Resurfacing safety: Study indicates plasma safer than CO2 laser

Key Points

National report - A recent retrospective analysis reveals - somewhat surprisingly - that the dramatic results of plasma skin resurfacing (PSR) also come with markedly improved safety over CO₂ laser resurfacing, a study co-author says.

"The reason CO₂ resurfacing has fallen out of favor is that it has a poor safety profile," says Richard Fitzpatrick, M.D., a La Jolla, Calif., dermatologist in private practice.

In contrast, he says benefits of the Portrait PSR system (Rhytec) include significant skin-tightening and rejuvenation, with a far better safety profile.

Specifically, researchers assessed incidence rates of hypopigmentation, hyperpigmentation, persistent erythema, scarring, and bacterial and viral infection for all patients. Half of the PSR patients included in the sample underwent more than a year of follow-up; the rest had at least six months' follow-up.

Ultimately, Dr. Fitzpatrick says, "The papers that we reviewed had relatively similar complication rates reported by all the authors."

For patients who had undergone CO₂ resurfacing, hyperpigmentation (transient and other) represented the most common adverse effect, occurring in 21 percent to 34 percent of patients. Next came bacterial and viral infection (7 percent to 8 percent) and prolonged erythema.

Although scarring occurred rarely, he says, rates of late hypopigmentation range from 8 percent to 20 percent of CO₂ patients evaluated. And while initial recovery time for CO₂ patients averaged two weeks, erythema lasting two to six months occurred commonly.

Downtime

In contrast, investigators found that PSR requires four to seven days' downtime, with post-treatment erythema lasting two to three weeks. Perhaps more importantly, postinflammatory hyperpigmentation occurred in only 3 percent to 4 percent of patients evaluated.

Additionally, infection occurred in less than 1 percent of PSR patients, and PSR patients experienced no hypopigmentation.

Patient and physician-rated improvements with PSR ranged from 30 percent to 70 percent, based on energy level used (3 to 4 J).

"We still haven't seen any cases of hypopigmentation in patients treated with PSR," Dr. Fitzpatrick says.

He says that during the past five-plus years, he has treated nearly 500 patients with this technology in his office and seen no increases in complication rates, with the possible exception of limited areas of infection.

Nevertheless, Dr. Fitzpatrick says, "It's a little surprising to find that one can resurface the skin and get potentially dramatic results with far greater safety. The reason for that is that with plasma resurfacing, the surface layer remains intact and acts as a biological dressing. It's far different from the CO₂ laser in that sense."

While PSR achieves deep heating of tissue, resulting in tightening, he says, "There is not a deep peel with this instrument," which further accounts for its safety.

Dr. Fitzpatrick says that when performing PSR treatments on areas other than the face, physicians must cut back the pulse energy to produce a more superficial response and avoid post-treatment problems.

"You cannot use the high energies (3 to 4 J) off the face," he says.

At these levels, Dr. Fitzpatrick says heating penetrates too deeply, which could slow healing and potentially create scarring.

Regarding study weaknesses, he says, "The fact that it's retrospective made it hard to control all the variables. So, we didn't know for sure that everybody was treating the same way."

However, Dr. Fitzpatrick says the studies analyzed reflect how physicians are generally using both instruments.