Carboxy therapy for Dark Under-Eye Circles

Carboxytherapy is a non-surgical treatment, and refers to the administration of minute amounts of Carbon Dioxide gas just beneath the surface of the skin. It is a relatively painless, in-office procedure that takes 4-5 minutes with no residual downtime, used for the treatment of dark under-eye circles, cellulite, and stretch marks.

How does CARBOXY THERAPY work?

Carbon dioxide can increase blood flow, stimulate collagen production, reduce fatty prolapse in some cases (lipolytic effect).

Carbon dioxide is a natural constituent of our very being. We breathe in oxygen, and we exhale carbon dioxide. Plants take up the carbon dioxide, and in turn give us the oxygen that we need. Carbon Dioxide also happens to be the signal for poor blood circulation in the body. All cells in the body, regardless of their job (heart cells, brain cells, skin cells) release as their waste product carbon dioxide. Carbon dioxide is the “cost of doing business” of any cell in our bodies. So, we breathe in oxygen to our lungs, the red blood cells pick up the oxygen in our lungs and carry it to our tissues until they encounter an area that has been working hard and has an excess of carbon dioxide.

When the blood cells are exposed to high concentrations of carbon dioxide, they flip their conformation, release the oxygen molecules, and pick up the carbon dioxide so that we can exhale it from our lungs. In a sense, by injecting small amounts of carbon dioxide gas just below the surface of the skin, we are tricking it into increasing the blood circulation to that area.  Dark under-eye circles, cellulite, and stretch marks have all been shown to have some root cause in poor blood circulation.

What causes Dark Under eye Circles?

Dark under eye circles are difficult to conceal with makeup, and often make you appear tired, even when you’re fully rested. This problem is relatively common but it’s important to understand the origin of dark circles in order to develop a treatment plan.

Dark circles are typically caused by one of 3 factors, either alone or in combination.

1. Pigment deposition

The first possibility is that there is actual deposition of pigment into the skin of the lower eyelid. This pigment deposition is commonly due to post-traumatic hyperpigmentation, where the skin of the lower eyelids has been perpetually irritated, usually from chronic tearing due to allergies or dry eye.

Skin pigmentation is the easiest cause of dark under eye circles to treat because it responds well to a combination of carboxytherapy and home bleaching regimens. Do not use hydroquinones, the over-the counter bleaching agent, on delicate eyelid skin because in some individuals this can worsen the dark circles. Instead, prescribe a combination of kojic acid and arbutin to help reduce the hyperpigmentation. This gives patients a safe and gentle treatment product that they can use at home while the carboxytherapy sessions are performed in medical office.

2. Vascular pooling

The capillary network of the lower eyelids can become congested for a variety of reasons. Normally, the tears drain from the eyelids into the nose, but if there is some obstruction due to chronic nasal congestion from seasonal allergies or a nasal fracture, the drainage doesn’t function well, and the blood flow to the lower eyelids becomes sluggish, giving rise to the boggy blue tinge known casually as “allergic shiners.” The lack of appropriate oxygenation to the lower eyelid skin allows the bluish cast to show through the thin skin of the eyelids.

Carboxytherapy works to improve the capillary network of the lower eyelids, as well as to increase the dermal collagen layer in the lower eyelid skin. By injecting a small amount of carbon dioxide gas into the affected areas, blood flow is increased and improved capillary networks are formed for longer lasting circulatory benefit. The bluish cast is replaced with a healthy pink tone. Once a series of 4-6 sessions is completed, the skin has a more luminous appearance that lasts approximately 6 months.

3. Tear trough deformity

Depression beneath the lower eyelids called a tear trough deformity is a commonly inherited trait in the African American and Indian communities, but it can also develop in Caucasians over time due to the normal loss of bony architecture in the inferior orbital rim, which is the top of the cheekbone area. In the event that a tear trough deformity exists, a temporary filling agent can be placed in the valley to plump up the depression, which improves the appearance of the dark circles.

The treatment is not painful, and it is a one-time procedure performed called oculoplastic surgery. After this procedure the results last approximately 8 months to 1 year.

CARBOXYTHERAPY for Under eye Circles

Carboxytherapy can dramatically improve the appearance of dark under-eye circles.  Although sometimes caused by darkened pigment, or a hollow depression below the lower eyelids [tear trough deformity], the majority of dark under-eye circles are caused by poor circulation beneath the lower eyelids [vascular pooling]. The first study in English literature using carboxytherapy for rejuvenating the under- eye region found that by injecting a small amount of carbon dioxide gas just beneath the skin of the lower eyelid, circulation was increased and dark under-eye circles were markedly improved. The treatment takes only 5 minutes, and is virtually painless and risk-free. A series of 2-6 treatments spaced one week apart is all that is required to achieve a great result.


Dark circles require 4-6 punctures, 1 or 2 cm spaced, 1 or 2 seconds each, made all along the external inferior border of the eye orbit, next to the orbit bones (zygomatic bone). The free hand may be used to gently maintain the patient’s head in a position that avoids any unwanted movement.


One of the major CO2 side effects and complication is pertinent to the eyelid procedure. It is important to purge and remove any trace of oxygen/air in the tubes and needle.


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