The day before yesterday I was visited by a beautiful Mexican American girl. A few weeks earlier she had placement of tear trough implants to improve the purple bags under her eyes. The bags were gone but the purple discoloration persisted. She wanted Carboxytherapy. I was reluctant to treat her when she had not yet healed from her recent surgery. The presence of a foreign body increases susceptibility to infection and the recent placement of her implants made me fear that I could adversely change the location.

Some patients have impaired healing. Although bacterial infection is almost unheard of I am reluctant to treat patients who have cellulitis, dermatitis and dermatoses in the area to be treated. Similarly, patients with uncontrolled Diabetes Mellitus, immunosupression or immunosuppressant drugs, renal failure, dialysis, chemotherapy and active malignancies are in a catabolic state and may not heal normally.

Anticoagulation, platelet disorders, hemophilia, Von Willebrand.s disorder and clotting disorders can cause difficulty with bleeding.

Patients with chronic obstructive lung disease, CO2 retention, sleep apnea and cor pulmonale may acutely worsen with the administration of carbon dioxide. Congenital heart disease, congestive heart disease and restrictive pulmonary disease can impair circulation and oxygenation.

Collagen Vascular diseases can impair healing.

Patients with facial Rosacea have abnormally increased local circulation and impaired transdermal fluid loss. Patients with facial telangiectasias also have abnormally increased circulation. Patients with Poikiloderma of Civatte and patients with vascular red necks and faces have abnormally increased vascularity. All of these patients may worsen with Carboxytherapy of the affected areas.

It is important as a physician to do no harm and to help our patients. Knowledge of contraindications to treatment can enable us to help our patient and avoid harming them.

Michelle Zaniewski-Singh MD FACP FACE CMES FASLMS