A Comparative Multimodal Approach to Post-Inflammatory Hyperpigmentation After Energy-Assisted Liposuction: Laser Therapy With or Without Hyperbaric Oxygen

Abstract Background Post-inflammatory hyperpigmentation (PIH) is a frequent but underrecognized complication following energy-assisted liposuction and may compromise aesthetic outcomes, particularly in procedures marketed as minimally invasive and scarless. Although Q-switched Nd:YAG laser therapy is considered a standard treatment, incomplete resolution and recurrence remain common, suggesting the need for adjunctive therapies targeting the inflammatory tissue microenvironment. Objectives To evaluate whether hyperbaric oxygen therapy (HBOT) enhances the efficacy of Q-switched Nd:YAG laser therapy in the treatment of post-liposuction PIH. Methods A retrospective observational study was conducted on 186 patients who developed clinically relevant PIH (Post-Aspiration Hyperpigmentation Index [PAHPI] >10) after ultrasound-assisted liposuction (VASER®) between 2019 and 2024. Patients were divided into two groups: Group A (laser therapy alone, n=93) and Group B (HBOT followed by laser therapy, n=93). HBOT consisted of 20 sessions at 2 ATA for 45 minutes. PIH severity was assessed using PAHPI scores at baseline and after treatment, with a minimum follow-up of 6 months. Multivariable analyses evaluated the influence of procedural variables. Results Both groups demonstrated significant PAHPI reduction after treatment (p<0.0001). However, the combined HBOT and laser group showed significantly greater improvement compared with laser alone (p<0.001). The greatest improvements were observed in the abdomen and back, while lower limbs showed higher residual pigmentation. In the combined group, a significant inverse correlation was observed between lipoaspirated volume and PAHPI reduction (p<0.001). VASER application time was not independently associated with baseline PIH severity. Conclusions Adjunctive HBOT significantly enhances the efficacy of Q-switched Nd:YAG laser therapy in post-liposuction PIH treatment without increasing adverse events.