Plasma versus CO2

"CO2laser skin resurfacing remains the gold standard for the treatment of deep lines and wrinkles in the perioral region," says Ross A. Clevens, M.D., F.A.C.S., a facial plastic surgeon in private practice at the Center for Facial Cosmetic Surgery in Melbourne and Merritt Island, Fla., and president of the Florida Society of Facial Plastic Surgery.

However, he says, "Plasma skin resurfacing (Portrait PSR3, Rhytec) offers an excellent opportunity for substantial reduction in lines and wrinkles with a dramatically shorter healing period and downtime as compared with CO₂ laser skin resurfacing."

If a patient wants his or her wrinkles gone or treated as thoroughly as possible with maximal results, he says, "CO2 laser skin resurfacing remains the treatment of choice. However, laser skin resurfacing carries certain drawbacks."

Typically, he notes, it takes seven to 10 days for re-epithelialization; 10 to 14 days until the patient can apply makeup; and up to three months for pinkness in treated areas to resolve.

"A long-term and perhaps permanent risk of laser skin resurfacing is hypopigmentation," he adds.

If any of those risks prove unacceptable to the patient, Dr. Clevens says, "Then laser skin resurfacing is not a viable option; indeed, the patient's desired outcome of eradicating lines and wrinkles is not achievable" within the patient's parameters.

By the same token, he adds that if a patient tends not to wear makeup, "Oftentimes laser skin resurfacing is an unacceptable option" due to the long-term potential for hypopigmentation.

A place for plasma

Conversely, Dr. Clevens says that plasma skin resurfacing offers two modes, each with less downtime than is associated with CO2 lasers.

The first is a low-energy treatment consisting of three sessions spaced about a month apart.

"Each of those sessions is associated with a day or two of healing, and very transient redness, on the order of a few days," he tells Dermatology Times.

Plasma skin resurfacing also can deliver a single high-energy treatment, Dr. Clevens says. At the higher energy level, he says patients usually experience three to six days' healing time.

"The patient can apply makeup within five to seven days," Dr. Clevens adds, "and the patient is mildly pink for two to three weeks."

Alternately, he reveals that he sometimes follows up high-energy treatments with a second pass at either the high or low energy level, delivered during the same session to address individual wrinkles.

"If one treats the deeper wrinkles with a second high-energy pass," he says, "one gets better improvement than one would with a single pass."

To date, Dr. Clevens says he has treated approximately 100 patients with plasma skin resurfacing and has been very pleased with its results.

With this modality, he explains, "We can get a very good - perhaps not excellent or great - reduction in lines and wrinkles, with a procedure that offers a substantially shorter recovery period and does not carry a risk of pigmentary change."