Abstract
Background:
Hyperbaric oxygen therapy (HBOT) increases oxygen concentration in affected tissues that enhance the cellular hypoxia recovery process, neovascularization, fibroblast proliferation, increased reactive oxygen species, suppression of proinflammatory states, and vascular compression. The aim of this article is to demonstrate the experience in the use of the hyperbaric chamber as an adjunctive management for the prompt recovery of patients who underwent aesthetic plastic surgery.
Methods:
A retrospective descriptive study was conducted between 2021 and 2023, involving 296 patients who received HBOT after aesthetic surgical procedures, to demonstrate the recuperation time rate and the complication incidence in postoperative patients using HBOT.
Results:
Most participants were women, with a median age of 33.5 years. Surgical procedures were grouped in liposculpture, abdominoplasty, and breast interventions. Complications related to the surgical event were low (10.7%), with occurrences of hematomas (n = 14, 4.72%), anemias (n = 9, 3.04%), and wound dehiscence (n = 8, 2.70%). There were no reports of surgical site infections or necrosis. Recovery times to get back to work were 10 days for liposuction, 3 days for breast interventions, and 21 days for abdominoplasty.
Conclusions:
This study demonstrated the experience of using a postoperative hyperbaric chamber in aesthetic plastic surgery to promote recovery processes. The patient cohort in this study showed shortened recovery times than the data obtained from the major international plastic surgery organizations. Also, HBOT patients had a low complication rate, without infections, indicating the potential efficacy of this adjunctive therapy. Overall, this study underscores the promising role of hyperbaric chamber therapy in facilitating postoperative recovery and mitigating complications.
Takeaways
Question: Does hyperbaric oxygen therapy enhance the recovery of patients who undergo aesthetic plastic surgery?
Findings: A prospective descriptive study was conducted between 2021 and 2023, involving 296 patients who received hyperbaric oxygen therapy after aesthetic surgical procedures. Complications related to the surgical event were relatively low (10.7%), with occurrences of hematomas, anemia, and wound dehiscence. Patients undergoing hyperbaric therapy exhibited shortened recovery times and fewer postsurgical complications compared to the data from major international plastic surgery organizations.
Meaning: This study underscores the promising role of hyperbaric chamber therapy in facilitating postoperative recovery and mitigating complications, suggesting the necessity of protocols to optimize outcomes in aesthetic surgical practice.
INTRODUCTION
Hyperbaric chambers are a therapeutic option to increase oxygen concentration in tissues affected by various etiologies that cause cellular hypoxia. The mechanism by which the hyperbaric chamber increases oxygen availability in affected tissues is by increasing the atmospheric pressure at which the individual is located and by increasing the percentage of oxygen available in the environment (from 21% to 100%), facilitating the transport of dissolved oxygen in the blood once hemoglobin is maximally saturated.1
The use of the hyperbaric chamber produces physiological effects that favor a cellular hypoxia recovery process, such as increased dissolved oxygen in the blood, tissue oxygenation, clearance of other gases present in the affected area, neovascularization, fibroblast proliferation stimulation, increased reactive oxygen species, suppression of proinflammatory states, and vascular compression.2–4 At the molecular level, the hyperbaric chamber has effects that favor the release of growth factors, recruitment of totipotent cells, and chemotaxis.5
Hyperbaric oxygen therapy (HBOT) involves the patient inhaling 100% oxygen in an environment of at least 1.4 atm. Optional therapies often last 60–90 minutes at a pressure of 2–3 atm, with emergency treatments exceeding these parameters. The number of sessions is usually individualized for each patient based on their condition.6
Currently, the use of the hyperbaric chamber is indicated for pathologies such as gas embolism, carbon monoxide poisoning, gas gangrene, traumatic ischemia, decompression sickness, central retinal artery occlusion, wound healing problems, severe anemia, soft tissue necrosis and infection, intracranial abscesses, osteomyelitis, radiation injury, compromised grafts, burns, stroke, and myocardial infarction.1 However, in the daily practice of aesthetic plastic surgery, the hyperbaric chamber is used for the recovery of patients who have undergone aesthetic procedures for a faster and more effective postsurgical recovery. This has become popular and is applied in a generalized manner among plastic surgeons based on empirical knowledge rather than adequate scientific evidence.
When verifying the use of this practice in aesthetic plastic surgery within the literature, no study was found to be conclusive with all the scientific validity to establish the effectiveness of hyperbaric chamber usage in aesthetic plastic surgery for rapid and effective patient recovery. However, a retrospective study shows that presurgical HBOT decreases postoperative complications in patients who undergo abdominoplasty.7
Also, several articles have shown some indications of usefulness in this field, such as the use of HBOT for flap management and ischemia, keloid scars, postoperative infection, skin ulcers, increased granulation tissue, prevention of implant encapsulation, survival of transfer cells, and hair implantation.8–12
Given the above, the aim of this article was to demonstrate the experience in the use of the hyperbaric chamber as an adjunctive management for the prompt recovery of patients who underwent aesthetic plastic surgery.
METHODS
Study Design
A retrospective descriptive study was conducted. The data obtained from the patients’ medical records were collected between 2021 and 2023. This information was related to the aesthetic surgical intervention, use of HBOT, and the postoperative follow-up.
Subjects
The study population consisted of patient records from Dr. Aguilar’s practice at HAV Academy, Bogota, and Bucaramanga, Colombia (2021–2023). Participants included individuals who underwent aesthetic surgical procedures (liposuction, abdominoplasty, mastopexy, breast augmentation, and fat transfer) and received HBOT in the postoperative recovery; all patients were between 18 and 60 years. Patient records were excluded from the study in the event that the person could not complete the 5-day therapy due to a contraindication for hyperbaric chamber, the patient dropped out of the sessions, or the patient presented an intraoperative complication requiring immediate hospitalization or intervention by another specialty.
Hyperbaric Oxygen Therapy
Between 2021 and 2023, the postoperative patients were taken to postoperative hyperbaric chamber therapy 24 hours after their surgical intervention. The management protocol involved the patients undergoing daily sessions of HBOT for 45 minutes at a pressure of 2 atm for 5 days; all the patients got the same protocol. This therapy has an extra charge to the patients; each HBOT charge was around US $50.
Ethical Consideration
Each patient was informed to participate in the study and given the option to withdraw consent to participate at any time. An informed consent was signed before surgery for each patient participating in our report. The informed consent explained all the items according to the Declaration of Helsinki and Declaration of Taipei.
Statistical Analysis
The sociodemographic and clinical data of the patients were presented as frequencies, means, and SDs. Regarding the recovery of the patients, the average time for all stages of recovery of the study subjects was expressed in means. Additionally, the occurrence of postoperative complications was estimated. Statistical values were obtained using the Jamovi version 2.3 computer software, retrieved from https://www.jamovi.org).
RESULTS
A sample of 296 patients who received HBOT during the postoperative period of their aesthetic plastic surgery was obtained, of which 280 were women (94.6%); the median age was 33.5 years [interquartile range (IQR) 11] (Table 1).
Table 1.
Sociodemographic Characteristics
| Characteristics | Measure of Central Tendency, n or % | Dispersion Measurement |
|---|---|---|
| Age, y | Median 33.5 | IQR 11 |
| Sex | ||
| Male, % | 94.6 | NA |
| Female, % | 5.4 | |
| BMI, kg/m2 | Median 25.7 | IQR 2.7 |
BMI, body mass index; IQR, interquartile range.
The surgical time had a median of 240 minutes (IQR 70 minutes), with the majority of individuals undergoing 2 procedures simultaneously (49.3%), followed by 3 procedures (34.1%); a smaller proportion underwent only 1 procedure (15.5%); and finally, those who underwent 4 simultaneous interventions (1%). Surgical procedures were classified into 3 main groups: liposculpture (n = 174, 58.7%), abdominoplasty (n = 77, 26.1%), and breast interventions (n = 45, 15.2%). Complications related to the surgical event were hematoma (n = 14, 4.72%), anemia (n = 9, 3.04%), and wound dehiscence (n = 8, 2.70%); no ischemic or infection events were reported (Table 2).
Table 2.
Clinical and Surgical Characteristics
| Variable | Measure of Central Tendency, n or % | Dispersion Measurement |
|---|---|---|
| Surgical procedures | n | NA |
| 1 | 46 | |
| 2 | 146 | |
| 3 | 101 | |
| 4 | 3 | |
| Surgical time | Median 240 min | IQR 70 min |
| Tranexamic acid IV | % | NA |
| Yes | 97.6 | |
| No | 2.4 | |
| Surgical intervention | n, % | NA |
| Liposuction | 174, 58.7 | |
| Breast surgery | 68, 26.1 | |
| Abdominoplasty | 45, 5.2 | |
| Complications | n, % | NA |
| Infection | 0, 0 | |
| Tissue ischemia | 0, 0 | |
| Hematoma | 14, 4.72 | |
| Wound dehiscence | 9, 3.04 | |
| Acute anemia | 8, 2.70 |
IQR, interquartile range.
Of the patients who underwent liposuction as the main procedure (n = 174), the only late postoperative complication was hematoma (n = 5, 2.87%). Regarding their recovery process using the hyperbaric chamber, it took a median of 1 day (IQR 3.25) to be able to brush their hair independently; a median of 2 days (IQR 6) to dress independently; a median of 3 days (IQR 1) to shower independently; an average of 8 days (IQR 7) to put on their shoes independently; and an average of 10 days (IQR 1) to return to work (Table 3).
Table 3.
Liposuction Complications and Recovery Time
| Variable | Measure of Central Tendency, n or % | Dispersion Measurement |
|---|---|---|
| Additional procedures | n, % | NA |
| 0 | 1, 0.57 | |
| 1 | 107, 61.49 | |
| 2 | 64, 36.78 | |
| 3 | 2, 1.14 | |
| Complications | n, % | NA |
| Infection | 0, 0 | |
| Tissue ischemia | 0, 0 | |
| Hematoma | 5, 2.87 | |
| Wound dehiscence | 0, 0 | |
| Acute anemia | 0, 0 | |
| Days to brush the hair independently | Median 1 | IQR 3.25 |
| Days to dressing independently | Median 2 | IQR 6 |
| Days to take a shower independently | Median 3 | IQR 1 |
| Days to put the shoes independently | Median 8 | IQR 7 |
| Days to get back to work | Median 10 | IQR 1 |
IQR, interquartile range.
Of the patients who underwent breast area interventions as the main procedure (n = 45), the only late postoperative complication was wound dehiscence (n = 3, 6.6%). Regarding their recovery process using the hyperbaric chamber, it took a median of 8 days (IQR 1) to be able to brush their hair independently; a median of 10 days (IQR 7) to dress independently; a median of 2 days (IQR 1) to shower independently, an average of 15 days (IQR 7) to put on their shoes independently; and an average of 3 days (IQR 5) to return to work (Table 4).
Table 4.
Breast Surgery Complications and Recovery Time
| Variable | Measure of Central Tendency, n or % | Dispersion Measurement |
|---|---|---|
| Additional procedures | n, % | NA |
| 0 | 39, 86.66 | |
| 1 | 5, 11.11 | |
| 2 | 1, 2.2 | |
| 3 | 0, 0 | |
| Complications | n, % | NA |
| Infection | 0, 0 | |
| Tissue ischemia | 0, 0 | |
| Hematoma | 0, 0 | |
| Wound dehiscence | 3, 6.6 | |
| Acute anemia | 0, 0 | |
| Days to brush the hair independently | Median 8 | IQR 1 |
| Days to dressing independently | Median: 10 | IQR 7 |
| Days to take a shower independently |
Median 2 | IQR 1 |
| Days to put the shoes independently | Median 15 | IQR 7 |
| Days to get back to work | Median 3 | IQR 5 |
IQR, interquartile range.
Of the patients who underwent abdominoplasty as the main procedure (n = 77), the immediate postoperative complication was anemia (n = 9, 11.6%), and late complications were hematoma (n = 9, 11.6%) and wound dehiscence (n = 5, 6.5%). Regarding their recovery process using the hyperbaric chamber, it took a median of 1 day (IQR 7) to be able to brush their hair independently; a median of 8 days (IQR 1) to dress independently; a median of 8 days (IQR 1) to shower independently; an average of 30 days (IQR 10) to put on their shoes independently; and an average of 21 days (IQR 7) to return to work (Table 5).
Table 5.
Abdominoplasty Complications and Recovery Time
| Variable | Measure of Central Tendency, n or % | Dispersion Measurement |
|---|---|---|
| Additional procedures | n, % | NA |
| 0 | 4, 5.19 | |
| 1 | 36, 46.75 | |
| 2 | 36, 46.75 | |
| 3 | 1, 1.29 | |
| Complications | n, % | NA |
| Infection | 0, 0 | |
| Tissue ischemia | 0, 0 | |
| Hematoma | 9, 11.6 | |
| Wound dehiscence | 5, 6.5 | |
| Acute anemia | 9, 11.6 | |
| Days to brush the hair independently | Median 1 | IQR 7 |
| Days to dressing independently | Median 8 | IQR 1 |
| Days to take a shower independently | Median 8 | IQR 1 |
| Days to put the shoes independently | Median 30 | IQR 10 |
| Days to get back to work | Median 21 | IQR 7 |
IQR, interquartile range.
DISCUSSION
This article aimed to demonstrate the experience of using the hyperbaric chamber in the postoperative recovery process of aesthetic plastic surgery. Through this study, we were able to demonstrate the postoperative recovery time of patients using the hyperbaric chamber, identify the various postsurgical complications experienced by this group of subjects, and indirectly show the role of the hyperbaric chamber in the entire process. We could not prove that the HBOT is effective for the postoperative process due to the methodological limitations, but we compared the results of this study to the information available online to establish the first step of a new research line that we are going to develop in this field.
The median age was 33.5 years, and most patients were women, which is consistent with data reported by the International Society of Aesthetic Plastic Surgery (ISAPS).13 The complication rate in these patients was 10.7%, which is below the average complication rate for body contouring reported in the literature (11.17%).14 Excluding anemia, which is not modifiable by the hyperbaric chamber, the incidence was 7.6%, demonstrating a notable reduction in postoperative complication occurrence when using the hyperbaric chamber compared with current evidence. Procedures such as liposuction and breast interventions reported complication rates of 2.87% and 6.6%, respectively, which are lower than those reported in the literature (8.3% and 6.6%, respectively).14 The complication rate for abdominoplasty, excluding anemia, was 18.1%, which is comparable to the literature (18.8%).
It is noteworthy that there were no cases of surgical site infection in this study, which is a result of all aseptic processes and antibiotic prophylaxis protocols for surgical intervention,15 and the use of postoperative hyperbaric chamber, which not only promotes tissue recovery but also controls and mitigates the development of surgical site infections, whether through oxygen free radicals, neovascularization, recruitment of defense cells, or synergy with antibiotics.1
The recovery time for patients undergoing hyperbaric chamber therapy after liposuction had a median return to work time of 10 days, which is lower than the recommendations by the American Society of Plastic Surgeons (ASPS), ISAPS, and Cleveland Clinic, which suggest returning to work after 2 postoperative weeks.16–18 Patients undergoing breast interventions had a median return to work time of 3 days, which is also lower than the recommendations by the ASPS and the ISAPS, which suggest returning to work after a minimum of 5 days.19,20 Finally, patients undergoing abdominoplasty took 21 days to return to work, which falls within the ranges (from 14 to 30 days) mentioned by the ASPS, the ISAPS, and The Aesthetic Society.21–23 The recovery time wasn’t shorter because, although the use of a postoperative hyperbaric chamber helps with wound healing, a major surgery like abdominoplasty requires a protocol that includes preoperative hyperbaric therapy sessions for optimal results. These preoperative sessions can aid in preparing and fortifying the tissues in the surgical area, as has been demonstrated in other surgical contexts1 (Table 6).
Table 6.
Other Surgical Outcomes
| Main Intervention | Recovery Time with HBOT (Mean) | Literature Recomendation |
|---|---|---|
| Liposuction | 10 d | ASPS 14 d |
| ISAPS 14 d | ||
| Cleveland Clinic 14 d | ||
| Breast augmentation | 3 d | ASPS 5–7 d |
| ISAPS 5–7 d | ||
| Abdominoplasty | 21 d | ASPS 30 d |
| ISAPS 14 d | ||
| Aesthetic Society 14 d |
However, it is important to acknowledge the limitations of this study. First, it is a retrospective study that demonstrates the experience of using the hyperbaric chamber in aesthetic plastic surgery practice but does not make comparisons between groups to demonstrate the effectiveness of its use for patient recovery. Second, as a retrospective study, it was not possible to delve into new variables of interest or conduct interviews or follow-up with patients.
In conclusion, this study demonstrated the experience of using postoperative hyperbaric chamber in aesthetic plastic surgery to promote recovery processes. The patient cohort in this study had recovery time to return to work after liposuction and breast interventions that seemed to be really quick. Also this patient cohort showed a low rate of complications, with no infections in this group. For major interventions, new hyperbaric oxygen protocols focused on rapid recovery specific to aesthetic plastic surgery are required.
Future studies are needed to validate the effectiveness of hyperbaric chamber use in aesthetic plastic surgery with protocols designed for this type of intervention. The aim is to gain a comprehensive understanding of HBOT pre- and postoperatively and how it could reduce complication rates and recovery times, making aesthetic surgery a safer and quicker medical practice.
DISCLOSURE
The authors have no financial interest to declare in relation to the content of this article.
Footnotes
Disclosure statements are at the end of this article, following the correspondence information.
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