Plasma in aesthetic medicine

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374 Journal of AESTHETIC NURSING ► October 2019 ► Volume 8 Issue 8
CLINICAL ▼
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lasma electrosurgical devices have long been 
employed for tissue coagulation, cutting and 
cauterising. In the past few years, according to 
Gay-Mimbera et al, plasma medicine has been full 
of innovations. This field of aesthetics looks to ‘control 
the interactions between plasma components (as well as 
other secondary species that can be formed from these 
components) with specific structural elements and 
functionalities of living cells’ (2017).
Back to basics
Plasma is a resurfacing method that ‘uses plasma energy 
to create a thermal effect on the skin’ (Foster et al, 2008). 
This method differs from lasers, as it does not depend 
on chromophores or vapourise tissue. Instead, it leaves 
an intact layer of desiccated epidermis, which ‘acts as a 
natural biologic dressing and promotes wound healing 
and rapid recovery’ (Foster et al, 2008).
Plasma is often referred to as the fourth state of 
matter, which comprises of ionised atoms (Sotiris et al, 
2014). It is created when electrostatic energy mixes with 
an ionised gas. When the thermal energy from a plasma 
device reaches around 1-mm from the skin, it mixes with 
oxygen and nitrogen in the atmosphere and creates a 
plasma arc, which vaporises upon contact with the skin. 
(Sotiris et al, 2014)
According to Fridman, ‘plasma can exist in a variety of 
forms and can be created in different ways’ (2011). Plasma 
action’s mechanism on the skin involves two steps: 
immediate tissue contraction and thermal disruption. 
After the thermal effect of plasma, the denaturation 
of collagen and other proteins in the dermis induces 
clinically observed, immediate tissue contraction. Cold, 
as well as thermal, plasma is already used for a range of 
therapeutic applications, and the application of plasma 
has enormous potential. For example, plasma can also 
be used in wound healing for sterilising or disinfecting 
(Heinlin et al, 2010).
Periocular dermatochalasis and 
non-surgical blepharoplasty
Periocular dermatochalasis (also known as excessively 
loose eyelid skin) is mostly found in the upper eyelids 
where skin loses elasticity, thus dropping both outwards 
and down onto the eyelashes, resulting in droopy eyelids 
and even supero-lateral visual field obstruction. The 
periocular region is the first to display signs of early 
ageing which, naturally, brings with it several patient 
concerns, including dark circles, eyelid skin folding 
and lower lid bags. However, if this is not caused by 
involutional changes that accompany ageing, periocular 
dermatochalasis can also be a result of repeat swelling. 
Increasingly, it is being found that non-surgical 
blepharoplasty using plasma is becoming a more 
attractive alternative to surgery, as it eliminates the 
need for general anaesthetic which, in turn, means there 
is no risk of allergic reaction, blood clot or pulmonary/
cardiac complications. Further benefits of non-surgical 
blepharoplasty include a faster healing process and 
reduced chance of any scarring or damage to the patient’s 
vision or muscles (King, 2017).
Preparing and assessing the 
upper eyelid
Often, practitioners find it useful to refer to pictures 
of the patient at a younger age, as this can aid in the 
Plasma in aesthetic medicine: 
benefits and considerations
Abstract
In aesthetic medicine, plasma can successfully treat scarring, stretch 
marks, acne, dyskeratosis, xanthelasma, warts, verrucae, naevi, 
fibromas, seborrhoeic keratosis and a host of other skin lesions. 
For most patients, the most exciting revolution in plasma 
technology is non-surgical blepharoplasty. There are so many 
plasma or fibroblast devices on the market that vary in price 
and are marketed at both medics and non-medics, but what 
exactly is plasma? This article will discuss what plasma is, as 
well as exploring the indications for use, complications that 
come with this device and how to treat the upper eyelid.
Key words
► Plasma ► Resurfacing ► Blepharoplasty ► Surgical smoke 
► Periocular dermatochalasis 
CLAUDIA MCGLOIN
Clinical Director/Aesthetic Nurse Practitioner, 
The New You Clinic, Ireland
E: claudiamcgloin@hotmail.co.uk
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Volume 8 Issue 8 ► October 2019 ► Journal of AESTHETIC NURSING 375
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restoration of youthfulness and a natural look, while it 
is necessary to assess preseptal fat pads when redefining 
the superior sulcus (Naik et al, 2009). 
While plasma is a suitable treatment for patients with 
excessive eyelid skin, those with extreme hooding or 
pronounced subcutaneous fat in the upper lid may opt 
for a surgical procedure for various reasons, including 
personal preference. Following assessment, the patient 
is prepared using skin disinfectant and the application of 
a topical anaesthetic. 
Post-treatment considerations
As a result of carbonising tissue, the patient will have 
small brown spots on the areas that have been treated 
with plasma. These will last around five to seven days. 
While they will fall off naturally, the patient should 
not pick them, as this increases the chance of scarring. 
The day after the treatment, there ‘may be considerable 
peri-orbital swelling which resolves over the next 24–48 
hours, this may be even longer if both the upper and 
lower lids are treated at the same time’ (King, 2017).
While the non-surgical procedure eliminates the 
chances of other common complications which 
accompany blepharoplasty, it has its own set of possible 
complications, including infection, bruising, asymmetry 
and pigmentation. Plasma technology has proven to 
be safe, with data suggesting that there is no scarring 
because the basement membrane is not breached. 
However, as can be expected from any procedure that 
causes damage to the epidermis, scarring can occur from 
improper use, so adequate education and training is 
necessary (King, 2017).
Health Canada has listed the following side effects of 
this procedure to include ‘pain, swelling of the treated 
area, redness, sagging skin (particularly in the upper 
eyelids), hyperpigmentation (spots), ultraviolet (UV) 
sensitivity and skin peeling and crusting’ (Taylor, 2018). 
These side effects can happen even when the device is 
used properly. If used improperly, other risks include:
 ► Skin punctures with the needle tip
 ► Severe burns caused by overuse or prolonged use
 ► Burns to the eyes
 ► Complications from burns, such as infection and 
permanent scarring. 
However, it is interesting to note that Canada does not 
permit the use of such devices to be used, with Health 
Canada stating that, ‘Plasma pens have not been 
approved for sale in Canada, which means that they 
have not been evaluated for safety … It is recommended 
that consumers avoid the use of plasma pens/fibroblast 
devices that may be offered at spas, cosmetic clinics, or 
any other location including private homes’ (Windsor-
Essex County Health Unit, 2019).
Companies selling unauthorised plasma pens have 
been contacted by Health Canada, informing them 
that it is ‘illegal to advertise, import for sale, or sell 
these devices without the proper approvals and 
licensing’ (Windsor-Essex County Health Unit, 2019). 
Aestheticians and spas have also been made aware of 
licensing requirements, as well as possible risks and 
complications (Taylor, 2018).
While the non-surgical procedure eliminates common surgical complications, other side effects should be considered
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CPD reflective questions
 �What is plasma used to treat?
 �What are the possible side effects/complications of plasma treatment?�What is smoke plume? 
Plasma contraindications
Certain patients are not suitable for plasma treatments. 
This includes patients ‘with an ongoing anticoagulant 
treatment, wearing pacemakers or metallic objects 
in the treatment area such as piercings, suffering 
from epilepsy, pregnant or breastfeeding women, 
or with an infectious skin disease on the treatment 
zones, or patients who were exposed to tanning beds, 
natural sunlight or who had high skin phototypes’ (de 
Goursac, 2018). 
Surgical smoke plume
It must be noted that there is a worry about the surgical 
smoke plume from these devices that could have an 
impact on the practitioner. Little is known or discussed 
about this, but the evidence below speaks volumes.
Surgical smoke plume is defined as ‘a potentially 
dangerous byproduct generated from the use of 
energy-based devices such as laser and electrosurgical 
units’ (Schuco, 2019). Such devices cause tissue to 
vapourise and expel into the air, to be then inhaled by 
the practitioner and patient. 
During such procedures, smoke plumes cause 
bacteria and viruses, as well as other chemicals and 
toxins, to be released into the air. The smallest particles 
released are usually viruses which travel deepest into the 
human body. Surgical smoke evacuators are necessary 
because, if not used, the practitioner and patient both 
inhale these particles, thus carrying bacterial and 
viral pathogens directly into the respiratory system. 
Toxins commonly found in smoke plume are carbon 
monoxide, methane, benzene, formaldehyde, hydrogen 
cyanide and phenol (Schuco, 2019).
One risk of inhaling smoke plumes is human 
papillomavirus (HPV). There are numerous case studies 
which examine perioperative professionals who work 
with lasers and electrosurgical devices who have HPV-
positive cancerous masses (Stratton, 2017).
In conclusion, the use of plasma in aesthetics is a 
suitable non-surgical approach to combatting ageing 
and periocular dermatochalasis, but requires expert 
training and knowledge to ensure it is safe for both 
the patient and practitioner. Certain precautions 
should be made to carry out procedures safely, like the 
implementation of smoke evacuation units, which are 
essential as they remove the smoke plumes and cellular 
matter from the air. 
References
de Goursac C, Medical blepharoplasty using jett plasma lift 
medical. PRIME. 2018;9(4):26–31
Foster KW, Moy RL, Fincher EF. Advances in plasma skin 
regeneration. J Cosmet Dermatol. 2008;7(3):169–179. https:// 
doi.org/10.1111/j.1473-2165.2008.00385.x
Fridman G, Friedman G, Gutsol A, Shekhter AB, Vasilets VN, 
Fridman A. Applied Plasma Medicine. Plasma Processes 
Polym. 2008;5(6):503–533. https://doi.org/10.1002/
ppap.200700154
Gay-Mimbrera J, García MC, Isla-Tejera B, Rodero-Serrano A, 
García-Nieto AV, Ruano J. Erratum to: clinical and biological 
principles of cold atmospheric plasma application in skin 
cancer. Adv Ther. 2017;34(1):280–280. https://doi.org/ 
10.1007/s12325-016-0437-z
Heinlin J, Morfill G, Landthaler M et al. Plasma medicine: 
possible applications in dermatology. J Dtsch Dermatol 
Ges. 2010; 8(12):968–976. https://doi.org/10.1111/j.1610-
0387.2010.07495.x
Heinlin J, Isbary G, Stolz W et al. Plasma applications in 
medicine with a special focus on dermatology. J Eur Acad 
Dermatol Venereol. 2011;25(1):1–11. https://doi.org/10.1111/
j.1468-3083.2010.03702.x
King M, Focus on plasma: the application of plasma 
devices in aesthetic medicine. PMFA. 2017; 4(5):24–26. 
www.thepmfajournal.com/media/3336/24-26-pmfajj17-
focusonplasma-new.pdf? (accessed 16 September 2019)
Naik MN, SG Honavar, S Das, S Desai, N Dhepe. Blepharoplasty: 
an overview. J Cutan Aesthet Surg. 2009; 2(1):6–11. doi: 
10.4103/0974-2077.53092
Sotiris TG, Nikolaos G, Irini G. Plexr: the revolution in 
blepharoplasty. Pinnacle Medicine & Medical Sciences. 
2014;1(5):423–427. https://pjpub.org/pmms/pmms_160.pdf 
(accessed 24 June 2019)
SCHUCO. Surgical smoke plume. 2019. www.schuco.co.uk/
surgical-smoke-plume (accessed 16 September 2019)
Stratton M. Surgical smoke transmits infectious diseases; here’s 
how to stop it. Infection Control Today. 3 April 2017. www.
infectioncontroltoday.com/operating-room/surgical-smoke-
transmits-infectious-diseases-heres-how-stop-it (accessed 24 
June 2019)
Taylor N. Health Canada issues warning about cosmetic 
plasma pens. New Market Today. 7 December 2018. www.
newmarkettoday.ca/local-news/health-canada-issues-
warning-about-cosmetic-plasma-pens-1151351 (accessed 24 
June 2019)
Windsor-Essex County Health Unit. Health Canada advisory for 
unlicensed plasma pens/fibroblast devices. 4 January 2019. 
www.wechu.org/alert/health-canada-advisory-unlicensed-
plasma-pensfibroblast-devices (accessed 24 June 2019)
Key points
 � Plasma is widely used in aesthetics to treat a 
variety of conditions 
 � There are various plasma devices available 
 � Smoke plume is a concern with plasma devices 
and precautions must be made
 � Plasma is a popular choice for treating non-
surgical blepharoplasty
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