Carboxytherapy: What It Is, What the Evidence Says and the Spa Version

Carboxytherapy means using carbon dioxide on or under the skin to bring more blood to the area, and the evidence for it is small studies and audits for the injected version and thinner still for the surface version. Two different treatments share the name. One is a medical procedure in which a trained provider puts the gas under the skin. The other is a cosmetic “CO2 facial,” in which a mask or gel releases carbon dioxide at the surface. Know which one you are being offered before you pay for either.

Carboxytherapy: Two Treatments Sharing One Name

The medical version goes under the skin. One audit of cellulite treatment describes carbon dioxide “infused subcutaneously into the affected areas.” According to a 2025 review in the Journal of Clinical and Aesthetic Dermatology, the technique has been used for skin laxity, atrophic (sunken) scars, stretch marks and cellulite, and several studies describe benefits for dark circles under the eyes.

The cosmetic version stays on the surface. A gel or mask releases carbon dioxide at the skin, and the idea is the same: when tissue registers more carbon dioxide, the body sends more blood to it. The same review describes a gel made for “the transcutaneous release of carbon dioxide” and says it increases microcirculation, the flow of blood through the smallest vessels.

Marketing blurs the two, and it matters. A study of injected gas in thighs says nothing about a mask on a face, and a photograph from one is not evidence for the other. The surface version is the one on our own menu: our non-invasive CO2 carboxy facial is applied to the skin, not injected.

Injected vs Surface: The Two Versions Side by Side

The evidence and risk rows come from the sources in the next section.

What the Research Says

A 2022 review of carboxytherapy in dermatology describes it as a medical technique in which sterile carbon dioxide gas is injected into the tissue under the skin. It lists skin rejuvenation, atrophic scars, stretch marks, cellulite and certain types of hair loss as uses, and discusses drawbacks including inadvertent lipolysis, long-lasting emphysema and suboptimal outcomes.

For the injected version, the main data are small. A clinical audit of carbon dioxide therapy for cellulite in Aesthetic Plastic Surgery reported minor complications: pain at the injection site, a crackling feeling and aches that did not last more than 30 minutes, and bruising at the needle entry that cleared within 7 to 10 days. The audit compared measurements before and after a course of sessions, and it describes no comparison group, so it cannot rule out other explanations for the change.

Stretch marks show the same pattern. A 2020 network meta-analysis in the journal Medicine compared treatments for stretch marks across 14 randomized trials, this one among them. Its authors noted that participants and staff were unclearly blinded in most trials, that every included article reported positive results, which can point to publication bias, and that larger trials are needed. A fair reading: it may help some people, and nobody has proved how much or for how long.

For the surface version the evidence is thin. The 2025 review of a CO2 gel is a write-up of a roundtable discussion, a company paid for it, and one author is that company’s consultant. That does not make the idea wrong. It means the review is a lead, not independent proof. Our own page is plainer about the likely size of the effect: “Results are immediate but not permanent.” A short-lived glow is a realistic expectation, and a lasting change in structure is not.

Carboxytherapy Before and After: How to Read the Photos

Photographs are how most people judge these treatments, and they are easy to make flattering without lying. Check five things.

Lighting. Harsh light from above or the side throws shadows into every dimple and under the eyes, and soft, even light flattens them. A pair shot under different lamps can show a change that is only the lamp.

Time of day. Skin and swelling shift through the day. A morning “before” and an afternoon “after” are not a fair pair.

Swelling and flush. Right after a treatment, skin can be flushed or swollen. Our page says the flush from a CO2 facial fades within about an hour, so an “after” taken during it shows a flush, not a result. Ask how long after the session the photo was taken, and whether one exists from weeks later.

Makeup, tan and filters. Makeup, self-tanner, a new camera angle, a closer zoom or a beauty filter can each produce what looks like a result.

Who is in the photo. One striking pair is a best case. Ask for several, including people with your skin tone and your concern.

Who Should Ask a Doctor First

Injected carbon dioxide is a medical procedure, so whether it suits you is a question for the doctor offering it. The sources we read give no list of who should avoid it that we can vouch for, so ask the provider to name who should. The audit gives a rough yardstick: a crackling feeling and aches over within 30 minutes, bruising gone within 7 to 10 days. Pain beyond what you were told to expect, or anything getting worse instead of settling, is a reason to go back to the provider and see a doctor.

If cellulite, stretch marks, scars or dark circles are what bother you, a doctor or dermatologist can tell you which options exist for your skin, including any that need a prescription.

Questions to Ask Before Any Carboxytherapy or CO2 Facial

A good provider answers these without hurry. Vague answers are information too.

1. Is the gas injected or applied to the surface? The answer decides who should be doing it and what the risks are.
2. Who will do it, and what training do they have? Injections belong with a doctor or other trained medical provider.
3. What is it meant to change, and what is that based on? Ask them to name a study, not a brochure.
4. How many sessions, and what is the total cost? Ask for the whole course.
5. What will I feel, and what do I do if it burns? A sensation that is stronger than described should be reported at once.
6. What are the risks, and what recovery should I plan for? Compare the answer with the audit’s figures.
7. Do my health, medicines or pregnancy change the plan? Tell them everything before you start, not after.

Where a Spa Fits: A CO2 Facial for Tired Skin

If your skin is simply tired, a surface CO2 facial is a low-commitment thing to try. Our 60-minute CO2 facial at the District 1 spa costs 500,000 ₫. Its page says carbon dioxide is applied to the skin to bring oxygenated blood and circulation to the surface, with no downtime, and that most guests feel warmth and a light tingling or fizzing. It should never feel like burning; if it does, tell the aesthetician at once.

The page is equally clear about its limits. It does not extract, so for active acne choose Acne Care Treatment, which clears congestion first. It does not list cellulite, stretch marks or scars among what it helps with, so those stay with a doctor. Tell your aesthetician first if you are pregnant or have rosacea, highly reactive skin or any broken or irritated skin on the face; the treatment may then be adjusted or postponed.

Dullness often has an ordinary cause worth ruling out first; our article on why your skin looks dull goes through eight. For an event, our seven-day plan for glowing skin shows where a facial fits.

Lines and firmness call for a different technology. Collagen Boosting Therapy is microneedling with a stem-cell serum, 60 minutes for 1,200,000 ₫, and our CO2 page itself sends you there when you want lasting structural change. It is not a stronger version of the CO2 facial, and the two are not interchangeable. Our guide to boosting collagen in the face grades the evidence for each approach. Unsure which facial? Our guide to choosing a facial by concern sorts them, and the facial treatments menu in District 1 lists all twelve.

The Short Version

Ask which of the two treatments you are being sold. The injected one has small studies behind it, minor but real side effects and a place with a trained medical provider. The surface one is a gentle facial with thin evidence and a realistic promise of a short-lived glow. Read photos with lighting, hour and flush in mind, and take the questions above with you.

Frequently Asked Questions About CO2 Facials

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