Cellulite refers to a change that gives the skin a wavy and irregular appearance, and it affects 80%–90% of women after puberty. Numerous treatments have been proposed such as balanced diet, physical activity, massage, topical products, radiofrequency, therapeutic ultrasound, and light emitting diode therapy, among others.1 Carbon dioxide (CO2) therapy, commonly known as carboxytherapy, refers to the administration of CO2 with therapeutic proposals. The technique originated in France in 1932, and originally the treatment was carried out percutaneously (through the skin) by the so-called heated carbonated water baths or the application of water-saturated CO2 directly to the skin of patients. The technique was used for arteriopathy and ulcer treatments.2,3 The results encouraged further studies, leading to the expansion of indications of new treatments. After the development of new technologies, the application was no longer topical and involved passing the CO2 to be
infused directly into the subcutaneous tissue, ensuring faster and better results. Sequential studies described the effectiveness of the carboxytherapy treatment of localized adiposities; demonstrated measurable reductions in circumference regions of the abdomen, thigh, and/or knee; and showed histological evidence of the effect of gas leakage, showing its possible lipolytic effects.3,4 Ferreira et al5 described the increase in collagen remodeling induced by intradermal injections of CO2. In another study, Abramo et al6 showed that after the controlled infusion of CO2, vasodilation of the microcirculation skin was observed, accompanied by an increase of peripheral blood flow and an increase in skin temperature at the injection site (on average 3.48°C). Cellulite affects, especially, the buttocks and thighs; its etiology is multifactorial and involves complex issues, and its treatment and evaluation require the use of new methodologies.7–11 The lipolysis caused by carboxytherapy seems to be caused by temperature increase and local blood flow and have been demonstrated in previous studies; however, clinical studies are still required, with good analysis techniques that prioritize their effects on cellulite.2–6 This study aimed to verify the effectiveness of controlled infusion of CO2 in the treatment of cellulite in gluteal and posterior thigh bilaterally.