Plasma skin regeneration technology

Journal of Drugs in Dermatology, Nov, 2007 by Melissa A. Bogle, Kenneth A. Arndt, Jeffrey S. Dover

Abstract

Plasma skin regeneration is a novel type of skin rejuvenation technology developed over the last 3 years. Plasma is the fourth state of matter in which electrons are stripped from atoms to form an ionized gas. Although high temperature plasmas have been used in surgery for over a decade, plasma had previously been used as a conduction medium for electric current. Unlike lasers which rely on the principle of selective photothermolysis to deliver heat to specific targets in the skin, plasma technology delivers heat energy directly to tissue upon contact without reliance on skin chromophores. The plasma itself produces controlled thermal damage to the skin surface to elicit changes such as new collagen formation and improvement in photodamaged skin. The technology can be used at varying energies for different depths of effect, from superficial epidermal effects to deeper dermal heating.

The plasma skin regeneration (PSR) device (Portrait[R] PSR, Rhytec Inc, Waltham, MA) is cleared by the US FDA for multiple single-pass, low-energy treatments and single treatment, one-pass, high-energy treatment of facial rhytides and for the treatment of superficial skin lesions. The PSR device consists of a radiofrequency generator that excites inert nitrogen gas as it flows into the handpiece. The activated, ionized gas is termed plasma. Nitrogen is used for the gaseous source because it is able to purge oxygen from the surface of the skin, minimizing the risk of unpredictable hot spots, charring, and scar formation. (1) This is the same reason nitrogen gas is pumped into fuel tanks on airplanes to force out any oxygen. Nitrogen does not burn so there is no risk of spark or explosion.

After being formed in the handpiece, the plasma is directed through a quartz nozzle in a millisecond pulse onto the skin. As the plasma hits the skin, energy is rapidly transferred causing instantaneous heating without epidermal removal. The plasma appears as a characteristic lilac glow which transitions to a yellowish light called a Lewis-Raleigh afterglow (Figure 1). The depth and area of the thermal effect are determined by the energy setting and spot size of the handpiece. The energy can be adjusted from 1.0 to 4.0 J per pulse.

[FIGURE 1 OMITTED]

PSR technology can be used at varying energies for different depths of effect, from superficial epidermal sloughing to deeper dermal heating. The Portrait PSR is currently the only commercially available plasma skin regeneration device with 4 clinical treatment guidelines (PSR1, PSR2, PSR3, and the very low energy "express" technique). Studies examining a single pass of 1.0 to 4.0 J over postauricular skin showed that at 1.0 to 2.0 J, thermal energy was limited to the epidermis and dermoepidermal junction. At 3.0 and 4.0 J, thermal injury reached the papillary dermis (averaging 8.2 and 11.8 [micro]m, respectively). (2) The PSR1 protocol uses a series of low-energy treatments spaced 3 weeks apart. The first treatment is performed at 1.0 to 1.2 J, and energies are increased as tolerated at subsequent visits. Recovery time is 3 to 4 days. The PSR2 protocol uses one high-energy pass (3.0-4.0 J) with a recovery time of 5 to 7 days, and the PSR3 protocol uses 2 high-energy passes (3.0-4.0 J) with a recovery time of 6 to 10 days. A series of treatments in the mid-energy group (1.5-3.0 J) has had good results in improving skin texture and discoloration, but they have only slightly less recovery time than a single high-energy treatment, and less skin tightening. (1) Thus, most practitioners prefer to use the suggested PSR1, PSR2, or PSR3 protocols. The newer express technique of plasma skin regeneration is performed at very low energies (0.5 J) in a series of 3 treatments in 3-week intervals. (3)

All protocols improve fine lines, textural irregularities, and dyspigmentation. However, skin tightening is probably more pronounced with the high-energy treatments. In a pilot study evaluating the use of a single full-facial treatment at high energy (3.0-4.0 J), Kilmer et al demonstrated a mean improvement in overall facial rejuvenation of 50% by one month with progressive improvement in skin quality at a 9-month follow-up. (4,5) Potter et al used silicone molding to demonstrate a 39% decrease in fine line depth 6 months after one high-energy, full-face treatment. (6) Bogle et al evaluated a series of 3 low-energy (1.2-1.8 J), full-face treatments for facial rejuvenation and found a 37% improvement in facial wrinkles at 3 months follow-up. (7) In the same study, participants rated themselves as having a 68% improvement in overall facial rejuvenation at a 3-month follow-up. (7) The comparison of biopsy samples from the upper lip revealed new collagen formation and significant improvement in sun damage after completion of the treatment series. (7) Initial studies on the very low-energy (0.5 J) express treatment have reported no associated downtime, a 25% reduction in physician wrinkle assessment at the one-month follow-up (with increased improvement at 3 months), and a 40% to 80% improvement in patient-rated overall improvement. (3)