Plasma skin regeneration

What is plasma skin regeneration?

Plasma skin regeneration is a non-laser treatment that uses a device to deliver energy in the form of plasma to rejuvenate skin by improving facial lines and wrinkles (rhytides) and skin pigmentation associated with photoageing. The Portrait® PSR device is the first non-laser technology approved by the FDA and clinically proven to perform skin resurfacing and regeneration using plasma energy.

How does it work?

To understand how plasma skin regeneration works a basic understanding of skin structure is required. Briefly, the skin consists of 3 layers, the epidermis, dermis and subcutis. The epidermis contains pigment-producing cells called melanocytes, which are responsible for skin colouring. The dermis is made up of collagen and elastin fibres that provide skin with strength, toughness, elasticity and pliability.

As the body ages, the appearance and characteristics of the skin alter. The epidermis becomes thinner, so blemishes become more visible, and collagen in the dermis is gradually lost which contributes to the formation of facial lines, sagging skin and wrinkles.

Plasma skin regeneration technology uses energy delivered from plasma rather than light or radiofrequency, compared to other skin regeneration modalities (eg, radiothermoplasty). Portrait works by delivering millisecond pulses of nitrogen-based plasma to the skin via a handpiece. Within the handpiece, an ultra-high-frequency (UHF) generator excites inert nitrogen gas, which is converted into activated ionised gas called plasma. This plasma-containing energy is directed through a quartz nozzle out of the tip of the handpiece and onto the skin. The energy delivered produces a heating action that works at the skin’s surface to remove old photodamaged epidermal cells, and below the skin surface or dermis to promote collagen growth.

The Portrait device can be used at varying energy levels to achieve differing results. The amount of energy delivered ranges from 1-4 Joules per pulse. Currently, there are three recommended treatment protocols:

• PSR1 – low-energy (1-1.2 Joules) treatments spaced three weeks apart
• PSR2 – one high-energy pass (3-4 Joules) performed in a single treatment
• PSR3 – two high-energy passes (3-4 Joules) performed in a single treatment.

Although all protocols improve fine lines, tone and texture, and skin pigmentations, it appears that skin/tissue tightening is more pronounced with high-energy treatments. The low-energy treatments marketed as Portrait Express™ produce results gradually over time and have very little if any, associated downtime. Most patients can have their first treatment at their first consultation and return to their daily activities directly afterwards.

Who is suitable for plasma skin regeneration?

Plasma skin regeneration is used to rejuvenate skin by improving facial lines and wrinkles (rhytides) and skin pigmentation associated with photoaging. It is best performed during the early signs of ageing such as:

• Age spots and skin discolouration (hyperpigmentation)
• Early jowling
• Loosening skin
• Creasing around the nose and mouth
• Wrinkling around the nose and mouth.

What does the procedure involve?

The following is an outline of the Portrait plasma skin regeneration procedure.

Pre-treatment assessment/preparation

• Discuss with the patient to define treatment areas and determine goals of treatment.
• Take pre-treatment photographs if required.
• For low-energy PSR1 treatment, a topical anaesthetic cream is applied 1 hour before treatment starts. For higher energy PSR treatments, a combination of inhalational analgesics such as Penthrox™ and a strong topical anaesthetic cream is required.

Application of Portrait PSR

• The amount of energy absorbed is affected by the hydration of the epidermis. Dry skin absorbs more energy. For this reason, as each area is about to receive treatment the anaesthetic cream is wiped off with a dry gauze immediately before applying the device.
• The tip of the handpiece should be held about 5mm from the skin’s surface as the pulses of plasma energy are delivered.
• A full-face treatment usually takes less than 15 minutes if performed with PSR1, but treatment with high energy PSR3 takes around 45 minutes as it requires two high energy passes.
• With the help of local anaesthetic cream and inhalational anaesthesia, the procedure is relatively painless. A localised sensation of heat will be felt.

Post-treatment and recovery

• Low-energy PSR1 treatments may cause mild redness of the skin that lasts 2-3 days. Some flaking of the skin may occur as dead skin is replaced with new skin.
• Higher energy PSR treatments will cause mild to moderate redness of the skin in addition to the skin turning brown and shedding or flaking over the next 5-10 days after treatment. Patients should be advised not to pick or peel skin to avoid scarring.
• During the healing phase and for several months after treatment, it is recommended that the treatment area is protected using a moisturising sunscreen with an SPF of at least 50+. Protective clothing and wide-brimmed hats should also be used.
• Usually, results are immediate and progressive. Clinical studies show that improvement progression continues for at least one year after treatment.

What are the side effects and complications?

Plasma skin regeneration appears to be very well tolerated by most patients, particularly low-energy treatments (Portrait Express™). Shaving or application of make-up can be done soon after treatment. In most cases, patients can return to work directly after treatments or the following day, depending upon their skin condition and treatment.

To date, no major side effects have been reported. Some of the side effects and complications that may occur, especially after higher energy level treatments include:

• Excessive desquamation (scaling, peeling) and some crusting
• Redness and swelling for up to one week after treatment – this can be helped by applying an ice pack at 10-minute intervals for the first 24 hours. Where patients have received PSR3 with two high energy passes, redness can persist up to 6 to 8 weeks after treatment.
• Temporary hyperpigmentation.