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: http://www.carbossiterapia.it/prodotti.php

Is Technology Changing The Doctor-Patient Relationship (for the Worse)?

The first point of contact for a patient to ask post-surgical questions should be the surgeon who performed said surgery. The trend seems to be in exactly the opposite direction.

I've noticed a concerning trend. I participate in websites like RealSelf.com that connect plastic surgery patients and cosmetic surgeons. These sites are allowing patients to have near immediate access to expert plastic surgeons from across the nation and plastic surgeons to interact with potential patients.

In the past few months an increasing number of patients in the early post-operative period (some with dressings still in place!) have posed questions to “online surgeons” seemingly before seeking follow-up with the plastic surgeon who just performed the procedure. It is concerning that a patient would seek advice from a surgeon they do not have a doctor-patient relationship with and who is unfamiliar with the specifics of the surgery that they've recently undergone. Patients have even gone so far as to inquire about where to seek second opinions and whether revision surgery will be necessary all within the first post-operative week.

The early post-operative timing of this phenomenon is most concerning. This is the period in which we need to reassure our patients that bruising and swelling will resolve, dressings and sutures will be removed and that they truly will look great once they’ve healed. This period can cause patients significant distress and many require a lot of hand holding at this point.

We’re obviously failing some of our patients if they're reaching out online during this period instead of calling our offices and dropping in to be evaluated. I agree that second opinions are highly valuable and would not hesitate to arrange such for a concerned patient. However, a patient-initiated second opinion from an unfamiliar, online surgeon who has an incomplete picture of the patient's history is problematic at any time point let alone while the compression dressing is still in place!

What could possibly be responsible for this trend? As cosmetic surgeons are we so difficult to reach that our patients need to seek online advice from others? As we become more amenable to interacting with potential patients online are we failing to care for those who have already made a trip to our operating room? Is it simply easier for our patients to log onto a website rather than call the doctor's office? What can we do to direct those online inquires back to our own practices rather than into the digital ether?

As a Facial Plastic Surgery practice, my entire team is in the business of building relationships. If a patient has a professional, responsible and ethical plastic surgeon, the first point of contact to ask post-surgical questions should be the surgeon who performed said surgery. This trend seems about as far astray of that goal as one could imagine.

Has anybody else noticed this trend online? Have you experienced this with one of your own patients? What you have done to prevent this from happening in your practice? Please contribute your thoughts.