Sponsored By Revolution Medical;
Plasma is the fourth state of matter next to solids, liquids and gases. Despite making up 99% of the universe, it is not discussed much. Plasma is formed when energy passes through a gas (such as air). During the heating that occurs, atoms in the hot gas are moving so fast that electrons can be knocked loose when they collide with each other. This process is called ionization.
As an aesthetic application, this refers to the use of plasma energy to create a unique nonablative thermal effect on the skin. According to studies1,2 this leaves a layer of desiccated epidermis which acts as a natural bandage for idealized healing. Tissue is not vaporized, treatment is not chromophore dependent, and there is no easily discernable line of demarcation, making it dramatically different from laser technology.
Histology has shown that even after a year, improvement in collagen production and reduced elastosis is still occurring. Outcomes are similar to low and medium fluence CO2 laser with minimal thermal necrosis and a favorable healing profile,2 making plasma an ideal nonsurgical modality for skin rejuvenation, wrinkle reduction and improving skin tone. In addition to affecting intracellular pH, plasma also damages biofilms, bacterial cell walls and proteins, making it an effective modality for anti-microbial therapy. “This is particularly appealing to patients post-COVID,” said Joni Collins, DMS, PA-C, founder and owner of Twelve Twenty Eight Wellness Aesthetic and Regenerative Medicine in Marietta, Ga.
With Pure Plasma from Revolution Medical (Newport Beach, Calif.) practitioners enjoy a powerful, customizable, low downtime energybased therapy that is less a tool for a technician and more a specialized paint brush for an artist. Equally important is the company support; Revolution Medical partners closely with practices to ensure success from understanding and training to bringing business their way.
“When I first was inquiring about the device, I wanted to research the whole deal. Representatives actually sat me down, spent more than half a day teaching me, sharing scientific literature demonstrating how it works as well as safety and efficacy,” Dr. Collins continued. “We also discussed the financials, return on investment (ROI), the treatment experience, downtime, and more. I even had a call the next day with their chief executive officer (CEO), Jeff Nourse. The Company obviously cares about the brand and makes sure the right people are using the products the right way.”
Plasma devices are not new, according to Michael Gold, MD, founder and medical director of Gold Skin Care Center, Advanced Aesthetics Medical Spa; The Laser & Rejuvenation Center; and Tennessee Clinical Research Center in Nashville, Tenn. “Pure Plasma is an amazing technology to tighten the skin and get rid of wrinkles around the mouth and the eyes – that is where I think it excels. The tightening and smoothing of the skin and wrinkle reduction are really impressive, healing is so fast and the downtime is relatively minimal.”
Joseph DeLozier, MD, plastic surgeon and founder of the DeLozier Cosmetic Surgery Center (Nashville, Tenn.), agreed. “In the region around the eyelids, I have been very impressed with how much benefit there is, especially when it is done aggressively. It is extremely effective in some of the thinnerskinned areas of the face, particularly the eyelids, and used in combination with other treatments like microneedling.”
Regional sales manager Randy Matscherz, BSME is also a clinical trainer for Pure Plasma. “With a degree in mechanical engineering, I am a technology guy, and in my mind the best way to describe Pure Plasma is an evolution of a technology that has been around for a while – an existing technology that we have finally domesticated. Our mission is to provide the best science-backed, non-invasive technologies that work for patients and practitioners in terms of safety, results and profitability, which is why we work so diligently with our practice partners.”
Pure Plasma uses nitrogen gas plasma, emitted from the distal end of the handpiece, specifically chosen for its controlled and predictable delivery of thermal energy to the skin at depth. This heats all tissue components even down to the reticular dermis creating a uniform physiological improvement. It targets water, so it penetrates deeply and heats consistently. Because it purges the oxygen from the target area, there is no burning or charring. At low energy levels, transdermal permeability is increased. “This nitrogen gas plasma technology has greatly broadened my ability to perform multi-modal therapies, which I love to do,” said Joseph Ayers, PA-C, who practices at ELAN Skin in Nashville, Tenn. “It is a great standalone treatment but excellent in combination, and I can do dual or triple therapies in a single day including Pure Plasma because of the way it affects the skin. It is also very fast. I can do a chest, neck and face all together in under 30 minutes.”
A big difference between Pure Plasma and previous successful plasma devices is power, according to Mr. Ayers. “It is in the wattage. Other devices give you 100 W to 200 W and it is like trying to fly a jet plane with a propeller engine. Pure Plasma is up to 900 W and there is no delay during treatment. Recalibrating with another popular device, for example, requires regular pauses every five or ten pulses. It takes an hour to do something Pure Plasma does in ten minutes.”
According to Dr. Gold, the device serves numerous commonly-sought indications. “Plasma does resurfacing, skin regeneration and skin tightening very well,” he said. At higher settings, the epidermis and upper dermis are shed when new skin has formed, with recovery taking seven to ten days. With lower settings and one to three days of recovery time you can get a more superficial effect. Regardless, the barrier remains intact, acting as an insulator and protection for the wound. Using a single highenergy session or multiple low-energy sessions will provide a deeper regeneration of the skin, with studies showing continued improvement even after a year.2
For skin tightening, the instantaneous skin heating by the plasma causes immediate tissue contraction, with the cascade of neocollagenesis stimulated via thermal disruption of elastosis. Neovascularization and fibroblast migration restore skin function and health, as well as appearance. “We can also treat acne, actinic keratoses, viral papilloma, atopic dermatitis, scars, rhytides on and off the face, and fine lines and wrinkles,” Dr. Gold reported. “I also like it for certain pigmentary indications, it treats surprisingly well. I have had success treating melasma with Pure Plasma. It is not fractional CO2, but it is a resurfacing-remodeling that will destroy the pigment with pinpoint accuracy. The pigment cells are disrupted, and we get collagen regeneration and so forth, with a lot less downtime than more aggressive treatments. Also, you can get great results in one or two sessions. I typically do not do more than that and the outcomes are pretty impressive. It is my go-to for wrinkles around the eyes and mouth, especially the eyes where it works incredibly well.”
“One problem with a CO2 laser, when treating around the periocular area, is I have to utilize intraocular metal protective shields to protect the cornea,” mentioned Mr. Ayers. “It is very cumbersome to put those in, and take them out to treat the upper eyelid and very close to the eye. Patients do not like them either. Treating that delicate area with Pure Plasma, I can treat right over the eyelid down to the eyelashes, up to the eyebrow, and the whole face, without any intraocular protection. It is just that safe. Pure Plasma is FDA cleared to do a ‘soft blepharoplasty’ around the eyes without intraocular protection.”
Another major advantage with Pure Plasma is that it is skin-type friendly. “You can use fractional CO2 on all skin types, but you must be careful on darker skin types and know what you are doing,” said Dr. Gold. “This device is not chromophore dependent, so you can safely treat all skin types. Of course, anytime we treat darker skin, we need to make sure we are prepping the skin properly, working with skincare to minimize the chance of post-inflammatory hyperpigmentation (PIH) as a precaution; you can never be too careful. However, the chance of PIH with Pure Plasma is relatively low, if any.”
Dr. Collins described Pure Plasma as a complete game changer for her practice. “Things like CO2 laser or other ablative energy-based devices have so much downtime, and in 2023, nobody wants that,” she said. “Pure Plasma means a lot to me because I developed a protocol called the 12:28 protocol, which I trademarked, for the face, neck and chest. It is one procedure every 28 days for twelve months (hence 12:28). By combining procedures, we hit several layers of the skin creating a collagen lattice for a natural, yet noticeable result. My patients love this, but some want even more ‘wow’ results. Adding Pure Plasma allowed me to create a tiered membership package for patients. Members that take part in that protocol get access to Pure Plasma at a discounted rate.
“Pure Plasma also adds something to my practice that actually penetrates to the deeper layers of the skin but with minimal downtime and predictable recovery, much less of an issue than ablative technologies for both the patients and provider,” Dr. Collins continued. “I can safely use it all over the body. You can do so much with it alone or in combination and can do a lot with the settings, so it brings out the artist in the provider, which sets them apart from other practices. And every provider that I have trained so far that has seen the device is fascinated with it because of the minimal downtime, good ROI, and the results. The before-and-after pictures speak for themselves.”
Pure Plasma is a great standalone therapy in Mr. Ayers’ hands, but he lives for combination protocols. “I am regularly combining this with other technologies on the same day, stacking it as the last treatment. I am able to do dual or even triple therapy the same day. We achieve a much greater outcome, and a more positive overall experience for our patients.
“My most common multi-therapy using Pure Plasma involves radiofrequency (RF) microneedling,” Mr. Ayers continued. “I do the RF microneedling first after I have achieved good anesthesia and then I will go back over that area with Pure Plasma, back-to-back. Other options include intense pulsed light (IPL) plus RF microneedling stacked with Pure Plasma. The reason being: Pure Plasma is not a chromophore dependent technology; it seeks out water very similar to CO2 lasers without breaching the barrier or burning skin. By stacking IPL, I am targeting hemoglobin, reds, melanin or sun damaged spots. With RF microneedling, I am creating that microscopic trauma to the skin with the RF, adding a tightening effect; Pure Plasma is the icing on the cake. The nitrogen plasma gives me more of an exfoliation depending on the level of energy. I typically use a mild to moderate setting on the device going for that epithelial removal. It is a completely different but complementary vector. In other words, with the microneedling you have the physical damage plus the RF effect on the skin. Depending on the device you use, and how that profile affects the skin at depth, you then get the top-down extra with Pure Plasma.”
Mr. Ayers explained that exfoliating with Pure Plasma is not a direct scrubbing of the skin, as in an abrasive medspa facial, it is the mild (compared to laser) resurfacing effect performed at less aggressive settings using the device. “It is more of a delayed reaction because you are leaving that barrier – the upper epithelial layer – intact,” he began. “And as that lower epidermal layer is renewing, repairing from the plasma being absorbed, the top layer acts as a kind of a biological bandage, and I really like to use those terms with my patients because we are not really breaking the skin after the RF microneedling, we are just delivering this plasma energy through the skin. And as that upper epidermal layer is remodeling, that bandage protects it. When it is time for it to release, the bandage will come off on its own as shedding.”
Shedding during downtime is usually most significant at days three and four, during which makeup use is highly discouraged. “It depends on your energy settings. If you use a very low energy setting, I have had patients heal as quickly as four days. For one patient who I kind of maxed it out on – treatment of the entire face at 3.75 J and a short spacer – it took about 12 days to recover, similar to a moderately aggressive CO2 laser,” Mr. Ayers shared. “I tell people they can either take a boat to China, or a jet. It all depends how fast they want to get there and how much downtime they can handle. That puts it into perspective for patients. It depends on their goals and willingness to accept downtime.”
Just as one can dial in treatment parameters, one can dial in the downtime, Dr. Collins indicated. “During intake I ask questions to determine what kind of activities they like, what kind of work they do, are they outside a lot? Do they have any upcoming events? It is important for timing, how aggressive you can be, and defining both their goals and their downtime. I also learn what they define as downtime. In my office, I take the slow and steady pathway,” she shared.
“Pure Plasma combines the result of a heated energy device with the comfort and ease of a cooling tip, so I do a series of three sessions, one every six to eight weeks, and patients can genuinely return to work the same day with just a little bit of shedding,” Dr. Collins explained. “Overall, we are generally looking at about five days, and that is being very conservative. The first day you have some swelling, the second day it feels really tight, almost like you have a clear mask on. The third day is exfoliation, the fourth day you are a little pink, and on day five you wake up with this beautiful, tight, lifted, glowing skin. To me, the most noticeable period is at day three or four because of the shedding.” Also, the lack of need for anesthesia or other pretreatment protocols means people can drive themselves home afterward, she added. “That is surprisingly important for many patients.”
The Company’s business model stands apart from the conventional approach of simply selling equipment to clinics, according to Oxana Nourse, vice president of marketing at Revolution Medical. “We transcend the role of mere suppliers,” she said. “We become strategic partners for clinics and medspas. Our commitment does not end with a sale; it is where it truly begins. We forge lasting partnerships with clinics, offering comprehensive support in various forms. Our dedicated territory managers do not just vanish after the transaction.”
A deep, experience-based understanding of the needs of the medspa industry is their advantage. “We have walked in the shoes of clinic owners, having managed the largest medspa chain in North America and currently operating successful retail clinics,” Ms. Nourse elaborated. “This hands-on experience grants us unique insight into the needs and desires of doctors and clinic owners. We are intimately familiar with the consumer mindset, enabling us to provide tailored solutions that resonate with both medical professionals and their clients.
“Crucially, we do not merely peddle services; we deliver results,” Ms. Nourse continued. “Our cutting-edge devices are meticulously crafted to ensure high client satisfaction. The efficacy of our technology translates into tangible outcomes, guaranteeing not only delighted customers but also a substantial new revenue stream for our partner clinics. This focus on tangible results sets us apart in an industry often saturated with promises.” “They collaborate effectively to achieve the mutual goal,” Dr. Collins stated.
“They worked with me on a game plan from beginning to full-on daily use. It started with education and later included extensive training. We discussed how to make it useful in my practice, safe and effective, affordable and profitable for everyone. The lack of consumables is a big plus. They even worked to help me decide what the best way to pay for the device would be.”
“We recognize the financial challenges clinics face,” Ms. Nourse said. “By minimizing consumable costs, we enable our partner clinics to enjoy significantly enhanced profit margins. This financial advantage demonstrates our commitment to supporting the long-term success of the clinics we work with. We firmly believe that by investing in our partners’ prosperity, we secure our own, creating a symbiotic relationship that fosters growth and mutual benefit.”
“Revolution Medical has given me almost concierge-type service,” Mr. Ayers highlighted. “My rep responds to me within minutes. If I have questions, I can reach out at any time. There is a personal connection that you just do not see with other vendors, it is a direct reflection of what the company is all about. When we first purchased our Pure Plasma, we had so many people lined up that we actually ran out of nitrogen gas within our first 48 hours of having the device. My rep was here with a new tank of gas within hours. Other companies would get you a new device in a few weeks, meanwhile you lose business.”
The Company has been very strong in maintenance and training, according to Dr. DeLozier. “The device itself has been very reliable, with very little maintenance. Our representative has gone overboard with training. He has come back several times to be sure that everyone is comfortable using the device and is using it properly, much more so than probably any other device company I have seen to date. As far as support goes, they have certainly upped their game in terms of literature and information, but they have also helped us develop our own individual before and after pictures to help us demonstrate what we as a practice can do with the Pure Plasma device,” he said.
According to Mr. Matscherz, one exciting way that Revolution Medical stands alongside companies is by helping them harness social media to drive Pure Plasma patients their way, stimulating the circulation of modern wordof-mouth. “Instead of delegating in-house we have hired a marketing company specifically to assist our customers in driving business to their door using Facebook, Instagram, TikTok, what have you,” he shared, explaining that this gives the marketing company a little more autonomy; they can respond to changes in content presentation strategies, platform regulations, and more as it is their specialty. “Through this endeavor we help practices establish themselves through social media, or if they have an existing presence, we can help them do it and provide them with content directly. If they wish, we can use a HIPAA compliant database to help them market to existing patients. We want to be hands-on driving patients to our customers’ doors. Their success is our success.”
“In essence, our business model is not just about selling devices,” explained Ms. Nourse, “it is about nurturing enduring relationships, understanding the pulse of the market, delivering concrete results, and bolstering the financial health of our partner clinics. At our company, we redefine what it means to be a true partner in the aesthetic medical industry.”
References:
1. Foster KW, Moy RL, Fincher EF. Advances in plasma skin regeneration. J Cosmet Dermatol 2008;7(3):169-179.
2. Fitzpatrick, R., Bernstein, E., Iyer, S., et al. A histopathologic evaluation of the plasma skin regeneration system (PSR) versus a standard carbon dioxide resurfacing laser in an animal model. Lasers Surg Med 2008;40:93-99.
