The other day, Coral* came to see me. A health professional who works in the aesthetic industry, Coral has a youthful, volumized face in keeping with a woman who has access to all of the best anti-aging treatments.

On this visit, I can see that she is healing from a fractionated laser treatment (see our Pixel — one of my favorite treatments). Coral tells me that she had a very aggressive laser treatment and followed it up with a hyperbaric oxygen (HBO) treatment about 24 hours later.

“I loved the hyperbaric treatment. It made me feel energized and my face healed really quickly.”

OK, that sounds interesting to me.

I should share with you here that in my former life working at the hospital, I was a consultant for the HBO service at the Hamilton General Hospital so I have treated a lot of patients with HBO and reviewed a lot of scientific papers on the use of HBO for a variety of conditions.

HBO is the treatment that divers go through when they have the bends. You are placed in a chamber that can be sealed so that the contents (meaning you and the air in the chamber) can be pressurized to 1.5 to 3 times the normal atmospheric pressure. It is like diving down 33 feet (double normal pressure) or more. You will definitely feel the pressure in your ears, and possibly other places.

Then Coral said “I loved the hyperbaric so much that I am planning to have a treatment every month. I think it is a great anti-aging treatment.”

Whoa! This healthy, youthful-looking 40 year old is going to have HBO treatments every month?

I asked her if they had fully explained the risks and benefits of the treatment.

“Oh yeah, I filled in a consent form. It mentioned air embolism (a bubble of air in the circulation which can block blood flow) and pulmonary embolism (a blood clot in the circulation of the lung).”

I explained to Coral that there are 2 main groups of side effects from HBO treatments — barotrauma which means damage caused by the increased pressure of the treatment, and oxygen toxicity which is an effect of the high oxygen concentration in the blood achieved by the HBO treatment.

Some of the side effects of the treatment are self-limited: for instance, you may develop seizures from oxygen toxicity and the seizures stop when you return to a normal oxygen level. Others can cause permanent damage such as scarring of the lungs, called pulmonary fibrosis, from exposure to high oxygen levels.

This case really illustrates the importance of informed consent and the principle of risk vs. benefit.

Every treatment has some risk associated with it. In thinking of risk, we consider how likely it is that the side effect will occur, how serious the side effects are and how difficult it is to treat the side effects.

For something like cosmetic botox, the risk is that the botox will affect a muscle we don’t want — usually the eyelid so that the eyelid droops. This is annoying but not life-threatening or vision-threatening and will wear off naturally in time. There are eye drops that can help minimize the eyelid droop.

Overall, the likelihood of a botox-induced lid droop is very low (but it varies depending on the provider), the severity of a droop is low and it will wear off naturally. Overall, this sort of risk is very acceptable for an elective, cosmetic procedure, right?

In contrast, HBO has some very serious potential side effects, including ruptured ear drums, heart failure, seizures, shortness of breath and changes in vision. I agree that these side effects are less likely in healthy people but they still can occur in them. The treatments range from stopping the HBO treatment (seizures) to prolonged healing times and needing medications, all the way to needing life support.

HBO therapy increases the oxygen levels in your blood and tissues. For instance, HBO is used to treat conditions associated with oxygen deprivation to the tissues such as carbon monoxide poisoning, cyanide poisoning, compartment syndrome (where traumatized tissues become so swollen that the blood flow to an area is compromised) and radiation necrosis (where radiation treatments for cancer has caused scarring and shrinkage of blood vessels).

In certain conditions where tissues are compromised from insufficient oxygen levels, HBO can make the difference between tissue survival and tissue death. I am not aware of any studies showing that HBO has anti-aging benefits in healthy people. I think that someone has made the leap from HBO’s effect in compromised tissue to thinking it will benefit healthy tissue.

I definitely think that HBO is a worthwhile treatment for a serious medical problem like the ones I mentioned above but as an anti-aging treatment, it is another story. We don’t know what sort of benefit you can expect from HBO as an anti-aging treatment. Unless you are a Hollywood star whose fortune depends on remaining youthful-looking, I would think that the risks of HBO are unacceptable for an elective anti-aging treatment.

Coral had not been informed of all of the risks of HBO therapy. If she had known all of the possible side effects, she would not be considering having a treatment every month.

The moral of the story is to make sure you read the consent form when you are having cosmetic medical treatments (or any other medical treatment, for that matter). If you are having a treatment that is considered new or for a new or unusual indication, do your own research online to find out what the risks are. It helps to ask a doctor to put the risks into perspective for you.

You are the best judge of how much risk you are willing to take for the expected benefit of the treatment. Make sure that you are getting a good sense of the expected benefit of the treatment based on evidence.

And always ask whether there is another safer way to get the same benefits.

*Name changed to preserve anonymity.