Nitrogen plasma skin regeneration for the treatment of mild-to-moderate periorbital wrinkles: A prospective, randomized, controlled evaluator-blinded trial

Microplasma radio frequency technology using stationary tips on pig skin: A histological study

OBJECTIVE

To investigate the histological properties of microplasma radiofrequency (MPRF) using a stationary tip in different treatment strategies on porcine skin.

METHODS

Two Bama miniature pigs received MPRF treatment with two types of stationary tips in eight groups of parameters (power, duration, and pass) on dorsal skin. Skin samples were collected from each treatment zone immediately, at 1 week and 1, 3, and 6 months after treatment. Hematoxylin and eosin (HE) and Masson staining were performed to assess histologic changes as well as neocollagenesis. The dynamic changes of heat shock protein 47 (HSP47) and heat shock protein 72 (HSP72) were also detected by immunohistochemistry.

RESULTS

Skin damage increased with pulse energy, duration, and pass. Longer durations or repeated treatments may cause particularly severe skin damage. During the wound healing process, the newborn collagen of the dermis is rearranged. The distribution of HSP47 and HSP72 was consistent with the extent of collagen remodeling. It peaked 1 month after treatment.

CONCLUSION

MPRF can effectively cause epidermal ablation, dermal collagen hyperplasia, and remodeling. Increasing power should be the first choice when increasing treatment intensity. For longer durations or repeated treatments, caution should be taken to avoid excessive skin trauma.

The quantitative investigation of spark plasma on skin parameters with skin elasticity, thickness, density, and biometric characteristics

Cold atmospheric plasma has been developed and utilized as a novel technique for skin rejuvenation because of its various effects on cells and living things. This study investigated the accuracy of this claim and any possible side effects of using spark plasma to rejuvenate skin. The present work is the first quantitative investigation using animal models. 12 Wistar rats were divided into two groups for this investigation. To compare the skin's natural process with the treated skin, the first group underwent a single session of plasma therapy, while the second group served as the control group. The back of the necks of the samples was shaved for 20 cm. Before beginning treatment, the MPA9 multifunctional skin tester was used to determine the melanin index, erythema index, and transepidermal water loss (TEWL). The skin's thickness and density were assessed using sonography, and its elasticity index was calculated using a Cutometer. The samples were exposed to plasma radiation in the designated area (in a triangular pattern). The abovementioned signs were examined immediately after the following therapy and at the weekly appointment 2-4 weeks later. Optical spectroscopy was also used to demonstrate the presence of active species. In this study, we found that a plasma spark therapy session significantly boosts skin elasticity, and the ultrasound results revealed a significantly increased skin thickness and density. The plasma increased the amount of skin surface evaporation, erythema, and melanin immediately following the treatment. However, 4 weeks later, it recovered to its former state and did not differ significantly from before the therapy.

Modern blepharoplasty: From bench to bedside

The demand for procedures aiming to rejuvenate the upper third part of the face and the periocular region has increased in the past several years. Blepharoplasty is one of the most frequently performed procedures worldwide to date. Surgery is currently the first choice in order to achieve permanent and effective results; however, it is burdened by potential surgical complications feared by patients. There is an increasing trend in individuals to request less invasive, non-surgical, effective, and safe procedures for eyelid treatment. The aim of this minireview is to present a brief overview of non-surgical blepharoplasty techniques that have been reported in the literature in the past 10 years. Numerous modern techniques that provide a rejuvenation of the entire area have been described. Numerous less invasive methods have been proposed in the current literature and in modern-day routine clinical settings. Dermal fillers are a commonly chosen option for providing enhanced aesthetic results, especially considering that volume loss can be one of the main underlying causes of facial and periorbital aging. Deoxycholic acid use may be considered when the problem is represented by periorbital excess fat deposits. The simultaneous excess and loss of elasticity of the skin can be assessed with techniques such as lasers and plasma exeresis. Furthermore, techniques such as platelet-rich plasma injections and the insertion of twisted polydioxanone threads are emerging as viable methods to rejuvenate the periorbital region.

Treatment of Keloids Using Plasma Skin Regeneration Combined with Radiation Therapy Under the Evaluation of Patient and Observer Scar Assessment Scale

Purpose

Keloids are caused by uncontrolled excessive proliferation of fibrous tissue. Multiple treatment strategies including steroid injection, surgical excision, laser therapy and radiation therapy have been reported. Few studies have evaluated the performance of plasma skin regeneration (PSR) in the treatment of keloid. This study aimed to evaluate the effectiveness of PSR combined with radiation therapy for keloids on different body parts.

Patients and Methods

A total of 71 patients with 98 keloids were enrolled in this study. Keloids <4 mm thick underwent single-dose PSR, while keloids ≥4 mm thick were administered compound betamethasone injection beforehand. Radiation therapy was administered after 24 hours and again 7 days later after PSR. The outcome was evaluated using the patient and observer scar assessment scale at 12 months post-treatment.

Results

Patient-reported average scores for all keloids significantly decreased from 35.05±9.94 to 21.84±7.04 (p < 0.05). Keloids on face and neck, chest, and back responded better than those on shoulders and limbs. The recurrence rate was observed to be 15.3% (15 out of 98). Adverse effects were mild.

Conclusion

PSR combined with radiation therapy is an effective and safe strategy to treat keloids. Location could be a factor that affects curative effects.

A Prospective Study Evaluating the Use of Helium Plasma for Dermal Resurfacing

BACKGROUND AND OBJECTIVES

A novel helium plasma device was evaluated for efficacy and safety for dermal resurfacing (ClinicalTrials.gov Identifier: NCT03286283). The helium plasma device delivers energy in a controlled, bimodal fashion that when compared with the nitrogen plasma predicate device in a porcine animal model demonstrated a more limited depth of thermal effect but a greater skin tissue contraction.

STUDY DESIGN/MATERIALS AND METHODS

Fifty-five eligible subjects seeking improvement in facial rhytids were enrolled for study at one of three investigational sites. Most subjects underwent full-face treatment. Power levels were limited to 20% at peri-oral and peri-orbital areas-a level that correlates to an energy density 40% lower than the highest setting on the predicate device. Three-month post-treatment Fitzpatrick Wrinkle and Elastosis Scale (FWS) scores were compared with baseline scores as determined by blinded independent photographic reviewers (IPRs) and study investigators.

RESULTS

Blinded IPRs observed a ≥1-point FWS improvement in 63.64% of subjects whereas study investigators noted a ≥1-point FWS improvement in 54 of 55 subjects (98.18%) of subjects. 90.9% of subjects indicated "improvement" in appearance utilizing the modified Global Aesthetic Improvement Scale. Subgroup analysis showed 1-point (±0.05) FWS improvement by IPRs and study investigators for Fitzpatrick Skin Types II and III, age≥62, two of three study sites, and post-treatment oral steroid use. Eighty Non-Serious Adverse Events in 39 subjects were reported, most of which resolved within 14 days or less. There were no Serious Adverse Events or Unanticipated Device Effects reported.

CONCLUSION

At the modest power level studied, a significant improvement from a single pass helium plasma dermal resurfacing treatment was observable in most subjects by IPRs and investigators, and no serious adverse events were reported. The discrepancy between IPR and study investigator FWS improvement may be explained in part by the limitations of assessing two-dimensional photographs versus live in-person evaluation of subjects. Studies evaluating higher energy levels and/or multiple treatment passes are ongoing. Lasers Surg. Med. © 2020 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals, Inc.

Helium Plasma Skin Regeneration: Evaluation of Skin Tissue Effects in a Porcine Model and Comparison to Nitrogen Plasma Skin Regeneration

Background and Objectives

Helium plasma skin regeneration (PSR) is a novel skin rejuvenation technology with significant differences compared with nitrogen PSR technology but that may exert similar skin tissue effects. Study objectives included a comparison of acute and chronic skin tissue changes among the two plasmas in a porcine animal model.

Study Design/Materials and Methods

In this study, both helium and nitrogen gas plasmas were used to treat the dorsal skin of Yorkshire cross mini pigs with 20% (8.6 J/cm²) and 40% (17.8 J/cm²) power helium plasma single pass treatment (4 liter gas flow, continuous energy delivery, and linear non‐overlapping passes) compared with high energy nitrogen plasma double pass treatment (PSR3 @ 14.1 J/cm²: 4.0 J, 2.5 Hz pulse rate, overlapping horizontal, and vertical passes). Acute and chronic skin contraction, maximum acute depth of injury and chronic reparative healing depth were assessed along with representative histopathology in each treatment paradigm.

Results

High‐energy nitrogen plasma treatment exhibited greatest mean depth of acute tissue injury 4 hours post‐treatment whereas helium plasma treatment exhibited greater acute skin tissue contraction. Then, 20% and 40% power helium plasma treatment results were each very similar among animals as a percentage of nitrogen plasma treatment results for both depths of acute tissue injury and acute skin tissue contraction. Mean depths of reparative tissue healing were similar among treatment paradigms 30 days after treatment with significant intra‐ and inter‐animal variability observed within each treatment paradigm. Thirty‐day mean skin tissue contraction was greater for helium plasma treatment; however, the data varied significantly between animals in all paradigms. Histopathologic tissue evaluation after 30 days showed similar findings among the treatment paradigms with epidermal hyperplasia, flattening of rete ridges and with regenerative granulation tissue expanding the superficial and papillary dermis.

Conclusions

This study demonstrates modestly reduced depth of the thermal effect, greater skin tissue contraction and similarity of acute and chronic histopathological findings for helium plasma when compared with nitrogen plasma in a porcine animal model. © 2019 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals, Inc.