The aim of this study is to assess the efficacy and tolerability of carboxytherapy in the cosmetic correction of dark circles. Carboxytherapy is a cosmetic technique based on the subcutaneous injection of carbon dioxide that improves the quality and elasticity of the dermis by increasing the oxygen release to the tissue through an enhancement of the Bohr effect. A prospective clinical trial was conducted on 35 patients requesting the correction of dark cicles. Our protocol was based on weekly treatment sessions and lasted 3 weeks. Each treatment session was based on the bilateral injections of the tear-through defect. Pre- ∖treatment photographs and 6-month post-procedural follow-up photographs were examined and analysed through a face objective assessment scale. All 35 patients were treated. The average scores showed a significant reduction of the skin discoloration without major side effects (p < 0.00001). This study proves that it is possible to carry out multiple injections during the same session to increase the application time of the carbon dioxide and to decrease the number of sessions. These results allowed us to validate a 3-sessions injection protocol to increase the patient compliance.
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