Webinar

Christopher Zachary, MDProfessor and Chair

Department of DermatologyUniversity of California - Irvine

Chris Zachary’s take on plasma

Early on –> … “I blew off the technology!”

& Now…

• “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

• Furthermore, now there is proven long-term patient results out over 5

+ years.

• With high energies, you can get very nice skin tightening, excellent

reduction in pre-cancers and very nice color and texture and tone

• Portrait technology provides a highly effective mechanism for patients

requiring skin rejuvenation across a spectrum of indications.

• This technology is safe, reliable and effective. 

• I am personally delighted to see this technology back in harness!”

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

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

Portrait® plasma – what is it?!

Aurora Borealis Sun

Plasma Zone of Effect of Portrait Nitrogen Plasma

Inner Zone = Zone of Thermal Damage

Outer Zone = Zone of Thermal Modification

Gaussian distribution of energy delivered to the whole skin architecture

Non-fractionated, non-chromophore

dependence provides full coverage

Thermal (plasma) energy delivered to the skin

Predictable, non ablative impact at all

energy levels

Portrait’s 3DimensionalThermal Effects

on Skin Architecture

Note the depth of heating effect at ~ 70°C for triggering neocollagenesis in 100% skin architecture

3D Thermal heating within 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

• 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

• 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

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

Non-Contact Plasma Pulse

Plasma is formed inside disposable nozzle connected to

the handpiece

Day 0 following treatment (at 3.5 J)

Day 4

Day 10

100% treatment of skin architecture 100% intact architecture• Highly reactive dermis• Vacuolation occurs at high energy

Developing line of cleavage between Zones of Thermal Damage and Modification

New Stratum Corneum under line of cleavage

Regenerated Epidermis

100% regenerated epidermis with residual activity in basal layer

Zone of Thermal Modification: intense fibroblast activity, neocollagenesis & neovascularization regenerating the reticular dermis

Portrait Plasma Treatment Histology

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 Pre-Tx

Immediate Post-Tx: 3.5 J

Retention of Cellular Contents — Portrait Plasma Pulse

“A wound response without an open wound…unique…” Dr. Eric Bernstein, upon analyzing

the study histologies

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

Portrait Treatment Protocols

Full Spectrum of Treatments

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: 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 DeviceCompared to CO2 LasersKenneth O. Rothaus, M.D.1, Richard Fitzpatrick, MD2

1New 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 (7-8%) 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.

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

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%.

CO2 PLASMA

Healing Time

Erythema

PIH

Hypopigmentation

Infection

2-3 weeks 4-7 days

months 2-3 weeks

21-34% 3-4 %

8-20 % 0 %

7-8% <1%

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.

Pre-treatment 1 Month Post PSR

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Poster#: P3001

Pre-treatment

30 days Post-treatment

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Portrait: High Energy Single Treatment

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1 Year Post-treatment

Portrait Long-Term Results - Eyes and Eyelid Tightening

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Portrait High Energy Single Treatment

Portrait High Energy Single Treatment 3.0 Joules Double Pass on Deeper Rhytides

Before 4 Weeks Post-treatment

Photographs Courtesy of V. Gurvits, DO

Portrait®: Peri-oral Rhytides

High Energy Single Treatment

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Before

After

No Botox!

Portrait High Energy Single Treatment

Before After

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Portrait High Energy Double Pass Single Treatment

Neck, Chest & Hands(40-60% patient rated improvement)

Portrait Results: Non-Facial Treatment

Photographs Courtesy of V. Gurvits, DO

Pre-treatment 6 Months Post-treatment

Pre-treatment 4 Months Post-treatment

Photographs Courtesy of V. Gurvits, DO

Portrait Results: Non-Facial Treatment

Pre-Treatment 6 Month Post

Portrait® Plasma Single Treatment - 3.5 J 1st pass, 4.0 J 2nd pass

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Portrait Results: Acne Scars

1 month laterPre-treatment

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Portrait Low Energy Single TreatmentOf Ethnic Skin

Before One Year

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Portrait Results: Long Term

Portrait® Results: Long Term

Before 13 mos

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“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

Portrait Long-Term, 1 year Results - Eyes and Eyelid Tightening