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Entries by Sabine Zenker, MD (4)


Carboxytherapy- the CDT Evolution System

After performing Carbon Dioxide Therapy CDT for a long time with different technologies, I discovered that there are huge technology-dependent differences in the treatment itself. Since I tried out a new machine recently, I wanted to share my thoughts on one of them here.

Carboxytherapy is a treatment that takes its origins from 'spa medicine' in the 1920s. In 1932 injections of medical CO2 were put into practice and the studies demonstrated a good effect on patients suffering from arterial problems. Collateral signs of improving cutaneous aspects during the treatment encouraged the University of Siena, Faculty of Medicine to develop specific research. It has been possible to verify Carboxytherapy effectiveness in subcutaneous application with an adequate methodology and medical system for the improvement of local blood flow, the reduction of local adiposity, the increase of the dermis thickness, elasticity and quality as well as the reduction of skin irregularities (such as associated with liposuction and other body contouring techniques).

Carbon Dioxide Therapy (CDT) consists of injection into the sub-cutaneous tissue of medical carbonic CO2 with a small 30 G needle. The CO2 injection system with a needle linked to a tube is single use and the gas is medical and sterile. Even thought this method does not need any anaesthesia and is minimally invasive, the treatment must be realized by a medical practitioner who can follow up the patient. The treatment is secure and non– toxic. CO2 is naturally produced by cells as a by-product of metabolism. It is transported in the blood and exhaled through the lungs.  (Medical CO2 gas is used for laparoscopy surgical procedures.) Using a certified medical systems (such as CDT Evolution) there are no risks of air embolism, even if the CO2 gas is injected directly into a blood vessel.

The technology I worked with most recently is the CDT Evolution system (Carbossitherapia), an Italian system approved in the European Union (Law 93/42 CE0051 classeIIb). It is equipped with a mechanism pain control for the most sensitive patients who sometimes feel an annoying sensation during the injection of CO2 in the tissues. This pain control is what amazes me and my patients very much comparing this system to others: I can concentrate on my work rather than on pain management...

Read more about the CDT Evolution System here:


Question: Calcium Hydroxylapatite For Collagen Stimulation - Which technique is best? 

What Calcium Hydroxylapatite injection technique is best for collagen stimulation?

It is well known, that CaHA stimulates collagen production. Which is the best-in-class injection technique to maximize the desired effect and ho much risk should you take?

Mesotherapy with CaHA? Linear threading with blunt tip Cannulas after having effected subcision?


I Want To Be A Fibroblast!

medical spa md fibroblastWhat criteria is most important when choosing a treatment or technology to stimulate fibroblasts for skin rejuvenation?

Being a dermatologist focused on aesthetic treatment options for improving skin's condition  it's quality and overall appearance I clinically and scientifically overlook tons of different approaches.

Basically, and I think we can agree on this, many treatments try to target the fibroblast. Its about the stimulation of this branched tissue cell who's function is to maintain the structural integrity of connective tissues by continously secreting precursors of the extracellular matrix such as ground substance, a variety of fibers notably the reticular and elastic ones and cytokines.

The goal in many skin rejuvenation treatments is to activate and stimulate the fibroblasts... and there are countless strategies to do this: You might choose chemical peels, energy based devices such as non-fractionated or fractionated resurfacing lasers, intense pulsed light (IPL), infrared light or radiofrequency. One might think of dermal filler substances such as hyaluronic acid or – better – calciumhydroxylapatite (there are even publications on a stimulating effect botulinum toxin type a...). Further one might consider microneedling, dermabrasion, etc..

Or think about "newer" technologies such as platelet rich plasma, carboxytherapy, nitrogen plasma energy, kinetic HA (kinetic Hyaluronic Acid). And last but not least cosmeceuticals (this list is not exhaustive!!).

Which strategy to choose? It's actually very difficult to find way through this jungle!

I would like to encourage and activate the discussion here and ask for your opinion: What are the most important criteria for you when you do your choice? Is it about mangeability, about downtime, about scientific proof, about safety, about treatment protocols (such as e.g. multiple treatments), about clinical experience of other physicians, about availability, about the learning curve, about the deligability, about the costs?

What's your decision maker here?


Peeling Melasma

Treating melasma is one of the most challenging indications in aesthetic dermatology.

In my hands and over the years, chemical peels in combination with bleaching agents still work the best. Most recently, very interesting and promising new bleaching cosmeceuticals are coming up, matching both, efficacy and safety compared to the gold standard substances such as low dose hydroquinone and or kojic acid.

Anyhow, I do strongly believe in the fact, that -for a therapeutic effect- we still need highly efficacious treatments to resolve and manage these hyperpigmentation conditions: Chemical Peels in combination with bleaching substances are a very potent way to treat melasma. It`s either about raising the concentration of the working agents or about performing multiple treatments.

Overall, the physician has to have a broad experience in combining those agents and secondly, the patient needs to be educated on following a life-long "skin-diet"-program.

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