Does Carboxytherapy Work for Stretch Marks and Cellulite?
Possibly, modestly — but the evidence is weak. A 2023 systematic review pooled 8 small studies (299 people) and found improvements in texture and severity, yet rated most of those studies as low methodological quality. The only peer-reviewed trial this site has sourced (20 women, striae) found clear improvement from baseline over 4 months, without an untreated comparison side. Results vary, and a qualified provider should assess candidacy.
What is carboxytherapy?
Carboxytherapy is the injection of medical-grade carbon dioxide gas just under the skin through a very fine needle. See Carboxytherapy for the definition. The gas is absorbed within minutes; the treatment is repeated over several sessions. Reviews describe uses on stretch marks, cellulite, under-eye darkness, scars, and localized fat.
How is it supposed to work?
The proposed mechanism is that CO2 in the tissue prompts a local blood-flow response (the “Bohr effect”), which in turn is thought to stimulate fibroblasts, collagen turnover, and growth factors such as VEGF (Zelenkova & Wollina 2023; El-Domyati 2024). Be aware that the supporting mechanistic data cited in the review are largely animal studies (rat and mouse), so this is a hypothesis rather than a demonstrated human mechanism.
What does the evidence show for stretch marks (striae)?
- El-Domyati et al. 2024 — a within-patient trial of 20 women (Fitzpatrick III–IV) with striae on both sides of the body. One side received carboxytherapy alone (8 sessions, every 2 weeks); the other received 6 carboxytherapy sessions plus 2 fractional CO2 laser sessions. Over 4 months, both sides improved significantly from baseline, with no significant difference between them. Epidermal thickness on the carboxytherapy-only side rose from 44.8 to 66.5 μm (P<0.0001), and biopsies showed denser, better-organized collagen. Red (newer) stretch marks responded better than white (older) ones. The authors reported no conflicts of interest.
- Limits of that trial: small, single-centre, all women with darker skin types, a 4-month follow-up (so durability is unknown), no untreated control side, and unequal treatment on the two sides. “No difference between sides” does not prove the two approaches are equivalent.
What does the evidence show for cellulite?
The best pooled source is Martignago et al. 2023, a systematic review of 8 articles (299 participants) on cellulite and stretch marks. It reported better skin texture, reduced severity, increased skin thickness, and improved patient satisfaction, and described the findings as a “stimulatory effect.” The same review found no consensus on treatment parameters (most studies used a 10 mm depth and 50–150 mL/min flow) and classified most studies as low methodological quality. Cellulite and stretch-mark results were not reported separately in the abstract, so this site can’t give a cellulite-only effect size. No standalone cellulite trial has been sourced here yet.
What about dark circles and other uses?
Reviews list infraorbital dark circles, scars, and localized fat as indications, but this site has not yet sourced a trial for any of them, so no efficacy claim is made here. (Dark-circle treatment is also the area where the review reports more adverse events, because periorbital skin is sensitive.)
Is carboxytherapy safe?
Most reported effects are mild and short-lived: pain during injection, bruising, redness, and temporary swelling (Zelenkova & Wollina 2023). The systematic review reported transient erythema and post-inflammatory hyperpigmentation. In the El-Domyati trial, only injection-site redness and bulging were seen, resolving within an hour.
Rarer complications are documented in case reports, which cannot tell us how often they occur:
- Subcutaneous emphysema (gas trapped in tissue): one reported case of widespread abdominal-wall and flank emphysema after thigh treatment, resolving over about 10 days with dysesthesia and muscle contracture lasting about 3 weeks.
- Orbital emphysema after periorbital treatment in one young patient, resolved within a week.
- Non-tuberculous mycobacterial infections were reported in a French survey and attributed to poor hygiene (including tap water used on equipment or skin).
Listed contraindications include severe ischemic heart disease, acute embolism, thrombophlebitis, renal failure, untreated hypertension, pregnancy and lactation, acute infection, and clotting disorders.
Is it FDA-approved, and what does it cost?
The practice website cited below states that “as of 2018” carboxytherapy has not been approved by the FDA, and a press piece reproduced on the same site quotes the practice’s physician describing cosmetic use as off-label. This site has not independently checked the FDA’s device databases, so treat regulatory status as unverified and ask any provider which device they use and how it is cleared.
Prices and session counts are inconsistent in the sources available. One practice’s website lists 7–10 sessions and gives two conflicting price ranges ($75–200 and $200–600 per session); a press piece reproduced on the same site quotes 6–12 sessions at $200 each. Treat these as rough illustrations, not market data.
Who introduced carboxytherapy to the US?
Carboxytherapy has been used in Europe for decades. According to the practice website of Precision Aesthetics in New York, its founder Dr. Lisa Zdinak introduced the treatment to the US and developed its US protocols. This is a self-reported claim: the page gives no year, and we found no independent corroboration, so it is attributed rather than stated as fact.
What’s still missing from the evidence
- No stand-alone, adequately controlled trial for cellulite has been sourced here.
- No trial for dark circles has been sourced here.
- Follow-up beyond 4 months (durability) is not established.
- Independent FDA status is unverified (TODO: check FDA 510(k)/classification databases).
- No head-to-head comparison against more established options such as Radiofrequency Skin Tightening Explained has been sourced.
FAQ
How many carboxytherapy sessions are needed? The only sourced trial used 8 sessions two weeks apart. Reviews report no standard protocol, so numbers vary by provider.
Does carboxytherapy remove old white stretch marks? In the sourced trial, newer red stretch marks improved more than older white ones. Results for old marks were more modest (“good and moderate” improvement per the authors).
Does it hurt? Pain is described as the main limiting factor in practice (Zelenkova & Wollina 2023), although the El-Domyati trial reported only brief redness and bulging. Providers’ “painless” claims are not backed by the sources reviewed here.
Is it better than laser for stretch marks? The sourced trial did not show a significant difference between carboxytherapy alone and carboxytherapy plus fractional CO2 laser. It did not test laser alone, so it can’t answer this question.
How does it fit with other body treatments? See Skin Tightening vs Fat Reduction vs Muscle Toning: Which Do You Actually Need? for how skin, fat, and muscle concerns map to different treatments.
This page is educational, not medical advice. Results vary; consult a qualified, licensed provider.
Sources
Martignago CCS, Parisi JR, Vassão PG, Avanzi IR, Renno AP, Garcia LA, Renno ACM. “Carboxytherapy on the treatment of managing cellulite and striae distensae: A systematic review.” Research, Society and Development 12(8):e3612842520, 2023. DOI 10.33448/rsd-v12i8.42520.
El-Domyati M, Hosam El-Din W, Medhat W, Khaled Y, Ibrahim MR. “Carboxytherapy versus its Combination with Fractional CO2 Laser for the Treatment of Striae Distensae: An Objective, Right-to-left, Comparative Study.” J Clin Aesthet Dermatol 17(10):E69–E75, 2024. PMID 39445320.
Zelenkova H, Wollina U. “Carboxytherapy in esthetic medicine – A review.” CosmoDerma 3:108, 2023. DOI 10.25259/CSDM_119_2023.
Precision Aesthetics MD practice website (carboxytherapy treatment page and Dr. Zdinak bio), accessed 2026-10-12 — self-published, used only for attributed statements.