D104-18 The Price of Skin Tightening: Treating Helium in Odd Places With High Fio2

Abstract Demand for minimally invasive body-contouring procedures has surged, leading to widespread use of Renuvion/J-Plasma, a device that combines radiofrequency energy with helium plasma for subdermal skin tightening. FDA-approved in 2022 for aesthetic use, it delivers radiofrequency energy and helium plasma to heat subcutaneous collagen, tightening the skin. While generally safe, complications of subcutaneous emphysema and pneumomediastinum have been reported in five prior cases. This report describes the first known case of hypoxemia following Renuvion use and the first description of a helium washout strategy using high Fraction of inspired O2 (FiO2). A 59-year-old woman developed facial and chest swelling, dyspnea, and hypoxia (oxygen saturation of 80%) during a lower extremity Renuvion skin tightening procedure delivering plasma through subcutaneous incisions. She was transferred to the emergency department where examination revealed diffuse subcutaneous crepitus from the legs to face. Labs showed mild leukocytosis and lactic acidosis. Chest CT with contrast demonstrated extensive subcutaneous emphysema and pneumomediastinum without pneumothorax. She was admitted to the ICU on 28% FiO2 with supportive care including fluids, corticosteroids, and empiric antibiotics. Cardiothoracic surgery advised no intervention. Despite initial improvement, she remained dyspneic and hypoxic, requiring oxygen, four days later. Pulmonology initiated 15 Liters/minute oxygen via non-rebreather mask to wash out the helium with a maximum of 90% FIO2. Within 24 hours, her dyspnea resolved, subcutaneous emphysema markedly decreased, and she was discharged on room air. Subcutaneous emphysema and pneumomediastinum during this procedure likely result from gas escaping through fascial planes after helium fails to fully convert to helium plasma. Complications can include helium embolism, airway compromise, pneumopericardium and orbital emphysema. Other cases have used 32% FiO2 and hyperbaric oxygen therapy but have not noted hypoxia like this case. Use of high-FiO2 therapy accelerates gas reabsorption by increasing the alveolar and tissue oxygen partial pressures thus reducing the partial pressure of other gases and creating a steep diffusion gradient. This allows the inert noble gas, helium, to rapidly diffuse out the tissue into the bloodstream and out the alveoli. In this case, Boyle’s law and Fick’s law of diffusion supported the rapid clearance of helium and symptom resolution. High-oxygen therapy serves as an effective, accessible alternative when hyperbaric oxygen therapy is unavailable for helium-related subcutaneous emphysema or pneumomediastinum. This abstract is funded by: None