PLASMA
A term derived from the Greek for ‘entity’ or ‘form’, is the fourth state of matter and it is constituted by negatively charged electrons and positively charged ions with an overall neutral net charge. It can be created when a difference in voltage matches the dielectric breakdown of the gas included in the field.
Atoms are the elements of molecules; when the interaction among molecules is high, they result in a solid, able to maintain shape a volume until an extremely high strength can break such interaction.
When the interaction is weak among molecules, this can result respectively in a liquid, maintaining volume but losing shape, or in a gas, which maintains no shape or volume but occupies all the available space.
When external energy can split the molecules of the gas into positive and negative parts, we reached the fourth state of the matter: plasma. When activated, Plexr ionizes the air between the tip of the device and the human body by generating an appropriate potential difference.
The electric breakdown of the air is around 3000 V per mm, depending from some factors such as humidity and bodies the physical phenomenon is generated by.
Using the Plexr / Plexr Plus signal parameters, around half millimetre is the needed distance for the ionization of the air atoms. No plasma is generated when the probe is in direct contact with the tissue or too distant from it.
The plasma generation is similar to a micro lightning bolt that acts directly only on the epidermis. Before sublimating, the corneocytes transmit a selective estimated quantity of energy that reaches the right deepness of dermis, without irradiation (laser/light) or electric shock (radioscalpel/current).
No any form of energy is delivered directly from the device to the deeper tissue, no eddy currents are generated.
The action of Plexr on tissues allows:
1- immediate contraction of the collagen fibers
2- collagen reorganization
3- formation of new collagen (type III)
4- renewal the epidermal tissue.
This mechanism has been proved through several scientific studies
(see literature section).
Rossi et al. 2017, Dermatologic surgery. Clinical and Confocal Microscopy Study of Plasma Exeresis for Nonsurgical Blepharoplasty of the Upper Eyelid: A Pilot Study. Dermal matrix architecture by reflectance confocal microscopy
(RCM) of Patients 1 and 2: at baseline (T0), signs of skin aging characterized by a collagen with variable degrees of degeneration: in Patient 1 (T0 pt1) it was classified as huddled (asterisk) and in Patient 2 (T0 pt2) as coarse (arrow). At
T1, a strong collagen remodeling process was detected in both patients: bright and long fibers with a parallel alignment are detected in Patient 1 (T1 pt1) and in Patient 2 (T1 pt2). Scale bar = 50 mm.
Rossi et al. 2017, Dermatologic surgery. Clinical and Confocal Microscopy Study of Plasma Exeresis for Nonsurgical Blepharoplasty of the Upper Eyelid: A Pilot Study.
Technology and Applications
Plexr / Plexr Plus is conceived with three different handpieces: the output of each handpiece is in fact optimized so that an ad-hoc signal can be performed in function of the specific treatment. The choice of the handpiece is strictly dependent by the treatment the Dr. is going to perform.
White handpiece Blepharoplasty, lentigo solaris, moderate active acne, small wrinkles, umbilical lifting, small benign skin neoformations, coadjuvant for small keloids, moderate cutaneous renewal and skin rejuvenation, vaginal rejuvenation and vulvoplasty.
Green handpiece Active acne, medium benign skin neoformations, seborrheic keratosis, elastosis, dyschromia, small ruby angiomas, face lifting, xantelasmas, small fibromas, small scars.
Red handpiece Voluminous benign skin neoformations, big fibromas coadjuvant for keloids, big ruby angiomas, deep scars, acne scars, resurfacing, warts, seborrheic warts, hyperkeratosis, gingival whitening and so on.
However, there are factors that can furtherly influence the handpiece
choice:
– Experience of the doctor: as initial approach it is suggested to use the white handpiece, in order to better achieve and understand functionality of the device. With constant attendance to training courses and acquisitions of experience you will gather the necessary skills to treat different types of skin pathologies.
– Entity of the skin pathology.
– Skin type of the patient.
GMV strongly recommends to use only official Plexr Tips.
These kinds of needles, made with medical-grade stainless steel, are conceived to work combined with Plexr’s handpieces: they have been studied and designed to generate the correct quantity of Plasma. The Plexr Tips are
single use to optimize the result.
Why Plexr is different from other Plasma devices
Plexr is the unique device able to recreate the precise and stable phenomenon of Plasma intended for medical use, allowing the Doctor to work safely and successfully.
Plexr is designed to reproduce correctly the necessary physical dimensions observed in several scientific studies (see literature). Producing a general and incorrect signal to generate plasma is definitely not sufficient and/or dangerous.
To do that, specific parameters and specific electronic design are mandatory. This property avoids deep thermic damage, electric shock and allows to reach the desired result with minimal downtime.
The focused micro-plasma beam due to the ionization of the gases contained in the air, sublimates the stratum corneum of the epidermal tissue where the spot is performed, but the ionic flow doesn’t spread out to deeper tissue. The basal lamina is preserved and there is no dermal or electrical damage (see literature). A device designed with different parameters and composed by different electrical component causes different or even unpredictable/dangerous effects:
– Lower working frequency : too high penetration, thermic damage, high skin-tip distance (less accuracy).
– Higher working frequency (electrosurgical unit): reduced skin-tip distance, current flow, high superficial energy (skin cut).
– Higher working voltage : too high penetration, thermic damage, high skin-tip distance (less accuracy).
– Lower working voltage : no effect.
Therefore, possible consequences in using different devices are:
• more pain for the patient
• no same results
• scarring
• expertise of the operator: the space between good result and side effect (scars) is minimal. Trying to get better results means to risk scarring. Plexr does not produce scarring at all.
• Not estimable or long-lasting prominent side effects: redness (erythema), oedema and Post Inflammatory Hyperpigmentation (PIH).
• The stable plasma generated by Plexr opens to other protocol.
Why Plexr is different from LASERs
The target tissue of the coherent, monochromatic and unidirectional radiation turns out a new heat source, increasing temperature in the surrounding tissue.
Furthermore, LASER:
• Is skin colour and pathology depending
• Produces a not uniform effect
• Is more expensive
• Causes a longer downtime
• Implies more difficult treatment
• Is less versatile -cumbersome, no wireless, no portable
Before and After treatment protocols – General indication
Premise: the indication contained in this section explains the general precautions that are to be applied ALWAYS before and after treatments. We invite you to read single protocols to learn how to correctly execute each procedure.
Before
1. Removal of the makeup and skin cleansing.
2. Disinfect the area with a non-alcoholic disinfectant.
3. Apply the anesthetic cream 40 minutes before the treatment.
4. While treating, delicately remove the excessive cream, but do not remove it completely.
5.While treating, cleanse the treated area with a clean cotton pad.
Aftercare for the patient
• Wash in the morning and nights the treated area with Marseille soap.
• Use the “ Plexr Care Kit ” as per protocol:
1) Application of the skin cover on the treated area with high SPF to protect from the UVA and UVB rays until the healing process is over. Such process consists of onset of small scabs due the micro ablation and edema due to the formation of new skin.
2) Zinc Oxide cream antiseptic and anti-edema, to prevent and treat the formation of edema and redness, that in any case are essential and indicates skin turnover process.
3) K factor Cream which is a natural hydroquinone activator, is useful to prevent and treat the eventuality of hyperpigmentation on the treated area.
Treatment of the temporarily side effects
Scabs, edema and redness are part of the normal healing process and skin turnover. Normally this process lasts 7-20 days. The only side effects -reported below with the related remedy- rarely appear and are subjective from patient to patient. They are mostly due to an improper application of the protocol by the doctor and/or to a missing/wrong post treatment allegiance by the patient. That’s why the good communication doctor-patient is the goal.
Possible side effects:
• Excessive edema – Resolving spontaneously within one week. To accelerate the healing process can be used use Arnica Montana (2 pillows before sleeping) or antihistamine bilastine (as in the information sheet of the product).
• Persistent redness – Resolving spontaneously within three months without any interventional treatment. Patients with sensitive skin accounted for almost half of the patients presenting with prolonged erythema. To accelerate the process, apply an anti-dystrophic cream.
• Post Inflammatory Hyperpigmentation (PIH) – Even though it might occur such effect must not worry the doctor or the patient, if it should occur the patient must be informed that it is a temporarily effect and if not treated it can last up to maximum 6 months. There are lots of depigmenting agent in order to accelerate its complete disappearance, like creams with hydroquinone.
Always to remember that the first cause of such effect is given from the UV rays, thus such treatment is not to be recommended during the summer season and the skin cover is absolutely mandatory, especially in countries where there is major sun exposure or certain types of skin, Fitzpatrick higher than III
Higher proportional incidence of PIH among higher phototypes was observed but the transient nature of PIH was also demonstrated throughout Fitzpatrick spectrum (I-VI).
