What is Portrait PSR3 Plasma?
Treat your wrinkles and scars from the bottom up with a non-laser technology that leaves you with beautifully clear skin.
Portrait PSR3 Plasma Skin Rejuvenation
- Removes or improves fine wrinkles
- Often gives a brighter, healthier appearance than many fractionated lasers
- Removes layers of old skin and promotes growth of new, smoother, healthier skin
- Removes brown spots and some benign skin lesions
- Skin continues to tighten for up to one year after the procedure
- Parts of your face or your entire face can be safely treated with just local or topical anesthesia
Dr. Bentkover has been resurfacing skin with various modalities for over 30 years. Having started with dermabrasion in 1979, he presently offers two major ways to resurface your skin: Portrait PSR3 Plasma Skin Rejuvenation and Fractionated and Deep Carbon Dioxide Laser Resurfacing.
In the opinion of many facial plastic surgeons, the “gold standard” for facial resurfacing is carbon dioxide laser resurfacing. Dr. Bentkover has been using the Ultra Pulse® Carbon Dioxide Laser for facial resurfacing since 1995. He has uniformly very high patient satisfaction with this procedure for wrinkle removal and acne scars, with very predictable results.
However, some people want a less invasive procedure. The new fractionated carbon doxide lasers can also be less invasive, but the degree of improvement expected by most laser patients still requires a deeper, more invasive procedure. Plasma may be an alternative for you.
Dr. Bentkover was one of the first surgeons in New England to offer this technology. This technology enables Dr. Bentkover to treat your wrinkles, acne scars and facial discoloration quickly and the office, usually only requiring a topical or local anesthesia. This technology delivers vibrant results.
Dr. Bentkover brought Portrait PSR3 Plasma Skin Rejuvenation into the practice to provide an alternative to carbon dioxide laser resurfacing for patients with less severe wrinkles and/or patients who want an office procedure with less significant down time and healing time. While many patients will still benefit from laser resurfacing, many will be just as happy with Portrait PSR3 Plasma Skin Rejuvenation. At your consultation, you and Dr. Bentkover will decide which technology is best for you.
Portrait PSR3 Plasma Skin Rejuvenation is a nitrogen plasma spray instead of a laser. Plasma is an electrified gas that is the fourth state of matter – solid, liquid, gas, and plasma. Some patients are treated in three to four short, low energy treatments; some patients are treated with one high energy treatment. The choice of type of treatment depends on the depth of your wrinkles or scar, the color of your skin and how much down time is reasonable for you.
Portrait PSR3 Plasma Skin Rejuvenation does not remove skin. It works by heating the deeper layer of the skin, the dermis. This heat stimulates new collagen growth, which, over time, leads to tightening of the skin. Also, your skin peels on its own a few days after the treatment. You can continue to make new collagen for up to a year.
Unlike laser resurfacing, Portrait PSR3 Plasma Skin Rejuvenation requires no significant skin preparation and only topical or local anesthesia, sometimes combined with an oral medication. Your skin will be pink to slightly red after the procedure, peel in few days and be mostly free of discoloration in 10 days. Make-up easily covers any discoloration as it fades. Also, there is much less risk of skin over lightening or darkening than with the laser. In addition, after the treatment, skin tightening continues for up to a year.
Portrait PSR3 Plasma Surgery
Dr. Bentkover will carefully evaluate your skin and suggest which variation of the procedure he thinks will be most effective for you. Portrait PSR3 Plasma Skin Rejuvenation is performed either as a series of 3-4 low energy treatments 1 month apart (PSR1) or as a single high energy treatment (PSR2, 2/3 or 3). Your choice of procedure will depend on the depth of your wrinkles or scars, the degree of brown discoloration of your skin, and how much time you can take off from work or your regular activities. You and Dr. Bentkover will decide which type of treatment will best help you achieve your goals.
Method of Surgery
There is no significant skin preparation. As a matter-of-fact, if you are on a retinol, Retin-A™ or Renova™, we will ask that you stop using this drug 3-4 weeks before the procedure. We will also ask you to stop using any fruit acids like topical glycolic acid, lactic acid or vitamin C 3-4weeks before the procedure. The reason for this is that your epidermis acts as what is called a “biologic dressing” after the treatment, and retinols or fruit acid treatments remove or thin the outer most layer of the epidermis (stratum corneum).
Portrait PSR3 Plasma Skin Rejuvenation requires only a topical anesthesia for a low energy treatment and topical plus injected local anesthesia with some oral medication for a high energy treatment, even of the whole face.
After the procedure you will be asked to keep your face covered with a petroleum based product like Aquaphor™. Depending on the level of energy delivered to your skin, you can expect to see your skin turn brown between 1 and 4 days after the procedure. This brown mask will slowly peel over a few days, leaving some areas of pinkness easily covered with make-up. The amount and longevity of the pink discoloration is related to how high an energy was required for your particular treatment. In any event, it will not be as red or last as long as with a laser resurfacing. After it is all peeled, you may return to your usual skin care except for the use of retinols and fruit acids like glycolic acid, lactic acid, or vitamin C. You should avoid those products for another three weeks or so. Our aesthetic nurse will advise you when to resume your full pre-op skin care program.
Recovery: What to Expect
Neither procedure is very painful afterwards. You may feel like you have a bad sunburn for an hour or so. Our patients often take no pain medication after the first day or no pain medication at all. Most redness is gone in 7-10 days.
With a high energy treatment, you may have some pinkness that persists for a month or so, but it is generally very faint and can easily be covered with a mineral makeup like Jane Iredale™. It might look like a very light sunburn.
Your skin may continue to tighten for up to a year. Retreatment for high energy Portrait® therapy would be no sooner than 6 months, usually at a year.
Plasma Skin Resurfacing Long-Term Results
How long does it last?
Our algorithm for skin rejuvenation:
- Mild Peri-ocular Rhytids
- PicoSure® Laser
- Mild-Moderate Facial Rhytids
- Portrait® Plasma
- PicoSure® Laser
- ZO® Skin Care
- PicoSure® Laser
- Portrait® Plasma
- Mild-Moderate Facial Rhytids + Hyperpigmentation
- Portrait® Plasma
- PicoSure® Laser
- Moderate-Severe Facial Rhytids
- Carbon Dioxide Laser
- Moderate-Severe Facial Rhytids + Hyperpigmentation
- Carbon Dioxide Laser, sometimes combined with Plasma
Primary Uses for Plasma
- Clears epidermal pigment really nicely
- Approved for Fitzpatrick 1-4, best for Fitzpatrick 1-3
- nGrades 1-3 Rhytids (Mild to Moderate) on a Wrinkle Severity Scale of 0-5
- Excellent and long lasting overall improvement in skin texture and visual quality of skin, including decreasing pore size
- Better overall rejuvenated appearance to the skin than the carbon dioxide laser
Plasma: 4th State of Nature
Highly Excitable Ionized Gas
- Non contact, non chromophore dependent ms pulse.
Nitrogen gas energized with a tungsten filament in hand piece
- Gaussian distribution of energy
1-4 J/cm2. Repetition rate of 1-2.5 Hz
Optimal distance from skin: 8-10 mm and can de-focus to decrease affect
Portrait® PSR3 Treatment Options: Depth of Cleavage
Histology Day 10
This polarized image highlights new collagen in the Zone of Thermal Modification
Note perpendicular orientation of the new collagen fibers (green)
- Stop retinols/fruit acids 6 weeks before
- Hydroquinone 4% bid for 6 weeks
- SPF 60+
- Day of…
- Hydrate skin with topical anesthetic x 1 hour or Aquaphor
- Diazepam 10 mg po and oxycodone 5 mg 1 hour before Tx
- <1.5 j, usually just topical anesthetic, BLT or 4-5% lidocaine x 1 hour
- > 1.5 j, 20 cc topical and 1/2 % lidocaine with 1:200,000 Epinephrine blocks plus directly along jaw line and pre auricular
- Grid with a removable marker
- Ice mask for 30 minutes with initial Aquaphor in office
- Aquaphor until stops peeling, about 7 days
- Wash with Cetaphil bid after seen at 24 hours
- After peeling (molting) completed, a benign moisturizer and SPF 60+
- Sometimes desonide lotion bid for 7-14 days and resume hydroquinone for Fitzpatrick 4 or if a lot of pre op dyschromiar
- 6 Weeks: ZO Skin Health or similar/CRx or similar
- 12 weeks add back retinol
Plasma skin resurfacing is…
- A long lasting treatment for mild to moderate Facial Rhytids
- A long lasting treatment for hyper-pigmentation in Fitzpatrick skin types 1-4 with overall excellent skin rejuvenation with very predictable results
- Maintenance of results is best supported by a medically based treatment program
A peel with a laser or similar device designed to remove the damaged upper layers of skin and allow the growth of new healthier, smoother, tighter skin.
For Portrait PSR3 Plasma Skin Rejuvenation, depending on the dose used in your treatment, the skin is generally pretty close to normal color in about 1-10 days with little or no persistent pinkness.
What is the advantage of Portrait PSR3 Plasma Skin Rejuvenation over laser resurfacing or vice versa?
The technologies achieve similar but still different results.
- Laser – for deeper wrinkles and scars with a few days longer down time than Portrait® but redness that takes 3-4 months to resolve.
- Portrait PSR3 Plasma Skin Rejuvenation – can usually achieve about 60-70% of the results of the laser with less down time and much less redness (really just pinkness) of a shorter duration.
- The one that is best for you depends on the depth and extent of your wrinkles and how quickly you need to recover. Dr. Bentkover will help you weigh the pros and cons of each.