Dr. Potkin

At the Beverly Hills Center for Hyperbaric Medicine, physician and medical director Ralph Potkin, M.D., says his clients frequently include plastic surgeons and others who refer patients for a better outcome.

"Many people have been using hyperbaric oxygen therapy in cosmetic surgeries such as abdominoplasties or breast reduction, especially if the patient has a circulatory problem, if there is a question of the surgical wound not healing properly, or if the patient is a smoker."

Dr. Nassif

In addition to smokers and others with problems in healing, Dr. Potkin says his patients sometimes, in fact, have none of those problems and are referred simply to improve their outcome.

"The protocol that we've developed is beneficial even for patients without circulatory or wound-healing problems, and many patients are normal, nonsmokers who simply want to do whatever they can to optimize their results," he tells Cosmetic Surgery Times. "This is just another thing the patients can do that's proactive and gets them involved in optimizing their healing."

The treatment is offered the day before surgery to help offset the impact and minimize any reperfusion injury, Dr. Potkin adds. "If we know there's a procedure coming up, we can give a hyperbaric treatment the day before in order to alter the inflammatory response to minimize it."

As a general rule, HBOT will typically be covered by insurance if the related surgery has been covered — meaning most cosmetic surgery-related HBOT use would likely not be covered. Costs at Dr. Potkin's center run around $250 per treatment, but he says that isn't usually a big deterrent. "When you're dealing with cosmetic surgery patients who are paying thousands of dollars for a procedure anyway, they're often willing to spend extra money to stack the deck in their favor and improve the outcome," he says.

PROCESS & INDICATIONS Under hyperbaric oxygen therapy, air pressure is increased two- to three-times normal levels and the patient breathes and is in a chamber with 100 percent pure oxygen. The process dissolves oxygen, driving it into tissues and raising normal blood oxygen concentration as much as 10- to 20-fold and promoting the growth of healthy new cells.

The therapy has specific FDA approval for indications ranging from carbon monoxide poisoning and complications from radiation therapy to gas gangrene, crush injuries, blood-loss anemia and thermal burns. The treatment is also FDA indicated for treatment of necrotizing soft tissue infections, skin grafts and flaps, and healing enhancement in certain problem wounds.

Dr. Potkin says that, in his experience, the process can improve healing time by as much as a half; however, published research for HBOT use in the field of cosmetic surgery is still spotty.

SLIM CLINICAL SUPPORT In a literature review on HBOT use for flaps and grafts, Harold Friedman, M.D., and colleagues reported that research currently weighs much more heavily on the side of animal studies than on more reliable clinical research. "Although there are a significant amount of animal data supporting the application of hyperbaric oxygen for grafts and flaps, there is very little clinical information other than case reports and series to sustain its choice over other modalities of therapy," the researchers write. They add that more multicenter prospective clinical studies are needed to support HBOT's choice over other therapy modalities.

Paul S. Nassif, M.D., F.A.C.S., a facial plastic and reconstructive surgeon in Beverly Hills says that, despite the lack of research on HBOT with cosmetic surgery, he recommends the treatment to all of his patients, who largely consist of rhinoplasty patients. "Even though there isn't a lot of research in regards to cosmetic surgery, there is in terms of wound healing and chronic infections of the bone, and [other issues], and in those cases, it has proven to be a wonderful adjunct to healing," he says.

"I'm impressed just from seeing the patients who have had it, especially facelift patients who are swollen," Dr. Nassif says. "I recently had a patient who had a full face rejuvenation and a peel and she was extremely swollen the next day. She went in [for HBOT] the first day after surgery and she almost looked like a different person the next day, and this happens to a large percentage of patients — you really see a large reduction in swelling." He concedes that other factors could explain the improvement, but that signs point to HBOT. "Could it be the icing or the head of the bed elevated? Perhaps, but in comparing patients that have had swelling and HBOT and those who didn't have HBOT, I personally feel it does help."

ANECDOTAL BENEFITS Susan Kaweski, M.D., F.A.C.S., former chair of the Technology Assessment Committee for the American Society of Plastic Surgeons, says that while plastic surgeons typically don't use HBOT on a regular basis, in appropriate cases, it can nevertheless have its benefits. "I have actually used hyperbaric oxygen therapy for a patient who was a two-pack per day smoker and had a history of scleroderma," Dr. Kaweski says.

"She developed an area of skin necrosis after her abdominoplasty, and I immediately sent her to hyperbaric oxygen therapy, which she received over the course of two to three months. The area healed without requiring a skin graft. Another very obese patient developed a wound infection after abdominoplasty and required hyperbaric to heal her wound," Dr. Kaweski adds. She warns, however, that, though extremely rare, the risks of unsupervised HBOT given in high doses over prolonged periods of time can be significant.

"This is not a therapy to be taken lightly. Oxygen therapy can result in toxic neurologic effects; barotrauma injury, which can affect the ears, sinuses and GI tract; lung and chest injuries such as pneumothorax, scarring of the lungs and pulmonary edema; and even problems with routine medication absorption rates. Therefore, I would only use hyperbaric therapy as needed and not on a routine basis."

Reference

Friedman HI, Fitzmaurice M, Lefaivre JF, Vecchiolla T, Clarke D. An evidence-based appraisal of the use of hyperbaric oxygen on flaps and grafts. Plast Reconstr Surg. 2006;117(suppl):175S-190S.