By Jim E. Gilmore, MD, Dallas, TX
Plasma skin regeneration is a new technology that uses plasma energy to regenerate the skin. Portrait® PSR3 (Rhytec, Inc.) has been approved by the U.S. Federal Drug Administration (FDA) for the treatment of facial rhytides, superficial skin lesions, and actinic keratoses for full face and regional resurfacing (eyes and mouth). FDA approval for the chest, neck, hands, and acne scarring has been requested but not yet granted.
We are evaluating this technology, which uses nitrogen plasma discharge as its energy source rather than light or radio frequency emission. Although there are no published outcomes studies yet, our initial results have been promising.
In our series of close to 20 sites, mainly periorbital and periorofacial, there is evidence of good collagen remodelling and diminished rhytids and patient satisfaction. Those with high energy treatment–four joules or greater-are showing the most early improvement as opposed to low energy of one to two joules and sequential treatment. No evidence of hypertrophic scarring, hypopigmentation, or prolonged erythema on patients at over three months. One case of herpes simplex I break through and one case of acne vulgaris-mild. We are monitoring outcomes; we will update results.
This minimally invasive, non-ablative skin rejuvenation is adaptable as an office procedure. It can be delegated to a supervised physician extender (where legal) or used as an adjunct to surgery, and is available for sale only to physicians.
Plasma is generated inside a hand piece with UHF energy imparted to a flow of nitrogen gas. The resulting plasma energy (plume) is comprised of highly
energized (ionized) nitrogen molecules, which are delivered in milliseconds. The nitrogen plasma has a very low thermal time constant, which means it gives up its thermal energy very rapidly so the skin is not broken down, charred, or vaporized upon treatment. This rapid dissipation results in a controlled and uniform energy transmission. The fact that plasma energy is not chromophore specific is also critical to the predictable flow of energy to skin architecture.
We are finding this procedure to be complementary to other skin rejuvenation technologies, including intense pulsed light. Some have proposed that the skin effect is similar to other minimal laser technologies (e.g., Erbium: YAG laser), but no direct comparison has been done to date. Our clinical application to periorbital and perioral rhytids has been very promising and has produced no scarring or hypo-pigmentation. The clinician has options ranging from weekend peel delivered as two or three sequential low energy treatments with some redness for a few days to more definitive high energy treatments that produce redness over a longer period of time. It is important that the skin surface not be “blown away” but left as a protective barrier. None of the skin responses has been as dramatic as those noted with CO2 laser (skin injury).
The operation is simple and the machine occupies little space. The process appears to be safe and effective, producing uniform results for us to date. Plasma skin regeneration seems to provide rapid healing with minimal pain and down time, producing only mild redness for a few days. The observed histo-pathology shows regeneration of the reticular dermal architecture with low (one joule) or high (three to four joules) treatment energy. A full face procedure can be done in less than 30 minutes, and regional treatments require about 15 minutes in our hands. Most treatments are done with topical lidocaine gel with or without pre-treatment sedatives (diazepam, etc.). Regional blocks are an option, as is IV sedation, although neither is usually necessary.
The AAFPRS is willing to share our early experiences with Academy membership and to communicate with other research scientists using plasma regeneration. This procedure appears to answer patient demand for minimal and quick skin rejuvenation.
Re-printed with permission from Facial Plastic Times, November/December 2005 issue by the AAFPRS.
The AAFPRS is the world’s largest association of facial plastic and reconstructive surgeons with more than 2,600 members – whose cosmetic reconstructive surgery focuses on the face, head and neck. Academy fellows are board-certified and subscribe to a code of ethics. In addition, the AAFPRS provides consumers with free information and brochures and a list of qualified facial plastic surgeons in their area by calling 1-800-332-FACE or by visiting the AAFPRS Web Site, www.FACEMD.org.