Transcript Chris Zachary, MD PPT

Webinar
Christopher Zachary, MD
Professor and Chair
Department of Dermatology
University of California - Irvine
Chris Zachary’s take on plasma
Early on –> … “I blew off the technology!”
& Now…
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“Portrait plasma actually delivered on the cosmetic outcomes that were claimed,
as they were based on an extensive series of preclinical and
IRB-controlled studies by reputable physicians across several aesthetic specialties
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Furthermore, now there is proven long-term patient results out over 5 + years.
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With high energies, you can get very nice skin tightening, excellent reduction in
pre-cancers and very nice color and texture and tone
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Portrait technology provides a highly effective mechanism for patients requiring
skin rejuvenation across a spectrum of indications.
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This technology is safe, reliable and effective.
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I am personally delighted to see this technology back in harness!”
Portrait® plasma – what is it?!
 Plasma (ionized gas) is the 4th state of matter (solid, liquid, gas, plasma)
 99% of the visible universe is plasma,
including most of the matter in the sun, stars
and the region of space around Earth
Sun
Aurora Borealis
 Portrait plasma formed by combining pulsed nitrogen gas and UHF energy
(no UHF energy delivered to the skin)
 N2 plasma (diatomic molecule-strong bonds)
 chosen for controlled, predictable thermal energy delivery to the skin’s architecture
 heats all tissue components
 not chromophore dependent
 Bottom line: thermal energy from the plasma generated is delivered at 5mm
and absorbed by the skin architecture, resulting in both immediate and long-
term tissue effects and skin regeneration
Plasma Zone of Effect of Portrait Nitrogen Plasma
Thermal (plasma) energy
delivered to the skin
Predictable, non ablative
impact at all energy levels
Gaussian distribution of
energy delivered to the
whole skin architecture
Non-fractionated, nonchromophore dependence
provides full coverage
Inner Zone = Zone of Thermal Damage
Outer Zone = Zone of Thermal Modification
Portrait’s 3Dimensional
Thermal Effects
on Skin Architecture
3D Thermal heating
within skin architecture
Note the depth of heating effect at ~ 70°C for triggering
neocollagenesis in 100% skin architecture
Portrait System and Delivery System
 No need for safety eyewear/
special room prep
 110/220 VAC single phase; <10A
 N2 gas C-cylinder
 Portable
Unique Features of Portrait Plasma Skin Regeneration
•
Works at and below the surface of the skin to modify the
skin’s architecture generating new collagen and elastin
•
Non-ablative at time of treatment, leaving the skin intact
•
Stimulates the body to regenerate the sun-damaged
structural elements of the skin
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Clinical improvements in skin tone, texture and laxity are seen
immediately and improvement continues up to a year
•
Creates a tremendous zone of regeneration filled with many times the normal amount
of cells that create collagen and decrease of elastosis
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Versatile treatment options: lunchtime treatment through high-end results comparable
to CO2 laser but with fewer complications and less downtime
“Portrait creates a natural, intact, and uninterrupted biological dressing that sheds
naturally. The patient’s own protective dressing could retain growth factors, accelerate
healing, and diminish the chance of scarring.” Dr. Suzanne Kilmer
Non-Contact Plasma Pulse
 Millisecond pulses of nitrogen plasma
 Pulses applied adjacently with slight
overlap
 Energy Range: 1- 4 Joules (.1 J)
 Rep Rate: 1-2.5 Hz (.5Hz)
 Optimal delivery distance:
5mm from skin surface
 Portrait Express/VLE (0.65 J)
delivery distance 25mm from
skin surface at 1J energy setting
Plasma is formed inside disposable
nozzle connected to the handpiece
Portrait Plasma Treatment Histology
 100% treatment of skin architecture
 100% intact architecture
Day 0 following
treatment
(at 3.5 J)
• Highly reactive dermis
• Vacuolation occurs at high energy
 Developing line of cleavage
between Zones of Thermal Damage
and Modification
Day 4
 New Stratum Corneum under line of
cleavage
 Regenerated Epidermis
 100% regenerated epidermis with
residual activity in basal layer
Day 10
 Zone of Thermal Modification:
intense fibroblast activity,
neocollagenesis & neovascularization
regenerating the reticular dermis
Retention of Cellular Contents — Portrait Plasma Pulse
“A wound response without an
open wound…unique…”
Dr. Eric Bernstein, upon analyzing the
study histologies
Immediate Pre-Tx
Stratum Corneum & Epidermis intact during Tx
Post-Tx dehydrated cell contents still present
Cytoplasmic or nucleic viral proteins will remain
within the intact cell wall which sheds 3-4 days
following Tx
Immediate Post-Tx: 3.5 J
No ablation or vaporization
of cellular material
Portrait Unique Energy Dependent Effect
0.65-1.0J
1.0-2.0J
3.0-4.0J
Above this line of cleavage, the skin will shed after new architecture is regenerated
Full Spectrum of Treatments
Portrait Treatment Protocols
For regional treatments (i.e., peri-orbital, -oral)
Demarcation lines not seen with regional area treatments
(i.e., eyelids) or around the jaw line for full face
FDA-cleared for treatment of:
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rhytides (of the body — on/off face)
acne scars
actinic & seborrhoeic keratosis
benign skin lesions
viral papillomata
A Retrospective Analysis of the Safety Profiles of a New Plasma Skin Regeneration Device
Compared to CO2 Lasers
Kenneth O. Rothaus, M.D.1, Richard Fitzpatrick, MD2
York Presbyterian Hospital, New York, NY; 2La Jolla Cosmetic Surgery Centre, San Diego, CA
Background and Objective:
Although the CO2 Laser is considered the
industry gold standard for laser resurfacing,
many physicians have abandoned the
technology due to the complications and
prolonged recovery. Portrait® Plasma Skin
Regeneration (PSR) is a new non-ablative
technology which when used at high
energy, approaches CO2 results, has a
higher safety profile, and faster recovery
time. Plasma’s thermal energy is delivered
to 100% of the skin and can safely be used
as an adjunct procedure for patients
undergoing
rhytidectomies
and
blepharoplasties to enhance aesthetic
outcomes. In addition, PSR is not a laser or
light
source
targeting
specific
chromophores, and does not require a
dedicated operating facility, sedation, or
specialized safety equipment. This report
analyzes the safety/efficacy profiles of
Plasma Skin Regeneration in comparison to
the CO2 laser.
Materials and Methods:
A review of current literature regarding
patient outcomes (~1100 patients) from CO2
laser resurfacing was done. In addition, a
retrospective analysis of high energy PSR
patients over the past two years (120
patients) at two sites was performed.
Results:
The incidence rate of the following complications
was
assessed:
hypopigmentation,
hyperpigmentation,
persistent
erythema,
scarring, and bacterial and viral infection. For
CO2 patients, the most common adverse effects
noted were hyperpigmentation (transient and
other 21-34%), bacterial and viral infection (78%) and prolonged erythema. Reports of late
hypopigmentation range from 8-20% of CO2
patients evaluated. Scarring was rare. Average
initial recovery time for CO2 patients is 2 weeks;
however, erythema lasting 2 – 6 months was
common.
CO2
PLASMA
2-3 weeks
4-7 days
Erythema
months
2-3 weeks
PIH
21-34%
3-4 %
Healing Time
Hypopigmentation 8-20 %
0%
Infection
<1%
7-8%
Of the 120 PSR patients evaluated, half of those
patients were over a year post-treatment, and
the others were at least 6 months. Patient and
physician rated improvements with the PSR vary
based on energy level used (3.0 to 4.0 Joules)
and ranged from 30-70%.
Poster#: P3001
Conclusion:
Due to the risk of complications and
prolonged recovery many physicians
have sought alternatives to CO2 laser
resurfacing. Plasma Skin Regeneration
is a new non-ablative technology that
does not create an open wound. Used at
high energy, PSR approaches CO2
results in terms of wrinkle reduction and
tightening with further improvement in the
tone and texture of the skin
Photos courtesy R. Fitzpatrick, M.D.
1New
Pre-treatment
1 Month Post PSR
The complication rate with Plasma Skin
Regeneration is extremely low, has a
high safety profile, short recovery period
and
represents
a
technological
advancement in resurfacing for the
aesthetic surgical patient.
Photographs courtesy of Suzanne Kilmer MD
Portrait: High Energy Single Treatment
Pre-treatment
30 days Post-treatment
Photographs Courtesy of R. Fitzpatrick, MD
Portrait Long-Term Results
- Eyes and Eyelid Tightening
1 Year Post-treatment
Photographs Courtesy of Dr. William F. Groff
Portrait High Energy Single Treatment
Portrait High Energy Single Treatment 3.0 Joules
Double Pass on Deeper Rhytides
Photographs Courtesy of V. Gurvits, DO
Before
4 Weeks Post-treatment
Photographs Courtesy of R. Fitzpatrick, MD
Portrait®: Peri-oral Rhytides
High Energy Single Treatment
Portrait High Energy Single Treatment
Photos Courtesy Roy Geronemus, M.D.
Before
No Botox!
After
Photographs Courtesy of R. Fitzpatrick, MD
Portrait High Energy Double Pass Single Treatment
Before
After
Portrait Results: Non-Facial Treatment
Photographs Courtesy of V. Gurvits, DO
6 Months Post-treatment
Pre-treatment
Neck, Chest & Hands
(40-60% patient rated improvement)
Portrait Results: Non-Facial Treatment
Photographs Courtesy of V. Gurvits, DO
Pre-treatment
4 Months Post-treatment
Photographs Courtesy of N. Uebelhoer, DO
Portrait Results: Acne Scars
Pre-Treatment
6 Month Post
Portrait® Plasma Single Treatment - 3.5 J 1st pass, 4.0 J 2nd pass
Photographs courtesy of Dr. Hong, Korea
Portrait Low Energy Single Treatment
Of Ethnic Skin
Pre-treatment
1 month later
Photographs Courtesy of R. Moy, MD
Portrait Results: Long Term
Before
One Year
Photographs courtesy of S. Bentkover, MD
Portrait® Results: Long Term
Before
13 mos
Photographs Courtesy of R. Fitzpatrick, MD
Portrait Long-Term, 1 year Results - Eyes and Eyelid Tightening
“We get great tightening results especially around the eyes with Portrait. The only technology that
compares to these results is full strength multi-pass CO2. Portrait is predictable and delivers 100%
coverage. The thinner skin of an eyelid is very well suited for plasma treatments.”
Richard Fitzpatrick, MD