Hyperbaric Oxygen Therapy in the Management of Dermal Filler-Induced Vascular Occlusion: A Scoping Review.

Abstract

Background: Hyperbaric oxygen therapy (HBOT) has been used in ischemic and inflammatory conditions due to its ability to enhance tissue oxygenation and support wound healing. Filler-induced vascular occlusion (FIVO) is a rare but potentially devastating complication of dermal filler injections that may result in skin necrosis or vision loss. HBOT has been increasingly reported as an adjunctive intervention in FIVO, but its reported use has not been systematically summarized.

Objective: To summarize the existing literature on HBOT use in FIVO, describe reported clinical contexts and treatment parameters, and identify gaps in current knowledge.

Methods: This scoping review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. A comprehensive search of PubMed, MEDLINE, Embase, and Google Scholar identified case reports, case series, experimental studies, and reviews describing FIVO cases managed with HBOT. Articles published in English or Spanish between January 2011 and May 2025 were included. Data were synthesized descriptively.

Results: Twenty-four studies met inclusion criteria, consisting primarily of case reports and small case series. HBOT was most often used as an adjunct to established therapies, including hyaluronidase, antiplatelet agents, vasodilators, and thrombolytic therapy. Reported HBOT protocols varied substantially, with treatment pressures of 2.0 to 3.0 atmospheres absolute and session durations of 60 to 120 minutes. Outcomes were heterogeneous and frequently confounded by multimodal management.

Conclusion: HBOT has been reported as an adjunctive intervention in selected cases of FIVO, but evidence remains limited to low-level observational data, highlighting the need for standardized protocols and prospective studies.