Plasma skin resurfacing - Obliterating wrinkles without open burns

Plasma skin resurfacing is one of the more interesting developments in facial rejuvenation. It has been developed as an alternative to the classic ablative resurfacing (typically done with a CO2 or Erbium laser) where some of your skin is literally burnt off. Ablative resurfacing has many drawbacks, including the risk of infection, scarring and loss of pigmentation, at least two weeks of down time, and so-forth. Yet it remains widely used, mainly because its results, especially in wrinkle reduction, tend to be a lot better than those of safer resurfacing techniques, such as nonablative lasers. Hence researchers are looking for new resurfacing alternatives that are as effective as ablative lasers but with fewer shortcomings. Plasma skin resurfacing appears to be the leading contender.

Most, if not all, types of skin resurfacing are based on the idea of damaging the skin in a controlled manner triggering the healing response, which eventually leads to skin remodeling and improvement in various signs of aging. Plasma skin resurfacing works the same way but with some clever twists. First, the damaging agent is plasma, which is high-energy ionized gas. Second, the gas used is nitrogen, which is chemically inert and capable of suppressing tissue burning since it displaces oxygen required for oxidation to occur. As a result, even though skin layers get damaged by plasma (via heating, fragmentation and vaporization), they do not burn off as they do under ablative laser and largely remain in place. There is no open wound during the healing phase. This approach reduces the risk of side effects such as scarring, infection and loss of pigmentation. Downtime is less than for ablative resurfacing but greater than for nonablative lasers.

The main indications for plasma resurfacing include wrinkles, sun damage, acne scarring and some superficial skin lesions. Some skin tightening may also be achieved. However, just for skin tightening, one may look at nonablative infrared lasers or fractional resurfacing, which appear to achieve similar degree of tightening with even less downtime and side effects.

Since plasma resurfacing is relatively new, best practices are still being refined. Treatments can be done at low- or high-energy settings. Low energy settings are typically used for more superficial effects, such as correction of discoloration, texture and fine lines. High-energy settings can also significantly improve wrinkles, acne scars and produce some tissues tightening. Low energy treatments are often repeated up to 3-4 times about 3 weeks apart, each requiring relatively little downtime. However, a single high-energy treatment may produce more visible results than even a series of low energy treatment albeit it is associated with greater discomfort and longer downtime. After a treatment, whether low- or high energy, the outer layer of the skin dries out but stays in places for a few days to allow healing to occur without infection. Eventually it sloughs off, revealing a layer of new freshly remodeled skin. The downtime is typically between 1 and 2 weeks whereas ablative lasers require anywhere from 2 to 4 weeks of downtime.

Currently, the most commonly use system for plasma resurfacing is Portrait (made by Rytec), which has 3 energy setting: PSR1 (low) and PSR2/3 (high). PSR1 setting is typically used with topical anesthesia, while PSR2 and PSR3 usually entail require local anesthetic injections and preoperative sedation.

So, how do the results of plasma resurfacing compare with more established alternatives? It appears that lower energy settings, used mainly for pigmentation, texture and fine lines, are no more effective than properly selected nonablative laser alternatives. High-energy setting appear to be more effective than nonablative methods but still not as effective as ablative resurfacing. Most experts feel that the results of high energy plasma resurfacing are currently about 50-60% as good as those of ablative lasers. Since plasma resurfacing is relatively new, refining of techniques and improvement of the equipment may narrow this gap in the future.

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