Does hyperbaric oxygen speed up recovery from a deep plane facelift? As an HBOT provider, our answer is a careful maybe. This is the best single result we have seen for cosmetic surgery recovery, and it still rests on twenty people.
Last week we said no to hair transplant scabs. This one is different, and the difference is not our opinion. It is the design of the study.
The number
Neel and colleagues published a case-control study in Aesthetic Surgery Journal Open Forum in 2023, drawn from a private practice in Riyadh between 2019 and 2022. Twenty women who had had a facelift: nine received hyperbaric oxygen, eleven did not.
The hyperbaric group started within 24 hours of surgery, at 2.0 ATA, with sessions averaging 78 minutes and around seven sessions each. Mean time to full clinical wound healing was 13.3 days in that group against 36.9 days in the control group, reported at p<0.001.
Thirty-seven days down to thirteen. That is a very impressive sounding number, so let us look deeper.
Why this one is better than most
One thing separates this study from most of the hyperbaric literature you will find quoted on clinic websites: it has a control group. There were eleven women having the same surgery who did not get the chamber, and they were measured the same way.
That sounds obvious. It is not. A great deal of what gets sold as evidence in this industry is a group of people who all had the treatment, with their results placed next to a general figure from somewhere else. That is not a comparison. This is.
Why it still is not proof
Twenty patients. Nine versus eleven. That is a small enough group that a couple of unusual cases in either direction move the average a long way.
It was not randomised. This matters more than the size. Nobody tossed a coin to decide who got the chamber. Which means the two groups may have differed before treatment started, in ways nobody measured. Patients who opt in to extra recovery treatment often follow the rest of their aftercare more closely too, and that alone could move a healing time.
The spread is enormous. Everyone quotes the averages. Look at the ranges instead: the hyperbaric group healed in 7 to 30 days, and the control group in 6 to 90 days. Somebody in the control group healed in six days, faster than anyone in the treatment group. A single very slow healer in a group of eleven drags that 36.9 day mean upward a long way.
“Full clinical wound healing” is a judgement. Somebody looked at a wound and decided it was healed, and that somebody knew which patients had been in the chamber. That is not fraud, it is just how an unblinded study works, and it is a known route for results to drift in the expected direction.
One practice, one surgeon, one country. Whether it holds up elsewhere is unknown until somebody else runs it.
Why the mechanism makes sense here
A deep plane facelift lifts a large flap of tissue and, in doing so, disrupts part of its blood supply. For a while that flap is living on less oxygen than it is used to. That is the specific situation where dissolving extra oxygen into blood plasma, so it can reach tissue red blood cells are struggling to serve, has a real theoretical basis. High oxygen also constricts vessels in a way that can reduce swelling without starving the tissue.
So this is not a case of a result appearing out of nowhere. The biology points the same way as the study. That is why we say maybe rather than no.
This one we could actually run
Unlike some of the protocols quoted around hyperbaric oxygen, this one is within what our chamber does. The study used 2.0 ATA with sessions averaging 78 minutes. We run a medical-grade hard-shell chamber at up to 2.0 ATA with sessions up to 90 minutes. If you were going to follow that protocol, we could follow it properly.
What we will and will not tell you
We will not tell you that you will heal in 13 days. That was a mean from nine women in Riyadh, and you are not a mean.
What we will say is that this is the most interesting result in the area, the mechanism is coherent, the protocol is one we can actually deliver, and the honest description of it is “promising, unproven, and worth a conversation with your surgeon”. If your surgeon thinks it is appropriate for you, come and talk to us. If they do not, listen to them.
The rest of this series
We are working through the surgical claims made for hyperbaric oxygen one at a time. So far: hair transplant scabs, where we say no. Still to come: diabetic foot ulcers, where we say yes, and surgical infection, where the answer is yes but you should be in a hospital rather than in our clinic.
Reference
- Neel OF, Mousa AH, Al-Terkawi RA, Bakr MM, Mortada H. Assessing the Efficacy of Hyperbaric Oxygen Therapy on Facelift Outcomes: A Case-Control Study Comparing Outcomes in Patients With and Without Hyperbaric Oxygen Therapy. Aesthetic Surgery Journal Open Forum. 2023;5:ojad065. Read the study
General information about published research, not medical advice. Medical oxygen is a prescription-only medicine in the UK. Speak to your surgeon or GP about your own recovery.