Effect of Carbon Dioxide Facial Therapy on Skin Oxygenation

September 2015 | Volume 14 | Issue 9 | Original Article | 976 | Copyright © September 2015

Rachel Seidel BAa,c and Ronald Moy MD FAADb,c

aGeorgetown University School of Medicine, Washington, DC
bKeck School of Medicine of the University of Southern California, Los Angeles, CA
cMoy-Fincher-Chipps Dermatology, Beverly Hills, CA

BACKGROUND: Recently popularized in the field of cosmetic dermatology, subcutaneous carbon dioxide (CO2) injections have been shown to improve the skin’s appearance by augmenting oxygen delivery and thereby aiding cellular metabolism and neocollagenesis. However, they carry several risks and cannot be used on the entire face, leaving them best suited for the treatment of localized skin concerns. To combat these issues, a less invasive CO2 facial suited for full-face treatment has been developed, though its efficacy in oxygenating the skin has not been thoroughly investigated.
OBJECTIVE: The aim of this study was to evaluate the ability of the CO2 facial to oxygenate the skin.
METHODS AND MATERIALS: Twelve patients were enrolled in this split-face study. They were treated one week apart with a CO2 facial on one side of the face and particle-free microdermabrasion on the other. Measurements of transcutaneous oxygen tension (tcPO2) were recorded at baseline and after each treatment. Statistical significance was assessed by comparing the average tcPO2 difference in mmHg following microdermabrasion and after a carbon dioxide facial using a 1-tailed paired t-test (α = 0.05).
RESULTS: The average increase in tcPO2 after CO2 facial treatment was statistically significantly greater (p = .0252) than after microdermabrasion.
CONCLUSION: Carbon dioxide facials improve skin oxygenation immediately following treatment, attributable to the generation of an artificial Bohr effect.

J Drugs Dermatol. 2015;14(9):976-980.


Well known as a substrate in various metabolic and energy-dependent processes, oxygen (O2) is necessary for repair and regeneration of the skin.1,2 Consequently, in a society that increasingly equates youth with beauty, the role of O2 in skin care has received considerable attention. Oxygen-themed products and recently popularized oxygen facials claim to improve elasticity, diminish the appearance of fine lines and illuminate the skin. However, the stability of oxygenating compounds in topical products is questionable and their ability to penetrate the stratum corneum, as well as their general efficacy, has not been clinically proven.
Subcutaneous carbon dioxide (CO2) injections have become increasingly popular in the field of aesthetic medicine given their ability to promote oxygenation of the skin from the underlying microcirculation.3 Unlike the topical application of oxygenating compounds, this technique ensures unimpeded delivery of O2 to tissues by generating a Bohr effect that exchanges O2 with CO2 at the level of dermal capillaries. Microcirculatory changes owing to the transient delivery of CO2 improve skin perfusion and facilitate nutrient delivery and waste disposal.4 The ensuing supply of oxygen stimulates collagen production and accelerates cellular metabolism.3,5,6,7 For this reason, subcutaneous CO2 injections are often used to promote dermal regeneration and thereby reduce the appearance of fine lines, scars and hyperpigmentation.4,8
A novel facial treatment recently emerged that combines the science of carbon dioxide therapy with mechanical exfoliation. Unlike subcutaneous CO2 injections, the CO2 facial generates CO2 bubbles on the skin surface, which permeate the epidermis with minimal discomfort. To assess its ability to oxygenate the skin beyond what is expected following mechanical exfoliation, and thereby assess its ability to produce the Bohr effect, we performed a split-face study that compared changes in transcutaneous O2 tension (tcPO2) after CO2 facial treatment with those following a standard microdermabrasion procedure.


This was a single-center clinical trial performed on 12 self-selected healthy male and female patients ranging in age from 23 to 64. Patients gave informed consent of the format utilized by the Western Institutional Review board, which conforms to the ethical guidelines set forth in the 1975 Declaration of Helsinki. Standard Operating Procedures for Clinical Research in accordance with the appropriate Moy-Fincher-Chipps oversight committee and Good Clinical Practice was observed.