Surgeon Presents HBOT Protocol to Improve Hair Transplant Graft Survival Rates

Dr. Nk Park of Noonopi Plastic Surgery presented a pre- and post-operative Hyperbaric Oxygen Therapy protocol at the Korean Society of Plastic and Reconstructive Surgeons.

Dr. Nk Park, Director of Noonopi Plastic Surgery, presented a structured Hyperbaric Oxygen Therapy (HBOT) protocol at a session of the Korean Society of Plastic and Reconstructive Surgeons. The presentation addressed graft survival as the central challenge in hair transplant surgery and proposed a two-stage HBOT intervention as a clinical solution.
 

[Image by Noonopi Plastic Surgery]

Dr. Park identified ischemia as the defining risk factor in post-transplant graft loss. When follicles are harvested and reimplanted, their original blood supply is severed. New microvascular connections — a process known as anastomosis — take several days to form, leaving grafts in a state of acute oxygen deprivation.
 
“This period is the most critical phase of any hair transplant procedure,” Dr. Park stated. “If follicle cells cannot survive the hypoxic environment before new vessels form, they undergo apoptosis — and the result is graft failure.”
 
Dr. Park noted that while advances in surgical technique, including slit methods and non-incisional implanters, have improved the precision of follicle placement, the survival of grafts during the early post-operative period remains the primary determinant of long-term outcomes.
 
HBOT involves breathing near-100% oxygen in a pressurized chamber at 2–3 atmospheres absolute (ATA). Under standard respiration, oxygen binds to hemoglobin in red blood cells, limiting the volume of oxygen the blood can carry. Under hyperbaric pressure, oxygen dissolves directly into blood plasma.
 

[Image by Noonopi Plastic Surgery]

Dr. Park explained that plasma-dissolved oxygen diffuses freely into surrounding tissue regardless of capillary integrity, allowing oxygen to reach transplanted follicles even before new vessels have formed.
 
“HBOT creates an oxygen environment around newly placed follicles,” Dr. Park said. “It prevents necrosis and accelerates angiogenesis — the formation of new microvessels — which is the mechanism that ultimately determines whether a graft survives permanently.”
 
The protocol Dr. Park proposed is delivered in two stages. In the pre-operative stage, HBOT is administered before surgery to elevate oxygen levels across the scalp tissue, preparing the recipient site by optimizing tissue oxygenation before grafts are placed.
 
In the post-operative stage, HBOT is applied immediately following surgery to supply oxygen directly to the transplanted area. According to Dr. Park, the objectives are prevention of follicle cell death, reduction of post-operative swelling and inflammation, and activation of the body’s tissue repair processes.
 
Dr. Park cited peer-reviewed research in support of the protocol. Studies published in Brain and Behavior (2018) and Life Sciences (2007) have demonstrated that HBOT provides measurable protection against ischemia-reperfusion injury (IRI) — the cellular damage that occurs when oxygen-deprived tissue is reperfused. Dr. Park drew a direct parallel between this mechanism and the conditions transplanted follicles face during the post-operative vascularization window.
  

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