Localized fat protocol

Principle
Stimulate blood flow and activate receptors involved in the natural lipolysis of the body.

Indication
Any kind of localized fat or skin irregularity after liposuction. Also a complementary treatment to liposuction.

Protocol

• Subcutaneous layer
• 1 session per day to 1 per week
• Flow: 1–2 cc/kg/min (50–80 cc/min)
• Approximately 2 minutes per injection
• Punctures spaced 15–20 cm apart
• Number of sessions: 10–20

Progressive flow (automatic mode) available with some machines

Submentonian area: deep dermis (and/or subcutaneous)
Flow: 1–2 cc/kg/min (50–80 cc/min)
Approximately 30–60 seconds (until onset of erythema or pain)
Usually three punctures.

Technique
Pinch and pull the skin between thumb and index finger and inject the pinched skin in its subcutaneous layers.

Injection Points
Injection points should be made in the area where localized fat resides. There are variations between men and women.

Men: abdomen, lumbar area, chest, submentonian area
Women: hips, abdomen, thighs, buttocks, submentonian area, back

Endpoint
Subcutaneous injection will let the gas diffuse and create a 15–20 cm diameter disk. Skin has a granitelike
appearance and shows erythema. Move the needle 15–20 cm away from the previous injection point (no overlapping) to treat the entire fat area. Note that the 15–20 cm circle occurs only during the first sessions. After several sessions, typically five to six, the skin offers less resistance to the gas diffusion and one or two injection points may then be enough to treat all the cellulite area.

Post-treatment Care
None.

Pain Management
Pain can be reduced with a ‘piano’ massage during the injection. Pain is more frequent during the first sessions: CO2 flow can be reduced in the first sessions and progressively increased from session to session. If too much pain is reported, change the injection point and reduce the treatment time, giving more, shorter injections. Some CDT machines have a progressive flow mode, which starts the injection at a low flow and increases it progressively during the course of the injection.

Results
Most patients report improvement after six to eight sessions. Treatment is usually delivered for up to a maximum of 20 sessions.

Maximizing Results
CO2 procedures may benefit from combined treatments such as RF, Cellu-M6®, Velasmooth®, manual lymphatic drainage massage and so on. Some nutritional advice and the maintenance of a steady body weight are recommended.

Reinforcement Sessions
Patients are usually advised to renew the treatment at least once each year in order to maintain the effect.

Remarks
After liposuction, fat areas may be compartmentalized and this will require multiple punctures to be made, as the gas will not diffuse evenly. Ultrasound imaging with high frequency probes may help.