Feel the Burn: Case Report of Internal Thermal Injury from Liposculpture

BACKGROUND Liposuction is a commonly performed aesthetic procedure. New technology is being integrated to target fine lines or creases in the skin, known as rhytides, and skin laxity that cannot be corrected with liposuction. "Liposculpture" is a new term to describe a variation of liposuction that integrates this new technology for both fat reduction and skin tightening. A new form of liposculpture known as Renuvion, which utilizes a helium-based plasma technology, is being added to improve cosmetic outcomes. In this case report, we describe a case of internal thermal injury masquerading as cellulitis from the use of this new technology. CASE REPORT A 37-year-old African-American woman with a history of anemia, hypertension, hyperlipidemia, and depression, with prior breast reduction and liposuction, presented to the emergency room with a 5-day history of waxing/waning fevers that began shortly after undergoing a liposculpture procedure. Imaging demonstrated subcutaneous emphysema and edema in the abdominal wall. Empiric antimicrobials were started given concern for surgical wound infection, but erythema and pain worsened despite treatment. Other infectious markers were negative including negative procalcitonin, normal white blood cell count, and no growth from wound and blood cultures, leading to consideration of a new diagnosis of thermal injury. Antibiotics were subsequently de-escalated to a combination of levofloxacin and doxycycline. She was also treated with topical silver sulfadiazine for her thermal injury. She required multiple rounds of infrared light therapy and lymphatic massage techniques with overall improvement but lasting hyperpigmentation by her 6-month follow-up. CONCLUSIONS Thermal injuries have been an extremely rare finding in patients undergoing cosmetic procedures. Treatments targeting skin laxity and rhytides may confer higher risk. It is important to note that presentations can mimic cellulitis or surgical site infection. In this case vignette, we describe a rare complication of thermal injury following a liposculpture procedure using a cold atmospheric plasma device in a previously healthy 37-year-old African-American woman.