INTRODUCTION

Ozone gas is composed of a molecule formed from three oxygen atoms (O3). Upon application, it improves tissue oxygenation, enhancing immune system function and proving effective in treating various pathologies. Ozone therapy is considered a complementary treatment that involves administering ozone to the human body, as it is considered a potent anti-inflammatory and highly effective in combating microorganisms, offering direct microbial action against viruses, bacteria, and fungi ⁽¹⁾.

In this context, the therapeutic efficacy of ozone became evident worldwide long ago, but its use in aesthetic treatments only began in 2000. At that time, studies and applications demonstrated that this gas activated blood circulation, oxygenated tissues, and stimulated red blood cell activity, thus making it possible to treat aesthetic dysfunctions such as localized fat, cellulite, sagging skin, stretch marks, acne, hyperpigmentation, and wrinkles. These dysfunctions are caused by poor oxygenation and peripheral circulation, inflammation, and toxin accumulation ^(1,2,3).

Body image refers not only to physical form; it encompasses both extrinsic and intrinsic factors through which a person experiences and conceptualizes their own body. The body image industry, through the media, awakens in people the desire to achieve a certain appearance. In this sense, health is not limited to the absence of disease. Health is associated with means and situations that enhance an individual's quality of life, capacity for autonomy, and overall well-being ⁽⁴⁾.

The benefits of high self-esteem bring physical and mental well-being and contribute to better relationships within the family and society, especially in the workplace, as it fosters a feeling of satisfaction with oneself and others. It is important to emphasize that aesthetics is not limited solely to procedures and techniques, but rather as a form of assistance to the individual that provides them with quality of life and self-esteem, helping to empower their beauty and well-being ⁽⁵⁾.

In this context, in recent years, due to these mechanisms of action, ozone therapy has also been used in aesthetic clinics, becoming a powerful ally in the treatment of various aesthetic conditions such as localized fat, cellulite, sagging skin, varicose veins, stretch marks, dark circles, acne, hyperchromia, hair loss, baldness, and facial rejuvenation. This demonstrates its significant potential for broad-spectrum clinical use ^(6,7,1).

The most common methods of ozone therapy are topical application with ozonated water and oil, plastic bags, or subcutaneous, joint, and muscle injections. Treatment requires a medical ozone generator, syringes, needles, aseptic equipment, and a bag. Due to its low investment in materials, ease of application, and excellent results, ozone therapy has become a powerful ally in combating aesthetic dysfunctions in general ^(2,6,1).

According to Antunes⁽¹⁾, the Brazilian Association of Ozone Therapy (ABOZ) argues that the application of Ozone Therapy in Brazilian aesthetic clinics is already regulated by Resolution No. 320/2020 of the Biomedicine Council⁽⁸⁾; Resolution No. 166/2015 of the Federal Council of Dentistry⁽⁹⁾; by the Nursing Council through Resolution No. 739/2024⁽¹⁰⁾, and the Federal Council of Pharmacy, by Resolution No. 685/2020⁽¹¹⁾. It should be noted that Ozone Therapy also became part of the National Policy for Integrative and Complementary Practices of the Unified Health System (PNPIC-SUS), by Ministry of Health Ordinance No. 702/2018, and later updated by Ordinance No. 1,988/2018⁽¹²⁾.

There are several ozone therapy application techniques available, including rectal insufflation, intra-articular application, topical application, and high-frequency application. High-frequency application has been shown to be effective for aesthetic purposes. It is worth noting that each equipment manufacturer has its own specific requirements, and the user manuals provided by the manufacturers should be consulted ⁽⁵⁾.

Ozone's effectiveness for general health is well-known worldwide. Regarding the use of ozone therapy in aesthetic treatments, excellent clinical results have been reported in the literature since the 2000s, supporting the use of ozone in various aesthetic treatments, such as combating localized fat, cellulite, wrinkles, sagging, acne, hyperchromia, stretch marks, telangiectasia, etc. The treatment of skin conditions is increasingly gaining prominence with ozone therapy, especially considering its role in the rejuvenation process ⁽⁹⁾.

Ozone therapy in Brazil has proven effective in supporting various complementary therapeutic treatments, as well as treating various aesthetic problems, such as sagging skin, localized fat, cellulite, varicose veins, dark circles, acne, hyperchromia, and others ⁽¹⁾.

Therefore, this research discusses the use of ozone, connecting what has been discussed separately in previous studies and combining the most significant conclusions found in the literature published to date on the subject to answer the question: How does ozone use improve the results of aesthetic procedures?

Therefore, the central objective of this work is to demonstrate, through bibliographic research, the importance of ozone use in aesthetic procedures. Associated with the central objective, the specific objectives are: to discuss the use of ozone in aesthetic procedures, to analyze how ozone is used in aesthetic procedures, and to investigate how ozone use aids in aesthetic procedures.

OBJETIVES

The present study aims to:

Discuss the effects of ozone therapy on weight loss, with an emphasis on lipolysis and improved blood circulation.

· Explore the impact of ozone on cellulite, considering its effects on microcirculation and lymphatic drainage.

· Address the role of ozone as a collagen biostimulator, analyzing its cellular mechanisms and benefits for skin regeneration.

METHODOLOGY

The methodology used in this work is bibliographic research, which is an excellent form of knowledge seeking. Therefore, writing a summary or literature review constitutes the main stage of all scientific research.

According to authors⁽¹³⁾, bibliographic research, as a methodological procedure, is important in the production of scientific knowledge, being able to generate, especially in underexplored topics, the postulation of hypotheses or interpretations that will serve as a starting point for further research.

In this context, bibliographic research is an excellent form of knowledge seeking. Therefore, writing a summary or literature review constitutes the main stage of all scientific research.

This article was prepared based on a review of scientific literature, using articles from specialized journals, books, and master's theses published in academic databases such as PubMed, Scopus, Google Scholar, and ScienceDirect. The main objective of the methodology was to gather and analyze the most recent information on the use of ozone in aesthetics, with an emphasis on weight loss, improving cellulite and collagen biostimulation.

Data Collection Procedures

Data collection was conducted through a systematic literature search, selecting scientific articles, books, and other relevant publications addressing the effects of ozone on aesthetics. The keywords used for the search were: "ozone therapy," "cellulite," "weight loss," "collagen biostimulation," and "ozone aesthetic treatment." Articles published between 2017 and 2025 were included, with an emphasis on clinical studies, systematic reviews, and experimental articles. To ensure source quality, only peer-reviewed papers were selected.

Analysis and Discussion

Data analysis was conducted qualitatively, comparing the effects of ozone in different aesthetic treatments. The selected publications were read and analyzed according to the biological mechanisms of ozone, such as lipolysis, cellular oxygenation, lymphatic drainage, and collagen regeneration. Based on the evidence found, the benefits and limitations of ozone therapy in weight loss, cellulite, and rejuvenation treatments were discussed.

Limitations

It is worth noting that this study is a literature review, which implies some limitations. No experimental analyses or clinical trials were conducted, and the conclusions depend on the quality and relevance of the selected articles. The ozone therapy methodology, although well established in some areas of aesthetics, is still undergoing constant refinement and analysis.

Theoretical Framework

The theoretical framework for this article was based primarily on up-to-date scientific studies, addressing both the physiological aspects of ozone and its practical applications in aesthetic health. The review focused on the proven effects of ozone therapy, considering the most recent scientific advances published up to 2025.

LITERATURE REVIEW

Ozone Therapy for Weight Loss

Studies on the mechanism of action of ozone therapy in weight loss reveal a complex and multifaceted process. One of the most notable aspects is ozone's lipolytic effect, which refers to its ability to break down fat cells. This effect is crucial for reducing adiposity and plays a significant role in weight loss ⁽¹⁴⁾.

The authors ^(14,15)began exploring the potential of ozone therapy in the field of weight loss, suggesting that ozone can influence lipid metabolism and the body's inflammatory response, crucial factors in the weight loss process.

Furthermore, ozone therapy, through its biochemical and physiological properties, such as improved oxygenation and modulation of oxidative stress, as described by the authors ⁽¹⁶⁾, can address multifactorial aspects of obesity that go beyond simple weight loss. This includes improving the metabolic profile and reducing systemic inflammation, aspects often associated with obesity. This holistic approach is essential, as obesity is a complex and multifactorial condition. Therefore, research into ozone therapy and weight loss not only expands scientific knowledge but also has the potential to offer a new perspective on obesity management, emphasizing the importance of innovative and multidisciplinary therapeutic approaches in medicine and public health.

Another important mechanism is the oxidation of fatty acids promoted by ozone. This process helps mobilize stored fat, making it available for use as energy. Additionally, ozone therapy can stimulate metabolism, increasing basal metabolic rate, which is a crucial factor for weight loss ⁽¹⁷⁾.

Thus, ozone therapy can improve blood circulation, which is beneficial not only for general health but also for optimizing metabolism and reducing fat deposits ⁽¹⁸⁾.

The therapeutic effects of ozone include antioxidant action against free radicals; increased erythrocyte flexibility, facilitating their passage through blood vessels and ensuring greater tissue oxygen supply due to increased 2,3-diphosphoglycerate (responsible for the transfer of O2 from hemoglobin to tissues); reduced platelet aggregation; analgesic, anti-inflammatory, bactericidal, fungicidal, and virucidal effects ⁽¹⁹⁾.

Many clinical studies are needed to establish a treatment protocol that is effective for volumetric reduction of adipose tissue with ozone therapy in the submental region, as the ozone concentration, route of administration, and frequency of application differ in the literature. The author ⁽²⁰⁾described local and systemic ozone applications, the former at a concentration of 1 to 8 g/mL twice a week, totaling 12 applications, and the latter systemic ⁽²¹⁾.

On the other hand, the application of ozone therapy for weight loss is still an emerging field, with studies and evidence still under development. The authors ⁽²²⁾, point out that, despite promising reports on the benefits of ozone on metabolism and inflammation reduction, more robust research is needed to validate these effects in the context of weight loss. The safety and application protocols of ozone therapy in this specific area are not yet fully established, as reinforced by search ⁽²³⁾, who emphasize the importance of a cautious approach, given the potentially reactive nature of ozone.

Therefore, ozone therapy is scientifically approved and is a highly effective treatment for lipodystrophy. This effectiveness is achieved because oxygen-ozone exerts its action through three main mechanisms: (i) it breaks down long fatty acids into short, hydrophilic chains, facilitating their transport through body fluids and, therefore, allowing their elimination from the body; (ii) it facilitates the removal of stagnant interstitial fluids (edema); (iii) oxygen-ozone binds to the red blood cell membrane, delivering more oxygen to the tissues and, therefore, activating local metabolism and improving venous and lymphatic circulation ^{(5), (12)}.

Ozone Therapy and Localized Fat

Fat accumulation (adiposity) is related to overweight and obesity. Obesity is a risk factor for several diseases, including diabetes, cancer, and cardiovascular problems ⁽²⁴⁾.

Currently, ozone therapy (O2-O3) is considered a minimally invasive, safe, and effective treatment method, applied in different concentrations and locations on the body, in the form of gas, water, and/or oil, and is very useful for reducing localized adiposity ^{(5, 25, 26)}.

Obesity is a chronic disease associated with genetic, behavioral, sociocultural, and metabolic factors, due to excessive food consumption and a sedentary lifestyle, which results in the accumulation of adipose tissue ⁽²⁷⁾.

Localized adiposity refers to the accumulation of fat cells in specific areas. Fat is divided into three patterns: android, with fat accumulation in the abdominal region; gynoid, with fat concentrated in the lower regions of the body; and finally, the mixed pattern, which consists of adiposity in both patterns ⁽²⁵⁾.

Treatment of localized lipodystrophy is among the most sought-after aesthetic problems in clinics and spas. The search for a sculpted and well-cared-for body is driving the market to adapt and increasingly develop aesthetic procedures and treatments for this purpose. Along with this market adaptation, it has been noted that clients are desiring treatments that promote, in addition to aesthetic results, a better quality of life and well-being ^{(10, 27)}.

Data from the Brazilian Society of Plastic Surgery (SBCP) indicates that in 2019 there was a 390% increase in the search for procedures such as botulinum toxin, peeling, laser, and thread lifts. Ozone therapy is an innovative, non-invasive method that satisfies this desire for increased self-esteem, aesthetically speaking, contributing to the overall appearance of individuals undergoing such procedures ⁽²⁸⁾.

The authors ⁽²⁷⁾ reported the case of a 31-year-old woman with a family history of multiple painful lipomas on the right forearm and painless lipomas on the left forearm and abdominal region. They administered 10 mL of ozone locally to the lipoma on the right forearm. One week later, a second application of 5 mL of O3 was administered. The lipoma on the right forearm reduced from 3.05 x 0.72 cm (cross-sectional area: 1.63 cm2) to 1.09 x 0.63 cm (cross-sectional area: 0.61 cm2) after the first application. Furthermore, pain decreased immediately after ozone therapy.

According to research ⁽²⁹⁾, regarding the properties of ozone in aesthetic disorders, such as localized fat, the authors clarify that, although this market is extremely new, it is quite promising, presenting excellent results.

The use of ozone gas is due to its antioxidant action, thus leading to the release of free radicals, which react with unsaturated fatty acids. According to research ⁽³⁰⁾, the use of O3 gas also results in the activation of the Nrf2 (Nuclear Factor Erythroid 2) protein, stimulating local microcirculation, thus decreasing tissue thickness and consequently damaging the fat cell membrane ^{(5, 19)}.

The author ⁽³⁰⁾conducted a study with 10 (ten) sessions of ozone therapy in the EGF, which resulted in a reduction in lipodystrophy. In this case study, 6 (six) ozone therapy sessions were performed on localized fat in the abdominal region, achieving satisfactory results in reducing abdominal circumference and lipodystrophy, which may have statistical impact on the results.

Therefore, ozone gas should be applied subcutaneously, to the site of Geloid Fibroedema (GEF) and localized fat. The gas enters the body, stimulates the immune system, activates circulation through nitric oxide, tissue oxygenation, and nutrition. It aids in the release of growth factors, stimulates tissue regeneration, and has antioxidant and lipolytic properties, aiding in the treatment of localized fat ^(19,
31-33).

The research ⁽³⁴⁾emphasizes that ozone therapy has gained prominence due to its vasodilatory, antioxidant, and lipolytic properties. These characteristics allow ozone to directly target the causes of cellulite formation and the increase in localized adipose tissue. The results indicate that ozone therapy may be an effective alternative for treating cellulite, promoting improvements in skin appearance and contributing to the reduction of localized fat. However, the authors emphasize the need for further clinical studies to standardize treatment protocols and evaluate the long-term safety and efficacy of ozone therapy in this context.

Ozone Therapy and Biostimulators

Aging is an inevitable process and can be triggered by a variety of factors, including physiological, genetic, and external factors. Each individual experiences this process uniquely. With increasing life expectancy, people have increasingly sought non-surgical aesthetic treatments. These treatments aim to manage the effects of aging naturally and harmoniously, while also reducing the risk of complications ⁽³⁵⁾. According to information found in the literature, ozone has anti-inflammatory properties that help rapidly break down fat. Furthermore, ozone combats microorganisms, improves cellular oxygenation, and removes toxins, such as free radicals responsible for aging ^{(36, 37)}.

A collagen biostimulator is a substance that can be injected into the deep dermis, subdermal layer, and supraperiosteal layer. When injected, it stimulates the production of collagen. Collagen biostimulator treatment is a minimally invasive treatment with little to no downtime, and its effects are gradual. Results are usually visible within a few months of the initial treatment and last up to two years or more ^(35,
38).

Ozone therapy has beneficial effects on hematopoietic tissue, especially red blood cells, promoting improved blood circulation and helping treat problems such as varicose veins, stretch marks, and sagging skin. Furthermore, ozone reduces skin inflammation and accelerates wound healing, which is useful for treating acne and hyperchromia. Ozone also has antioxidant properties, which allows the elimination of old cells and the regeneration of body tissues, aiding in facial rejuvenation ⁽³⁹⁾.

Used in adequate concentrations, ozone gas has the ability to modulate the inflammatory response, increase antioxidant enzymes, increase tissue oxygenation, and enhance the immune response via cytokines. The biological potential to stimulate tissue repair and antioxidant action is due to ozone's ability to increase mitochondrial and biosynthetic activity ^{(40, 41)}.

The effect of ozone therapy on the skin occurs through the reaction of ozone with water present in the tissues, resulting in reactive oxygen species (ROS) and lipooligopeptides (LOP), such as hydrogen peroxide (H2O2), which are rapidly reduced to antioxidants. This gas, which has a high selective oxidizing power, acts on the phospholipid layer of the erythrocyte membrane, triggering a dose-dependent chain of reactions that can be beneficial or harmful to the body. H2O2 acts in the intracellular environment of erythrocytes, increasing ATP production and O2 transport, in leukocytes, promoting the production of cytokines and interleukins, acting as an immunomodulator and in platelets, stimulating their activity, which increases the production of growth factors and autacoids, acting in a more dynamic and organized way in tissue repair ^{(36,
39, 42)}.

CONCLUSION

Ozone therapy stands out as a therapeutic tool with significant potential in aesthetics, offering unique benefits that make it an innovative resource in non-invasive treatments. Its ability to promote lipolysis, improve microcirculation, reduce inflammation, and stimulate collagen regeneration makes ozone a powerful ally in combating aesthetic problems such as localized fat, cellulite, sagging, acne, and skin aging.

The multifaceted action of ozone in aesthetics is what distinguishes it most. By improving tissue oxygenation and increasing cell flexibility, ozone therapy not only facilitates the reduction of adiposity but also promotes skin regeneration, bringing benefits to facial rejuvenation. The use of ozone stimulates collagen and elastin cells, providing firmness and elasticity, while reducing toxin accumulation and promoting healthier, more rejuvenated skin.

This treatment, which has already demonstrated promising results in several studies, opens up a vast field of possibilities in the aesthetics market. In addition to traditional treatments, such as localized fat reduction and cellulite reduction, ozone offers a safe and effective alternative for facial rejuvenation and the treatment of other dermatological conditions that impact a patient's appearance. This versatility of applications makes ozone therapy an innovative and valuable approach to meet the growing demand for aesthetic procedures that provide visible results, with shorter recovery time and reduced risks.

Despite its immense potential, ozone therapy still requires further clinical studies to standardize techniques and protocols, ensuring its safest and most effective application. Regulation and adequate training of professionals are essential for ozone therapy to continue its controlled expansion, consolidating its place in high-quality aesthetic practice.

Therefoe, ozone therapy not only offers enormous therapeutic potential but also represents a revolution in aesthetic care, providing professionals with a powerful tool to improve results and the patient experience. Its future is promising, with the expectation of a growing role in the treatment of various aesthetic conditions, contributing significantly to the well-being and self-esteem of those seeking more natural and effective care.

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Author Contributions

The author is responsible for all content of the article.

Funding and Acknowledgments:

This research received no funding.

Declaration of Conflict of Interest

Nothing to declare.

Scientific Editor: Francisco Mayron Morais Soares. Orcid: https://orcid.org/0000-0001-7316-2519