patient-reported outcomes
and high-elasticity measurements confirm this effect. In
the study by A. Kołodziejczak and H. Rotsztejn [2],
combined gel formulations conta
ining CO₂ and acidic
components significantly reduced under-eye dark
circles, correlating with regression of vascular and
pigmentary factors. In both protocols, gas diffusion
through the stratum corneum
—
rather than needle
penetration
—
mediated the change.
According to the review by Zelenkova [5], transdermal
CO₂ therapies produce capillary dilation, improved local
tissue nutrition, and increased dermal density, effects
that are most pronounced with repeated treatment
courses. Ultrasound and dermatoscopic imaging confirm
these structural shifts. Kroumpouzos [4] similarly
highlights enhanced tissue respiration and stimulated
lymphatic drainage, especially in chronically hypoxic skin
zones. Bagherani’s overview [6] further synthesizes the
dermatophysiological
mechanisms
and
clinical
manifestations of these non-
invasive CO₂ interventions.
All examined studies report durable positive outcomes:
increased turgor, more even skin tone, reduced
puffiness, and normalized capillary blood flow.
Assessment
methods
include
corneometry,
dermatoscopy, visual analog scales (VAS), and expert
photographic analysis. These findings substantiate CO₂’s
effectiveness within a physiologically compatible
framework and minimal risk of adverse reactions. A
detailed comparative summary of application methods,
treatment zones, characteristic effects, and their
verification techniques is provided in Table 1.
Table 1
–
Observed Physiological Skin Responses to Non-Invasive Carboxytherapy (Compiled by the
author based on sources: [1], [4], [5])
Application Method
Observed Effect
Clinical Area
Assessment Modality
Gel-
based CO₂ mask
Improved hydration and
skin elasticity
Periorbital region
Corneometry,
viscoelasticity meter
CO₂ with acid peel mask
Reduction in pigment
and vascular dark circles
Infraorbital zone
VAS, colorimetric
imaging
Topical CO₂ gel
Enhanced
microcirculation and skin
density
Cheeks, thighs
Ultrasound imaging,
dermatoscopy
Transdermal device
delivery
Stimulation of tissue
oxygenation and
lymphatic flow
Hypoxic dermal areas
Clinical observation, skin
thermometry
CO₂
-enriched gel
protocols
General dermal
revitalization and tone
unification
Face, neck
Expert panel, visual
scoring
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The data presented in Table 1 confirm that transdermal
CO₂ application can
induce targeted, predictable
changes in skin physiology comparable in direction to
those achieved by invasive techniques, while offering a
markedly higher safety and tolerability profile.
An examination of current evidence on non-injection
carboxytherapy highlights consistent physiological and
visually measurable improvements in skin parameters
following superficial CO₂ application. Gel masks,
transdermal patches, and devices delivering controlled
CO₂ stimulate a cascade of responses—
enhancing
microcirculation, dilating superficial capillaries, and
reinforcing
epidermal
structures
—
without
compromising skin integrity.
Martignago [3]’s systematic review documents
significant improvements in areas with pronounced
lipodystrophy
—
particularly the thighs, buttocks, and
abdomen
—after regular use of CO₂
-enriched masks.
Patients experienced a reduction in subcutaneous
unevenness and an improvement in skin texture,
corroborated by both clinical assessments and
standardized visual scales.
Zelenkova [5] demonstrates that
transdermal CO₂
therapy serves as an effective physiological treatment
for chronically hypoxic or microvascular-impaired skin,
especially in age-related and stress-associated
dermatology. Protocols targeting the cheeks, chin, and
neck yielded durable gains in capillary blood flow and
restoration of the epidermal barrier.
Bagherani [6] synthesizes data showing that non-
invasive CO₂ can be adapted across diverse
dermatological applications
—
from soothing sensitive
skin to enhancing recovery following aggressive
procedures
—
underscoring
its
versatility
within
comprehensive aesthetic rehabilitation programs.
The periorbital area
—
particularly prone to adverse
reactions from invasive treatments
—
also responds well
to non-
injection CO₂. Kołodziejczak [1], in collabora
tion
with Rotsztejn [2], reports that CO₂ masks and topical
applications reduce dark circles, puffiness, and
hyperpigmentation
by
locally
enhancing
microcirculation and lymphatic drainage. This effect is
especially valuable in patients with thin, inflammation-
prone skin.
Kroumpouzos [4] emphasizes the method’s clinical
importance for hypersensitive skin, where other
interventions may provoke flare-ups or exceed the
patient’s tolerance threshold. In such cases, CO₂
formulations function both to beautify and to reinforce
the skin’s barrier.
The collective data allow us to identify representative
clinical indications, target areas, and expected
outcomes, as summarized in Table 2.
Table 2
–
Target Indications for Non-Invasive
CO₂
-Based Therapies in Aesthetic Dermatology (Compiled by the
author based on sources: [1], [3], [5], [6])
Indication
Skin Area
Preferred Formulation
or Technique
Clinical Outcome
Reported
Striae distensae
Abdomen, thighs, hips
O₂ gel mask
Improved skin texture
and elasticity
Cellulite
Buttocks, posterior
thighs
Topical CO₂ + massage
Reduced dimpling,
smoother skin surface
Infraorbital
hyperpigmentation
Periorbital zone
CO₂ mask with acids
Brightening, reduced
puffiness and darkness
Age-related dullness
Cheeks, jawline, neck
Topical CO₂
formulations
Enhanced vascular
tone, skin revitalization
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Sensitive skin
management
Face, especially
reactive areas
Mild CO₂ creams/masks
Restored barrier
function, reduced
sensitivity
Multitarget skin fatigue
Face and neck
Combined CO₂
protocols
General dermal
recovery and improved
tone
Table 2 presents clinically relevant indications and
treatment zones for non-invasive carboxytherapy. The
synthesized evidence confirms its broad applicability,
excellent tolerability, and efficacy across skin types and
ages, supporting its role as the foundation of
individualized aesthetic correction protocols in
dermatocosmetic practice.
Discussion
Contemporary problematic-skin care increasingly relies
on modular protocols in which each intervention is
selected according to the predominant clinical
component
—
whether vascular, pigmentary, or textural.
Within this framework, non-injection carboxytherapy
has established itself as a physiologically rational and
safe modality, capable of both complementing
—
and in
certain cases replacing
—
more aggressive procedures.
A review of systematic studies and clinical reports
highlights significant advantages of transdermal CO₂
delivery compared with invasive and device-based
alternatives.
For
example,
Kroumpouzos
[4]
demonstrated that CO₂
-enriched masks achieve
pigmentary correction in the lower eyelid region on par
with plasmapheresis, while offering markedly superior
tolerability. Participants reported minimal discomfort
and zero post-procedural complications, making the
method particularly appealing for sensitive-skin
patients.
Summarizing data from Zelenkova’s
review [5], non-
injection CO₂ applications consistently alleviate vascular
congestion, stimulate capillary blood flow, and support
regenerative processes. Although dermal remodeling via
transdermal CO₂ does not match the level achieved by
fractional CO₂ l
aser, it boasts a far more favorable safety
profile, a lower likelihood of adverse reactions, and no
downtime.
Indications encompass the periorbital area and
chronically hypoxic regions. Kołodziejczak and Rotsztejn
[2] showed that CO₂
-plus-acid gel masks effectively
reduce both vascular and pigmentary components of
dark circles, diminishing puffiness and enhancing local
drainage. These outcomes are corroborated by both
clinical assessment and visual-instrumental metrics. In
his systematic overview, Bagherani [6] underscores non-
invasive carboxytherapy’s efficacy in treating striae and
early-stage cellulite; regular gel-based applications
promote skin tightening and diminish lipodystrophic
unevenness.
Although some sources (e.g., Peixoto [7] and Kumar [9])
discuss injectable carboxytherapy results, such
approaches fall outside the scope of this analysis, which
focuses exclusively on transdermal protocols.
The standardization of procedures remains a critical
challenge. At present, protocols differ in exposure time,
product composition, application technique, and
treatment frequency, making it difficult to compare
outcomes. Moreover, most studies report only short-
term effects, while data on the durability of results
without maintenance sessions (beyond six months)
remain fragmentary [6].
The adoption of unified efficacy scales
—
incorporating
both
subjective
and
instrumental
measures
(corneometry, VAS, photometric verification)
—
would
enhance the reliability of comparisons across methods.
Table 3 presents a comparative overview of the
therapeutic
effectiveness
of
non-invasive
carboxytherapy versus alternative aesthetic skin-
correction techniques.
Table 3
–
Comparison of the Effectiveness of Non-Invasive Carboxytherapy and Alternative Methods in the
Treatment of Acne Scars and Striae (Compiled by the author based on sources: [2], [4], [5], [6], [7])
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Method
Target Condition
Effectiveness
Side Effects
Carboxytherapy (non-
invasive)
Striae, vascular dark
circles, lipodystrophy
Moderate to high
Minimal (transient
erythema, warmth)
PRP
Post-acne
pigmentation, scars
Moderate
Erythema, bruising
Fractional CO₂ laser
Deep scars, wrinkles
High
Hyperpigmentation,
prolonged redness
IPL
Vascular lesions,
photodamage
Moderate
Temporary swelling,
burning sensation
As shown in Table 3, non-injection carboxytherapy
consistently delivers a high tolerability profile alongside
moderate-to-high clinical efficacy, especially in sensitive
and low-tolerance areas. Although its dermal
remodeling effect is somewhat less pronounced than
that of laser-based methods, it retains a crucial role
within comprehensive treatment protocols for patients
seeking a physiologically gentle yet effective therapy
without prolonged downtime.
Future research should focus on: Validation of unified,
skin-type- and area-specific protocols; Expansion of
long-
term outcome data; Integration of CO₂
-based
protocols into standard multifaceted correction
regimens
Conclusion
This study has systematically organized and synthesized
current scientific evidence on the use of non-injection
carboxytherapy within comprehensive care programs
for problematic skin. The literature review indicates
consistent clinical efficacy of this modality across a range
of aesthetic and dermatological concerns
—
post-
inflammatory
pigmentation,
striae,
vascular
irregularities, localized lipodystrophy, and pronounced
signs of skin hypoxia.
Compared with other non-invasive approaches
(fractional laser, IPL, PRP), transdermal carboxytherapy
offers a superior balance of efficacy and safety,
particularly when administered in courses or combined
with acid peels and supportive skincare. Its
mechanism
—
local hypercapnia, vasodilation, and
fibroblast metabolic stimulation
—
confers unique value
in gentle yet enduring strategies for skin-structure
restoration.
Our comparative analysis clarifies the specific niche for
non-
injection CO₂ therapy in aesthetic correction. The
most pronounced and reproducible benefits appear in
the lower-eyelid area (brightening and oedema
reduction), in striae management, and in early cellulite
protocols. In these contexts, improvements in
microcirculation, lymphatic drainage, and collagen
synthesis are most evident, with both instrumental
measures and patient-reported outcomes reflecting
high satisfaction.
Nevertheless, the review uncovered significant
methodological limitations in existing protocols. The
lack of standardized parameters
—
exposure times,
treatment frequency, formulations
—
and the paucity of
long-term follow-up impede the development of
predictive outcome models. On average, achieved
effects persist for 5
–
6 months, but data on extended
maintenance regimens remain sparse.
Overall, non-injection carboxytherapy
—
grounded in
physiological rationale and supported by clinical
evidence
—
emerges as a promising component of multi-
layered care for sensitive and problematic skin. Our
theoretical conclusions underscore the need for
empirical studies prioritizing protocol standardization,
patient stratification by skin condition, and integration
of objective assessment methods into future clinical trial
designs.
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