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Plasma screen

Article-Plasma screen

Key iconKey Points

  • Plasma resurfacing with Rhytec's Portrait PSR is nonlaser and nonlight-based
  • Some doctors say they still need to be convinced of the technique's benefits over current options
  • One plasma pioneer argues that plasma resurfacing's results are superior to those of a chemical peel

3.5-J double-pass Rhytec plasma treatment: (Left) pretreatment and (right) 1 month post-op (Photo credit: Richard Fitzpatrick, M.D.)
NATIONAL REPORT — Amid the nonstop introduction of new lasers and light-based therapies to the market, Rhytec's Portrait PSR plasma resurfacing technology stands out for its unique use of plasma energy instead of laser, light or radio frequency to rebuild skin below the epidermis. But the jury is still out on whether plasma resurfacing's benefits are as noteworthy as the technology.

The system has FDA approval for a range of indications, including correction of nonfacial and facial wrinkles in addition to treatment of superficial skin lesions, actinic keratosis, seborrhoeic keratosis and viral papillomata. It works by delivering nitrogen plasma energy below the surface of the skin to generate new collagen.

The Portrait PSR is officially described as nonablative, but its settings range from one to four joules per pulse, allowing for resurfacing that can be closer to ablative techniques such as CO2. But with a downtime of a week to 10 days, the recovery period is not as substantial as with CO2. In addition, its manufacturer reports that clinical studies to date show no evidence of hypopigmentation, which can be a risk with CO2.

CENTRAL FEATURES A key selling point that Rhytec emphasizes is the Portrait's ability to leave the epidermis "intact," allowing it to act as a biologic dressing until the new skin regenerates. But some question the actual significance of that feature.

"It's a relative advantage to have the epidermis intact and enhance the healing response, but I don't think that's the most important thing," says Richard Fitzpatrick, M.D., associate clinical professor at the University of California, San Diego, who helped pioneer plasma regeneration.

Dr. Fitzpatrick
"I think the most important thing is the temperatures that are reached in the dermis and the fact that the Portrait can heat several hundred microns down," he points out.

Dr. Fitzpatrick tells Cosmetic Surgery Times that he still ranks CO2 as the gold standard for skin resurfacing, but due to the downtime and notoriety for complications associated with CO2, it's a much tougher sell than plasma resurfacing. While he performs about two to three CO2 resurfacing procedures a month, Dr. Fitzpatrick says he usually performs as many as eight to 10 plasma resurfacing procedures per month.

PRACTICE MAKES PERFECT Technique is the key to the best results with plasma, he stresses. "It's very technique dependent — when I look at my early patients versus the ones I treat now, the ones I treat now are far better than the first," Dr. Fitzpatrick says. "One of the big factors to consider is the degree of coverage of the surface," he emphasizes. "For reasons I don't entirely understand, even if the surface is covered uniformly, it doesn't react uniformly, so you have to go back over some areas until you see a uniform tissue reaction."

"It's important to do repeated partial passes until you get the surface to react in a uniform manner." Areas that Dr. Fitzpatrick says he has the most success with include tightening around the eyes and cheeks and correction of significant photodamage around the mouth.

For the latter, he says he brings in Fraxel resurfacing as a back-up.

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