Where It Fits in the Array of Skin Resurfacing
Techniques Available Today.
Stuart H. Bentkover, MD FACS
Worcester and Stoneham, Massachusetts
The objective of most facial resurfacing techniques is to remove wrinkles or scars and rejuvenate your skin. The earliest techniques involved a mechanical removal of skin layers (dermabrasion) or the application of various chemicals to the skin (chemical peels). In the mid 1990’s lasers became a popular treatment method. The most common lasers used were, and still are, the carbon dioxide laser and erbium laser. Lasers work by delivering a light of a pure, single color (wavelength) to the skin. The part of the skin targeted by the laser is related to the color of the laser light and the color of the target in the skin. Each different colored laser beam has a color or range of colors that best absorbs the color of that particular laser. For the carbon dioxide laser, for example, the primary target of the laser beam is clear water. Since skin cells are mostly water, the laser targets these cells and vaporizes them away in a very controlled and precise manner. Fraxel® laser and fractionated carbon dioxide laser technology provide a new means of delivering the laser beam that spares tissue between adjacent areas targeted by the beam. The primary target is still water.
Most of the different resurfacing techniques still have appropriate applications today. The right technology for you depends on the depth of the wrinkles or scars to be treated, how much excess pigment or other signs of sun damage you may have in your skin, and how your skin reacts to light and heat. Your Facial Plastic Surgeon can often offer you a number of choices or a combination of choices that best fit your needs and your skin type. Most of these techniques lead to formation of a new epidermis (the most superficial layer of the skin) and a tightening of the dermis (the second layer of the skin) by the formation of new collagen, the basic building block of your skin. The amount of tightening depends often on the amount of heat delivered to the skin and the precision of the technique.
Most of us were taught in school that there are three states of matter, solid, liquid, and gas. Actually, there are four. The fourth state of matter is plasma, an electrified gas found many places in nature, like the explosions off the sun’s surface, electrical storms, and the Northern Lights (Aurora Borealis). Some of us even have plasma in our TV sets.
One of the newest technologies for skin resurfacing is called plasma skin regeneration. Instead of using a laser or a chemical to remove and heat the skin, this technology delivers heat to the skin through the careful and controlled application of a plasma gas. When applied to the skin, the plasma heats the epidermis and dermis. Over the course of usually 4-7 days, the heated epidermis begins to shed, leaving behind a brand new epidermis. At the same time, new collagen fibers begin to form and line up perpendicular to the surface of the skin, which is their normal orientation. New collagen formation can even continue for up to 1 year.
With the classic, full power, carbon dioxide laser resurfacing (still the standard to which most new resurfacing techniques are compared) the orientation of the new collagen is parallel to the surface of the skin. This can sometimes lead to a shiny appearance. Also, the collagen formation period is much shorter. Generally, a plasma treatment does not penetrate the skin as deeply as a full carbon dioxide laser treatment. It may not get rid of the very deepest wrinkles as well as the laser, but the down time for overall healing is much shorter. This can be an important consideration for busy people and is often a primary reason your physician may offer plasma technology. Also, some physicians feel that the quality of the skin after a plasma treatment looks more natural and more “rejuvenated” than with a laser treatment. While deeper laser treatments or chemical peels can sometimes leave the skin very light (hypopigmentation) or too shinny, the plasma treatment usually leaves a very natural and younger looking skin. Plasma skin regeneration is also a very effective and quick way of removing excess brown pigment in your skin from sun damage and some benign and pre cancerous lesions caused by the sun.
For most skin types treated, plasma skin regeneration is usually done in one treatment. The Fraxel® laser may have similar affects on the skin but usually requires a series of three to six treatments. For Mediterranean or South American skin types (patients who never get a sun burn), plasma is often done in three or four treatment sessions using a lower amount of energy than with the single treatment technique. Like most laser resurfacing techniques, it is generally not recommended for Asian or Black skin. While very controlled, the skin irritation generated by a laser or a plasma gas could cause an increase in pigment in these darker skin types. This is called post inflammatory hyperpigmentation.
Most plasma treatments can be done in the physician’s office. Similar to other resurfacing techniques, the type of anesthesia required for a plasma treatment can be as little as a topical anesthetic cream or as much as intravenous sedation or general anesthesia. The type of anesthesia depends on the size of the area to be treated (e.g. just eye lids vs. the entire face), the amount of energy used, and your personal tolerance for some discomfort..
Used by itself, or in combination with other resurfacing techniques, plasma skin regeneration is another, new and exciting technology that your Facial Plastic Surgeon can use to rejuvenate your skin.
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