J-Plasma® & Portrait® Plasma Skin Regeneration | Be Wary of this New Technology
To read the update - and learn why I change my stance (and the title of this post) on PSR (plasma skin regeneration) - skip down to "Update 9/6/19." It's near the bottom of the page.
I first became interested in J-Plasma skin regeneration when I saw amazing transformations by Dr. Jason Emer on Instagram. Most of the results were after ONE treatment. Unheard of! And most of the before pictures were of patients who had deep wrinkles, sagging skin and sun damage!
I must admit, I was a skeptic. You just don't see results like that.
And then I read about it - and it sounds like something out of Star Wars or The Terminator. Like you've suddenly jumped forward in time. Let me explain a little bit more. See if you don't agree with me!
There are 2 FDA approved plasma skin regeneration (PSR) devices right now. One is called J-Plasma from Bovie Medical Corporation. The other is the NeoGen® PSR. Neogen bought the original plasma skin regeneration technology, called Portrait, from a company called Rhytec, Inc. And even though Rhytec went out of business, you'll still hear PSR called "Portrait," like we call tissues "Kleenex." The name stuck. J-Plasma and Portrait / Neogen PSR are both a new form of nonsurgical skin resurfacing. They are NOT lasers.
Ok. I Get It. Plasma Skin Regeneration (PSR) Is Not Lasers. What Is It?
Let's start smaller. What's plasma?
You know about the 3 states of matter. We all learned it as kids:
- Solid (like ice)
- liquid (like water)
- gas (like steam)
But in the 1920s, a chemist by the name of Irving Langmuir came up with a 4th state - called plasma.
Wikipedia defines it like this:
"Unlike the other three states, solid, liquid, and gas, plasma does not exist freely on the Earth's surface under normal conditions. Plasma can only be artificially generated by heating or subjecting a neutral gas to a strong electromagnetic field to the point an ionized gaseous substance becomes increasingly electrically conductive, and long-range electromagnetic fields dominate the behavior of the matter."
So most times plasma doesn't exist here on Earth (but scientists think it's all over our universe). When it does exist, it's because we made it from neutral gases - like in neon signs, fluorescent light bulbs, and plasma TVs.
How do the J-Plasma & Portrait work?
Plasma skin regeneration devices use a hand piece that has an ultra high frequency generator (UHF). The generator energizes an inert gas (nitrogen for the Portrait device - or helium in the case of the J-Plasma) so that its atoms and molecules separate (called ionization) into negatively charged electrons, and positively charged ions. So the inert gas becomes an activated ionized gas called plasma. Then millisecond pulses of plasma are sent to your skin via the hand piece. As the plasma hits your skin, there is an immediate energy transfer to the skin. The longer the pulse, the more energy delivered.
In English, please? Plasma is made when electricity is sent through a gas. It's an electrically charged gas. The plasma transfers heat to your skin to make it more beautiful.
PSR can be used on top of your skin. It's called PSR resurfacing. The device is slowly passed over the surface of the skin. Skin changes are immediate and clearly visible. This method creates a dressing of skin that later peels off, revealing the new, younger looking skin below. Some clinics do 3 treatments using a lower energy setting so their patients have little to no down time after their treatments.
I'll be talking about PSR resurfacing in this article.
Watch NONINVASIVE PSR RESURFACING by Dr. Ron Shelton in New York City below.
**When I went to Dr. Shelton's website today, 9/6/19, it looks like he's no longer offering PSR resurfacing.
*This video is of PSR Resurfacing. Photos are of an actual patient and are unretouched. Results will vary.
OR PSR can be used under your skin - called J-Plazty® or J-Plasty. When it's used in this way, small incisions are made so that the plasma can be injected under your skin through the handpiece. This type of plasma skin regeneration is done by a plastic surgeon. It's often combined with liposuction and other surgical procedures. Because it tightens skin so well, it can eliminate the need to surgically remove skin.
I'll talk more about this kind of plasma skin regeneration in another post.
Watch the video about SURGICAL J-Plazty by Dr. Jack Zamora in Denver below.
As of today, 1/8/2020, Dr. Zamora is offering his J-Plazty treatment.
*This video is of J-Plazty. Photos are of actual patients and are unretouched. Results will vary.
What can PSR resurfacing treat? Who is the ideal patient?
Plasma skin regeneration treats all layers of your skin. The entire surface is regenerated. New collagen (which gives your skin structure - the scaffolding, so to speak) and elastin (which gives your skin it's elasticity, or ability to bounce back) are made.
Plasma skin regeneration is FDA cleared to treat wrinkles, superficial skin lesions, actinic keratoses (pre-cancerous spots), warts, and seborrheic keratoses (non-cancerous raised spots). It also gets good results on dark spots, sun damage, acne scars and loose skin. It's used to resurface the eyelids and the area around your eyes. Lasers are not safe in these areas. And other methods don't get consistent results.
The ideal patient has fine, moderate, and deep wrinkles and is considering laser treatments or a facelift. He or she may have sun damage, age spots or dark spots & hyperpigmentation. She would like to see dramatic improvement, improved skin elasticity, and skin tone. The ideal candidate also is prepared for the downtime required with high energy treatments.
How long is the recovery?
Most people choose 1 high energy treatment. When longer pulses are used like this (and higher amounts of energy are transferred) the top layer of your skin sheds. BUT this happens in 4 - 7 days, after the new skin underneath the top layer has formed. Studies have shown that all patients have a new, a fully regenerated epidermis (top layer of skin) by day 7, with fresh collagen seen by 3 months. Your skin may look a light pink for 2 - 3 weeks. This option can be very painful.
Plasma skin regeneration can be done using low energy settings also. Sometimes you'll hear them called Portrait Express. These low energy treatments don't penetrate the skin as deeply as high energy treatments do, so the recovery is much shorter. You can wear makeup or shave soon after treatment. Many people feel comfortable returning to work right after their treatment. Some prefer going back the next day. BUT to get a comparable effect to 1 high energy treatment, you'll probably need about 3 treatments.
Are people happy with the results? How long do they last?
The results are long lasting. Old, damaged epidermal cells are removed, and underneath your skin's surface, new collagen starts to grow. Treated areas are resurfaced. Dark spots and wrinkles fade. Your skin tightens and looks MUCH younger. This skin rejuvenation progresses more than a year after treatment.
- On RealSelf.com, plasma skin regeneration gets a 38% "Worth It" rating based on 21 ratings over all time.
- It gets a 50% "Worth It" rating based on 2 ratings in the last 24 months. So the numbers improved. Even so, it's not very reassuring when there are only 2 reviews over the last 2 years - definitely not a confidence builder.
To quote the great Homer Simpson, "D'OH!"
I think the reason for the low rating is twofold - the treatment is new to many people AND the recovery from high intensity treatments lasts about a week and isn't easy. (In other words, it's painful.)
- RealSelf reviewers say, "IT HURT LIKE HELL...." and "It was the most painful treatment I’ve ever had- injectable pain numbing and nitric oxide do even begin to help with the pain during the session of nearly 2 hours. After that- expect 10 days of puss, pain, burning and swelling- you will not be able to go out in public. No results are worth this pain."
- All the negative reviews on RealSelf.com were written between 3 and 9 years ago.
- The earliest studies I've found were published in 2007. That's 11 years ago and the technology has improved since then.
- I've had trouble finding great information about PSR for this article and it's 2019!
Another thing that hurt PSR was the demise of the original manufacturer, Rhytec, Inc., who filed for bankruptcy in 2008. The technology was purchased by Energist Medical Group, out of the United Kingdom, but since then, PSR has had a much smaller internet and media presence. So prospective patients - and medical providers - aren't as familiar with the technology.
So more and more doctors are learning about the treatment and are coming up with new treatment protocols to ensure their patients' safety - AND that you get a great result!
Does it hurt?
Anesthesia is used, but the kind of anesthetic is dependent on the kind of procedure you choose, your pain tolerance, and the amount of skin you have treated. Lower energy treatments require only a topical anesthetic cream. Higher energy and surgical PSR (under the skin) require nerve blocks, IV (intravenous) sedation, or general anesthesia.
How does Plasma Skin Regeneration Resurfacing compare to other skin resurfacing treatments?
Because PSR resurfacing treats all of your skin (vs. treatments like CO2 fractional lasers and micro-needling which only treat small parts of your skin), you get a more consistent result.
When the heat from Plasma skin regeneration is applied to the top of your skin, all the skin layers are affected. BUT the top layer of skin (the epidermis) remains intact. So, in PSR, that intact top layer of skin creates a natural dressing that protects your skin and speeds the new skin formation below. When compared to full power CO2 laser resurfacing (widely considered the gold standard in skin resurfacing), PSR patients have a much faster rate of healing AND less redness, pain, and itching after treatment. Researchers believe that this natural dressing is the reason. Healing from 1 high energy plasma resurfacing treatment is about 7 days. CO2 resurfacing takes 2 - 4 weeks of downtime.
Another thing. With the classic, full power, CO2 laser resurfacing (again, the standard to which other resurfacing techniques are compared), dermabrasion, and medium-depth and deep chemical peels the new collagen formed runs parallel to the surface of your skin. It can give your skin a shiny look. Some doctors feel that the skin looks more natural after PSR resurfacing when compared to lasers. This is probably because in PSR, new collagen fibers form and lay perpendicular to the surface of the skin, which is their natural orientation.
In PSR, new collagen formation can continue for up to 1 year. With CO2 laser resurfacing, the collagen formation period is much shorter.
Some doctors think PSR does not work as well on deep wrinkles as CO2 laser resurfacing.
CO2 lasers heat your skin to around 800C (almost 1500F). In comparison, J-Plasma energy levels are adjustable and operate at much lower temperatures (about 100 degrees) so there's little effect on the surrounding tissue. That's why you'll hear it called "cool" plasma.
Plasma causes much less damage to surrounding tissue. By comparison, lasers can easily go too deep, damaging the tissue surrounding the area you're having treated.
Most people choose to have 1 PSR resurfacing treatment. This 1 treatment alone gives results similar to 3 - 6 Fraxel laser treatments.
Is it safe for all skin types / colors?
Plasma skin rejuvenation can be done using high or low energy settings. Higher energy treatments penetrate the skin more deeply than lower energy treatments do.
Dr. Dan Yamini, a plastic surgeon in Los Angeles has found that:
- Lower settings give superficial effects similar to microdermabrasion.
- Higher energy settings go deeper into the skin and give effects similar to CO2 laser resurfacing.
- Recent studies suggest that using multiple low-energy treatments instead of a single high-energy treatment also allows significant correction of sun damaged facial skin. Results are comparable to high-energy treatment, but with less downtime.
Most people are treated with 1 high energy treatment. BUT for people with dark skin (Mediterranean or South American skin who never get sunburned), PSR is usually done at a lower setting and takes 3 - 4 treatments. Until more studies are done, it is NOT RECOMMENDED for Asian or very dark skin because of the risk of post inflammatory hyperpigmentation.
How long does a treatment take?
Are there any side effects?
- redness & swelling - with high energy treatments the redness may last 6 - 8 weeks after treatment
- itching
- peeling skin
- crusting
- scabs
- dark spots and skin discoloration (hyperpigmentation) are usually temporary
These side effects usually go away after 7 - 10 days. Ice packs and ointments (if recommended by your doctor) can help.
Is there anyone who should not have PSR?
- People with dark skin
- People who have a history of scarring & keloid scars
- People with open wounds or active skin infections (like in acne)
- People with lupus, psoriasis or vitiligo
- People who've taken oral vitamin A (isotretinoin) or blood-thinners
- Women who are pregnant or breast-feeding
- People who have an immune deficiency or auto-immune disorder
*This list of contraindications comes from ConsultingRoom.com.
How much does it cost?
Your cost will vary with the size of the area being treated and the qualifications of the person who treats you. RealSelf.com lists the average price for PSR at $2,200. DocShop.com lists the typical procedure at $1,800.
How do I care for myself afterward?
- No picking or peeling skin off.
- Protect your skin from sun using a moisturizing sunblock SPF 50+. Wear wide brimmed hats and protective clothing.
What’s the Takeaway?
Most of the doctors who've written about PSR talk about having done 100 or less PSR treatments (as of 3/29/2018). This means that with more time, they'll get better at this kind of skin resurfacing.
I think you can expect to see this technology really takeoff. There are a few reasons:
- The results that doctors are getting are VERY impressive.
- There is a lower risk of nasty side effects than with CO2 lasers (widely considered the gold standard), but a fairly comparable outcome.
- Skin builds normal collagen as a reaction to this treatment - so no shiny skin like with CO2.
- PSR can be used for high energy or low energy treatments. So you have the option of less downtime and more treatments or more downtime and 1 treatment. More choices make for happy customers.
- PSR machines are much less expensive than lasers. So more providers will be able to afford them. And over time, the treatment costs may come down.
An article on SeekingAlpha.com even called J-Plasma "The Botox Slayer." But if you don't have time to read the article yourself, let me clarify. Botox and PSR work very differently. Botox relaxes your muscles to minimize wrinkles. PSR resurfaces and tightens your skin. It minimizes wrinkles, dark spots, pores, etc. If you were on a budget, PSR - even though it's more expensive - would be a better VALUE for you because it corrects more things (wrinkles, darks spots, pores, tightens skin) AND gives lasting results. Botox only minimizes wrinkles. And to maintain the look, Botox requires maintenance - injections about every 3 - 4 months. Don't get me wrong. Botox is a great product! And the 2 would definitely get amazing results together! But for people who don't have the money or inclination to do both, J-Plasma really could be "The Botox Slayer."
No matter how you slice it, PSR is THE new and exciting technology. Used by itself, or in combination with other skin rejuvenation techniques, plasma skin regeneration is poised to takeoff. As doctors get more practice and better and better results - I think this technology is / will be something to consider for yourself!
Well, that's what I thought anyway.
Update 9/6/2019
Turns out I was wrong. As plasma technology has been more widely adopted, not all doctors and practices were getting good results. It's getting bad enough that "Health Canada is reminding Canadians that plasma pens are not authorized for sale in Canada and that these devices may pose health risks. Health Canada is also underlining that consumers should be wary of spas promoting plasma pen services."
And then there's this article on Seeking Alpha from February 21, 2019. It's called, "Apyx Medical's Stock Price Is About To Have A Liposuction - $3 Price Target (65% Downside)."
Below are quotes from the article summary:
"Apyx is a provider of J-Plasma technology that has failed every medical application and is now only targeted for two off-label cosmetic applications."
"J-Plasma use for dermal resurfacing has nasty side effects and heals very slowly - most cosmetic surgeons we have surveyed will not touch it with a 10-foot pole."
"Apyx did not reveal the results of its clinical study on J-Plasma use for dermal resurfacing - a red flag that it may have missed its endpoints."
"An almost identical product to J-Plasma called Portrait PSR has been a commercial failure for dermal resurfacing. J-Plasma appears to be following the same path."
"Apyx's new CEO, Charlie Goodwin, was allegedly engaged in fraudulent sales activities at Olympus/Gyrus, which include submitting fake claims to Medicare and making illegal payments to physicians and hospitals."
Like any cosmetic treatment, the end result of PSR is closely tied to the skills of the provider. This particular cosmetic treatment isn't offered by many providers. And some of the doctors that used to offer it don't seem to be offering PSR any longer.
At one point, I read a doctor answer on RealSelf talking about the huge number of lawsuits that came with PSR - but I cannot find it anymore (or I would have shared it). The post specifically talked about the pain that came with the procedure. All these things are a warning sign to me - thus the new title for this post, "J-Plasma & Portrait Plasma Skin Regeneration | Be Wary of this New Technology."
If you'd like to learn more about other methods of skin rejuvenation, (because it's always best to be well-informed!) you might consider reading these:
Medical Micro-needling - An Overview | Botox - What to Expect With Your Injections | 7 of the Best Treatments for Dark Skin
Amy Takken, RN
Amy Takken is a registered nurse with 20+ years of experience helping people improve their health. Her in-depth skincare articles have been featured on Nazarian Plastic Surgery and The Palm Beach Center for Facial Plastic & Laser Surgery. She's also been quoted on Dermascope.com. Amy loves research and constantly watches for new products and treatments to help you improve your skin’s health – because healthy skin is beautiful! To reach Amy, visit our contact page.
Masterpiece Skin Restoration is your online resource for all things medical aesthetics, skincare, beauty, and wellness. We keep you up to date on leading edge technology and the services available to help you restore your natural beauty.
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References:
https://onlinelibrary.wiley.com/doi/full/10.1111/j.1473-2165.2008.00385.x Advances in plasma skin regeneration
https://en.wikipedia.org/wiki/Plasma_%28physics%29
https://clinicaltrials.gov/ct2/show/NCT03286283 The Use of J-Plasma® for Dermal Resurfacing
https://apyxmedical.com/j-plasma-vs-laser-five-key-differences/
https://www.zwivel.com/blog/the-truth-about-j-plasma/
https://www.dermatologytimes.com/cosmetic-surgery/plasma-versus-co2
www.smartskincare.com/treatments/noninvasive/plasmaresurfacing.html
https://www.realself.com/question/plasma-rejuvenation-treatment-and-prices
https://www.docshop.com/education/dermatology/facial/portrait
https://seekingalpha.com/article/3547666-botox-dead-man-walking
https://apyxmedical.com/jplasma/
https://seekingalpha.com/article/1435201-bovies-j-plasma-may-slay-the-mrsa-dragon-and-other-nasties
https://www.skintherapyletter.com/cosmetic-dermatology/plasma-skin-regeneration/
https://jamanetwork.com/journals/jamadermatology/fullarticle/411275 Evaluation of Plasma Skin Regeneration Technology in Low-Energy Full-Facial Rejuvenation
https://www.dermatologytimes.com/cosmetic-surgery/plasma-technology-improves-wrinkles
https://onlinelibrary.wiley.com/doi/full/10.1111/j.1610-0387.2010.07495.x Plasma medicine: possible applications in dermatology
https://smallcaps.us/bovie-medical-is-making-its-move
https://kuark.com.tr/images/neogen/Advances%20in%20Plasma%20Skin%20Regen.,%20Foster%20Moy%20Fincher.pdf Advances in plasma skin regeneration
http://www.totalbodycontouring.com/clinical_papers/portrait_nitrogen_plasma.pdf
https://jamanetwork.com/journals/jamafacialplasticsurgery/fullarticle/407376 Nitrogen Plasma Skin Regeneration and Aesthetic Facial SurgeryMulticenter Evaluation of Concurrent Treatment
https://www.sbplasticsurgeon.com/face/plasma-rejuvenation/
https://jamanetwork.com/journals/jamadermatology/fullarticle/411275 Evaluation of Plasma Skin Regeneration Technology in Low-Energy Full-Facial Rejuvenation
www.totalbodycontouring.com/clinical_papers/portrait_clinical_data.pdf
https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/detail.cfm?mdrfoi__id=1274712 MAUDE Adverse Event Report: RHYTEC, INC. RHYTEC PORTRAIT PSR3 PORTRAIT SKIN REGENERATION
https://www.accessdata.fda.gov/cdrh_docs/pdf7/K073111.pdf 510(k) Summary For the Rhytec, Inc. Portrait® PSIR3
https://www.realself.com/article/the-skinny-plasma-resurfacing
https://www.ncbi.nlm.nih.gov/pubmed/19150295 Fractional carbon dioxide laser and plasmakinetic skin resurfacing.
https://www.costec.com.au/equipment/nitrogen-plasma-system/neogenpsr-nitrogen-plasma-system/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155739/ Skin resurfacing procedures: new and emerging options
https://www.skintherapyletter.com/cosmetic-dermatology/plasma-skin-regeneration/
https://www.researchgate.net/publication/226101812_Plasma_Resurfacing
https://plasticsurgerykey.com/nitrogen-plasma-skin-resurfacing/
https://kuark.com.tr/images/neogen/ArchivesPSR20020720Bogle,20Dover,20Arndt.pdf Evaluation of Plasma Skin Regeneration Technology in Low-Energy Full-Facial Rejuvenation
https://jamanetwork.com/journals/jamadermatology/fullarticle/190332 Treatment of Perioral RhytidesA Comparison of Dermabrasion and Superpulsed Carbon Dioxide Laser
https://www.zwivel.com/blog/the-truth-about-j-plasma/
https://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2019/69438a-eng.php Health Canada reminds Canadians that plasma pens are unauthorized and may pose health risks, following complaints involving Calgary and North York spas
https://www.realself.com/renuvion
https://www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2018/68366a-eng.php Plasma pens are not authorized in Canada and may pose health risks
https://onlinelibrary.wiley.com/doi/full/10.1002/lsm.23167 Helium Plasma Skin Regeneration: Evaluation of Skin Tissue Effects in a Porcine Model and Comparison to Nitrogen Plasma Skin Regeneration
https://www.nsmedicaldevices.com/news/apyx-medical-renuvion-trial/
www.aafprs.org American Academy of Facial Plastic & Reconstructive Surgery, Inc. I found lots of great information about plasma skin regeneration on this site, but it's not there anymore.
Disclaimer:
The Information provided on our website is not medical advice and should not be viewed as such. By law, only a medical doctor can diagnose or give medical advice. As a registered nurse, my goal is to educate, so I provide information on skin care, skin care products, and skin care treatments. If you have any condition that concerns you, please see a medical doctor. While most skin conditions are benign, some - like melanoma - can be deadly. If there is any doubt, please, please consult your physician. Thank you!