Hyperbaric oxygen therapy to boost healing after cosmetic surgeries in Jordan
العلاج بالأكسجين المضغوط لتعزيز التئام الجروح بعد عمليات التجميل وترقيع الأنسجة
In this context hyperbaric oxygen therapy means sessions of breathing high-concentration oxygen inside a pressurised chamber, prescribed for a skin graft or tissue flap whose blood supply has faltered after surgery, or for poorly perfused tissue being prepared to receive a graft. The distinction here is essential and must not be blurred: one situation is medically accepted and another is promoted without adequate evidence, and the difference between them is not a commercial detail but a difference in evidence. The accepted use is the **compromised** graft or flap, meaning one showing signs of reduced perfusion or oxygenation after surgery and at risk of being partly or wholly lost, together with the preparation of poorly perfused tissue, including tissue previously exposed to radiotherapy, before grafting and afterwards. In these situations hyperbaric oxygen is used as an adjunct alongside surgical management. The use that lacks adequate evidence is routine sessions after a cosmetic operation that has gone without complications, on the claim of speeding recovery, reducing bruising and swelling, improving the appearance of the scar, or energising tissue. This page does not attribute effectiveness where evidence does not exist, and there is no justification for selling a course of sessions to a patient whose wound is healing normally. The limits are explicit. Hyperbaric oxygen does not correct a surgical error, does not open a blocked artery or vein in a flap, does not bring back tissue that has already died, does not replace re-operation or releasing a tight suture or draining a haematoma, does not treat infection without targeted antibiotics, does not improve the cosmetic result itself, and does not prevent surgical complications in the first place. Any sign that a flap is failing, such as pallor, blue discolouration, coolness or increasing pain, calls for immediate review by the surgeon because timing is decisive, and waiting in the hope that sessions will resolve it is not acceptable. One point deserves saying plainly: smoking is the single largest factor in graft and flap failure, and hyperbaric oxygen does not cancel its effect. Each decision is made by the surgeon's assessment rather than by patient request. **The chamber is unsuitable for anyone with an untreated pneumothorax, which is an absolute barrier; active sinus or ear infection postpones it; certain chemotherapy agents conflict with it; uncontrolled epilepsy must be controlled first; pregnancy is excluded except in carbon monoxide poisoning; and claustrophobia needs preparation.**
Procedure steps
- 1
The surgeon's assessment of the graft or flap
The surgeon examines the tissue's colour, temperature, turgor and response to pressure, and looks for venous congestion, arterial pallor, a haematoma or a suture that is too tight, sometimes using tools to measure perfusion. This examination is what separates a genuinely compromised flap needing urgent intervention from normal recovery that needs nothing. Any problem with a surgical solution is dealt with surgically first.
- 2
Fixing the surgical cause before considering sessions
If the cause can be corrected, correction comes first: releasing a tight suture, draining a haematoma, changing a position that is pressing on the vascular pedicle, re-exploring the anastomosis, or removing dead tissue. Sessions are not used to delay an urgent surgical decision and are not prescribed instead of one, because delay is precisely what loses the tissue.
- 3
Deciding eligibility for hyperbaric oxygen
Hyperbaric oxygen is decided for the accepted situations: a graft or flap compromised by poor perfusion, or the preparation of poorly perfused or previously irradiated tissue before grafting. Before entry, the barriers to chamber use are assessed: lungs, heart, ears, sinuses, medication review, pregnancy and epilepsy. The programme is not prescribed for a patient recovering normally, however often it is requested, because that would be selling an unproven use.
- 4
Preparation and the session inside the chamber
You are shown in practice how to equalise ear pressure before pressurisation. Fire-safety rules are applied strictly: designated clothing, and no oil-based product, greasy ointment, cream, perfume or deodorant, and no lighters, phones or any electronic device. Pressure is raised gradually, oxygen is breathed for a set period, and pressure is then lowered. **Severe ear pain or bleeding from the ear stops the session.**
- 5
Monitoring the tissue and deciding to continue
The tissue is examined between sessions and photographed for comparison: has the colour improved, has turgor returned, have the threatened margins receded. Sessions for a compromised flap are short-term and intensive because the window is narrow, and if the tissue does not respond, surgical decisions are made about removing dead tissue and re-grafting rather than extending the programme in hope of recovering tissue already lost.
Before the procedure
Ask your surgeon one direct question before you pay: is my graft or flap genuinely compromised, or is my wound healing normally and I am being offered sessions that evidence does not support? Give the full history of your operation, the type of graft or flap, and whether the area was previously irradiated. Report all medications including blood thinners, steroids and any chemotherapy, and any epilepsy or seizures, chronic lung disease, previous collapsed lung or ear surgery, and say if you are pregnant or might be. Stop smoking completely, including vapes and shisha, because it is the largest factor in graft and flap failure and sessions do not cancel its effect. Contact the centre to postpone the session if you develop a cold, blocked nose, or an ear or sinus infection, and learn and practise ear equalisation. Remove all creams, ointments, oils, deodorants, perfumes and hair products before entry, and take no phone, lighter or smart watch into the chamber, as this is a fire-safety rule rather than a formality.
After the procedure
Follow your surgeon's instructions to the letter after every session: the position that protects perfusion, no pressure on the area and no sleeping on it, dressings exactly as taught, any antibiotic course completed, and no massaging or applying anything to the area without permission. Do not smoke or sit in a smoky room. Inspect the tissue daily in good light and photograph it if asked, and check your blood sugar after sessions if you have diabetes. Do not drive while dizzy or with blurred vision. Do not change your surgical plan on the strength of the sessions, since they are an adjunct rather than a substitute. **Contact the surgeon immediately, without waiting for the next session, if the graft or flap turns pale, blue or black, feels cold, swells rapidly or becomes rapidly more painful, oozes heavily, discharges pus or smells foul, or if you develop fever or shivering, the wound opens, or new numbness appears. Seek care immediately as well for severe ear pain, bleeding from the ear or hearing loss, shortness of breath or chest pain, or a seizure or twitching.**
Expected duration
A single session usually lasts sixty to one hundred and twenty minutes, plus preparation and observation. For a compromised graft or flap, sessions are intensive and short-term because the window is narrow, sometimes twice daily in the first days before tapering, whereas preparing irradiated tissue for grafting needs a longer programme divided before and after surgery.
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