APPLICATION OF HYPERBARIC OXYGEN THERAPY IN AESTHETIC SURGERY AND COSMETOLOGY: CURRENT STATE OF THE ISSUE, CLINICAL OUTCOMES, AND PROSPECTS

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Abstract

Hyperbaric oxygen therapy (HBOT), the administration of 100% oxygen under elevated atmospheric pressure in a hyperbaric chamber, has gained growing attention in aesthetic surgery and cosmetology. Its applications range from the prevention and management of ischemic complications in skin flaps and grafts to the treatment of necrosis following hyaluronic acid (HA) filler injections and the enhancement of postoperative recovery after aesthetic procedures. Despite promising clinical use, the quality of supporting evidence remains heterogeneous, with many protocols extrapolated from general surgery. This review aims to systematically evaluate current evidence on the efficacy, safety, and practical application of HBOT in aesthetic medicine, highlighting validated indications and identifying key knowledge gaps. A targeted literature search was performed across PubMed/MEDLINE, Cochrane Library, and relevant specialty journals (2000–2025), focusing on clinical studies, professional guidelines (e.g., UHMS), and case series in aesthetic surgery and dermatologic cosmetology. The strongest aesthetic indications for HBOT include: (1) salvage of compromised skin flaps and grafts (e.g., post-facelift, rhinoplasty, or oncoplastic procedures), supported by extrapolated and retrospective data; (2) adjunctive treatment of ischemia and necrosis after HA filler injections, with emerging support from TcPO₂-guided protocols; (3) accelerated recovery after rhytidectomy, with case-control and retrospective studies reporting reduced healing time and fewer complications; (4) possible reduction in keloid recurrence due to HBOT’s immunomodulatory effects, based on limited data; (5) supportive role in autologous fat graft survival, though further validation is needed. HBOT should not be regarded as a standalone solution but rather as a valuable adjunct when initiated promptly and integrated with standard interventions (e.g., hyaluronidase, surgical revision). Further high-quality randomized trials, protocol standardization, and cost-effectiveness studies are necessary to establish its routine role in aesthetic practice.