Key Takeaways
- Hyperbaric oxygen therapy (HBOT) means breathing pure oxygen in a hard chamber pressurised to about two to two and a half times normal air pressure. It’s an accepted hospital treatment for some problems, including skin grafts and flaps whose blood supply is failing.
- For routine facelift or rhinoplasty, the evidence is limited. The main facelift study is a small retrospective comparison of 20 women, and there are no published randomised trials in facial cosmetic surgery.
- Soft “mild” chambers and oxygen facials aren’t the same as HBOT. The Australia and New Zealand Hyperbaric Medicine Group doesn’t recommend mild chambers for any medical purpose.
- I recommend HBOT as an optional addition for most facial surgery patients, usually two to three sessions a week for the first two weeks. It isn’t proven to shorten recovery, it’s never a substitute for careful surgery, no nicotine and good aftercare, and you can decline it.
- HBOT is generally safe in a supervised medical facility, and ear pressure is the most common problem. It isn’t covered by Medicare after cosmetic surgery, and costs vary between providers.
Hyperbaric oxygen comes up more often in consultations now, especially from patients planning a facelift, deep plane facelift or rhinoplasty. It’s a reasonable question, because the idea behind it makes sense and it’s widely promoted.
In this article I explain what HBOT is, how it differs from mild chambers, why it might help healing, what the studies show, the risks, and how I approach it with patients.
I’m Dr Scott J Turner, a Specialist Plastic Surgeon (FRACS). This is general information, and whether HBOT suits you is decided individually.
What hyperbaric oxygen therapy is
In HBOT, you breathe 100% oxygen inside a hard-shell chamber pressurised to about two to two and a half times normal air pressure, usually for 60 to 90 minutes. At that pressure, much more oxygen dissolves directly into the blood plasma, so it can reach tissue whose small blood vessels have been disrupted.
It’s an accepted hospital treatment for a defined list of problems, including diving-related decompression illness, carbon monoxide poisoning, some radiation injuries, some non-healing wounds, and skin grafts and flaps whose blood supply is failing.
Medicare has specific item numbers for HBOT for a short list of conditions, such as decompression illness, diabetic wounds and some radiation injuries, given in a hospital-based hyperbaric unit. Medicare doesn’t pay for services provided for cosmetic reasons, so HBOT after cosmetic surgery isn’t covered.
Its use as a routine recovery aid after cosmetic surgery is much newer, and that’s where the evidence is thinnest.
Mild chambers and oxygen facials aren’t the same
Soft or “mild” chambers. These inflatable chambers, found in some wellness and shop-front settings, usually reach about 1.3 times normal pressure, often with around 30% oxygen. In 2010 the Australia and New Zealand Hyperbaric Medicine Group concluded that mild hyperbaric therapy doesn’t usually give the body more oxygen than breathing oxygen through a mask at normal pressure, and it doesn’t recommend it for any medical purpose.
Oxygen facials. These apply oxygen to the skin at normal pressure. They aren’t hyperbaric treatment.
If HBOT is part of your recovery, it should be in a hard chamber in a medically supervised hyperbaric facility.
Why it might help healing
Facial surgery lifts skin and soft tissue and temporarily disrupts its small blood vessels. Healing tissue needs oxygen, and when oxygen is short, healing can slow. In laboratory and wound-care research, higher tissue oxygen supports new blood vessel growth, collagen formation and resistance to infection.
The same reasoning applies to rhinoplasty. Cartilage has a poor blood supply, and the skin over the nose can be thin and tightly attached, particularly after previous surgery.
That makes the idea plausible. A plausible mechanism isn’t the same as proof that HBOT changes the result after a routine facelift or rhinoplasty, and it’s important to keep those two things apart.
What the evidence shows
| Evidence | What it found |
|---|---|
| Facelift, 2023 (20 women, retrospective, single surgeon) | Women treated after the surgeon started using HBOT were compared with earlier patients who didn’t have it. Average wound healing time was 13 days with HBOT and 37 days without, but the ranges overlapped widely (7 to 30 days versus 6 to 90). Healing was judged by observation and patient report. |
| Aesthetic surgery review, 2025 (11 studies, 734 patients) | About two-thirds of studies were in abdominoplasty or breast surgery. Average healing time in patients who had HBOT was about 11 days. The authors judged HBOT effective, but study designs and protocols varied widely, and they called for randomised trials. |
| Aesthetic surgery, medicine and anti-ageing review, 2025 (15 articles) | Concluded that the evidence to support HBOT’s use, and to justify its cost, is limited. |
| Acute surgical and trauma wounds, Cochrane review, 2013 (4 trials, 229 participants) | Found a lack of high-quality evidence that HBOT helps wounds heal. All four trials were at unclear or high risk of bias. |
| Compromised grafts and flaps | Hyperbaric medicine reviews support HBOT as an add-on when a graft or flap’s blood supply is failing, mainly on laboratory and observational evidence. Randomised trials are few and mixed. This is rescue treatment, not routine care. |
| Rhinoplasty | No published randomised trials. Expert reports describe its use in complex revision rhinoplasty where the blood supply to the nasal skin is compromised. |
| Fat grafting | A 2022 study in rats reporting better fat graft survival with HBOT was retracted in 2023. |
The facelift study was small, included only women, compared patients treated at different times, and wasn’t randomised or blinded. Its authors called for larger randomised trials before firm conclusions are drawn.
How I use HBOT
I recommend HBOT as an optional addition for most of my facial surgery patients, including after facelift, brow lift, rhinoplasty, eyelid surgery and fat grafting.
My reasons are the plausible mechanism, its accepted role when tissue is compromised, and its low risk in a supervised facility. It isn’t because HBOT has been proven to shorten recovery. As the studies above show, it hasn’t been tested in randomised trials in these operations, and for fat grafting the evidence is especially thin. It’s always your choice, and declining it doesn’t change your surgery or aftercare.
HBOT doesn’t replace stopping nicotine. All nicotine has to stop for at least six weeks before surgery (ideally eight) and at least six weeks after, and that matters far more than any therapy. I explain why in smoking, vaping and nicotine before plastic surgery.
What a course involves
I usually suggest two to three sessions a week for the first two weeks after surgery, at a local medically supervised hyperbaric facility. Sessions usually last 60 to 90 minutes, and the hyperbaric doctor checks your health before the first one. Protocols in studies vary: in the main facelift study, sessions started within a day of surgery and most were daily.
HBOT is provided by independent hyperbaric facilities, not by my practice. I refer patients to local providers and have no financial interest in any of them. Each provider sets its own fees, and prices vary, so check the cost with the provider before you start. Medicare doesn’t fund HBOT after cosmetic surgery.
Risks and side effects
In a supervised facility, HBOT is generally safe, but it isn’t risk-free:
- Ear and sinus pressure is the most common problem, like a plane descending. In one centre’s series of 2,334 patients, about 9% had some middle ear pressure injury at some point during their course. Equalising techniques usually manage it.
- Temporary short-sightedness can develop, usually after 20 or more sessions, and generally settles over weeks to months after treatment stops.
- Seizures from oxygen toxicity are rare. Over 20 years in one Australian hospital unit, they occurred in about 1 in 1,650 treatments, and the risk was much lower at about twice normal pressure or less than at higher pressures.
- Low blood sugar can occur in people with diabetes, so it needs to be monitored.
- Claustrophobia and anxiety can make sessions difficult for some people.
- Some conditions rule it out, most importantly an untreated collapsed lung. Some lung conditions, ear or sinus problems and certain medicines need assessment first.
How it fits into your recovery
The foundations of recovery matter more than any add-on: a careful operation, no nicotine, keeping your head raised, rest, and following your aftercare. I cover the other popular extras in arnica and bromelain after surgery, and what’s normal in bruising and swelling after a facelift. The preparing for plastic surgery guide covers the weeks before.
If you’d like to talk through whether HBOT makes sense for your operation, you can contact the practice.
Frequently asked questions
Does hyperbaric oxygen therapy help after a facelift?
It may, but the evidence is limited. The main facelift study, a 2023 retrospective comparison of 20 women, found an average wound healing time of 13 days with HBOT and 37 days without, but the groups were treated at different times and the study wasn’t randomised. Broader reviews describe the evidence in aesthetic surgery as limited. I recommend it to most of my facial surgery patients as an optional addition, but not because it’s proven to shorten recovery.
Is hyperbaric oxygen therapy safe?
In a medically supervised facility, it’s generally safe. The most common problem is ear pressure, which is usually managed with equalising techniques. Temporary short-sightedness can develop over a long course, and seizures from oxygen are rare. An untreated collapsed lung rules it out, and some other conditions and medicines need checking first.
How many sessions are needed after surgery?
There’s no agreed number. I usually suggest two to three sessions a week for the first two weeks after surgery. In the main facelift study, patients had an average of about 7 sessions (range 1 to 15), each lasting about 78 minutes at about twice normal pressure, starting within 24 hours of surgery. Protocols in other studies vary widely.
Is a mild or soft hyperbaric chamber the same as HBOT?
No. Soft, inflatable chambers usually reach about 1.3 times normal pressure, often with around 30% oxygen. Australia and New Zealand’s hyperbaric medicine group concluded that they don’t usually give the body more oxygen than breathing oxygen through a mask, and it doesn’t recommend them for any medical purpose. Oxygen facials apply oxygen to the skin at normal pressure and aren’t hyperbaric treatment either.
Does Medicare cover hyperbaric oxygen therapy after cosmetic surgery?
No. Medicare has specific item numbers for HBOT for a short list of conditions, such as decompression illness, diabetic wounds and some radiation injuries, and it doesn’t pay for services provided for cosmetic reasons. HBOT is provided by independent hyperbaric facilities, which set their own fees, so prices vary. I refer patients to local providers and have no financial interest in any of them.
