PORTRAIT® PLASMA PSR1

FOR RESURFACING

NATURE OF THE PROCEDURE

Plasma resurfacing using the new Portrait® PSR1 is a procedure completely unlike laser resurfacing or any procedure that uses light, radiation, or radiofrequency (RF). Portrait® PSR¹ initiates skin regeneration by delivering millisecond pulses of nitrogen plasma to the skin surface. The energy transmission is uniform and predictable with gentle impact. Rapid heating occurs and the epidermal layer remains intact, acting as an insulator and biologic dressing. Due to the presence of inert nitrogen creating a surface microenvironment, there is an absence of char formation on the treated skin. The upper dermis is modified through thermal conduction from the skin surface. One can accomplish this using either single high energy treatments or repeated non-ablative treatments. In either case, the old thermally modified architecture is progressively replaced by a new architecture. The skin regeneration cells that will form collagen should migrate from the deeper dermis into the surface to restore the skin to healthier function and appearance.

This procedure is best for wrinkles and sagging skin. It will help surface texture and pigment to a lesser degree. It will not necessarily help redness or "broken" blood vessels.

Unlike Carbon Dioxide (CO2) resurfacing at full power, the recovery time with the Portrait® PSR¹ is shorter. There is less redness, quicker healing, less discomfort, and higher patient acceptance. There is also much less chance of a "line of demarcation" particularly along the jawline between treated skin and untreated skin.

Some patients prefer a series of three treatments three weeks apart just using local topical anesthesia. Others prefer the single one pass treatment at higher energy. We will inject a local anesthetic when using the higher power. In either case, you will be wide awake and able to talk to our staff.

The beauty of the Portrait® PSR¹ plasma resurfacing procedure is that you may enjoy continued improvement of your wrinkling or scarring due to the continued rebuilding of collagen long after the procedure has been completed. This is unlike any other laser ablative or non-ablative laser or light based procedure.

FEES (Each Session)

Full Face - $950 per session ($2850 for three sessions) $2700 if prepaid (save $150)

Periocular (around the eyes including eyelids and crows feet) - $500

Perioral (around the mouth including lips) - $500

Cheeks- $500

We strongly advise you to complete all three sessions.

This is an all inclusive fee that includes pre-operative care, the treatment itself, and extensive, close, and careful post-operative monitoring.

All fees are subject to change. The fee is always what is current at the time of your actual treatment. Old fee schedules, handouts, or web site fees do not apply. Any quoted fees must be in writing and are only good for six months. No "verbal" quotes are accepted.

SCHEDULING

A visit with our staff is mandatory! We will assess your skin type, degree of wrinkling, prior history of anti-aging or surgical treatments, etc. If you wish to see Dr. Coverman or Jennifer to discuss this in more depth or other alternatives, there is a fee.

There is a $150 non-refundable fee for missed appointments without a 24 hour notice. If you need to cancel, please record the date, time, and name of the person you spoke with.

PRETREATMENT

Stop all acne and anti-aging creams three days before your procedure. We will recommend a night cream. DO NOT COME IN SUNBURNED!

If you have ever had herpes or think you may have (cold sores or fever blisters), inform Dr. Coverman or our staff prior to scheduling your appointment. We will give you a series of anti-herpes pills to take the day before the treatment, the day of, and six days after. This should help to suppress or prevent herpes from flaring, but there are no guarantees. A herpes flare could cause pain, pigment, infection, and scarring.

TREATMENT DAY

Apply the topical anesthetic cream that we gave you liberally and thickly one hour before coming to our office. Make sure that this doesn’t drip into your eyes. Just prior to the treatment we will wipe this off for you. You will lie down and the procedure will begin. You may feel some pinpoint scattered discomfort but in general the numbing medicine probably takes care of 90% of any pain or discomfort.

You will be wide awake and you may talk to our staff. At the conclusion of the procedure you may leave. We will apply an antibiotic ointment and make sure that you have and understand detailed instructions for post-operative care.

Do not apply any Retin A, anti-aging, acne, or any other product until at least one week after, or until all peeling has stopped and dryness has disappeared. USE COMMON SENSE!

POST TREATMENT

This may be uncomfortable. Normal over-the-counter doses of Advil, Aleve or Tylenol should be sufficient. You can combine Aleve and Tylenol at the same time for added pain relief if you are normally able to take these.

Your face will be red immediately after treatment. It will be visible to others. Plan your work, school, social and travel around this. By the second or third day it may be more brown, "brassy" and/or "crinkly looking." We will advise you what creams to use, etc. DO NOT use any cream that we have not discussed. No vitamin E, aloe vera, etc. We do recommend Elta (available for purchase at our office) to be used at all times as an emollient for the first week. When in the sun, use your sunscreen.

This will fade over the next seven days. You may wear make-up on the fourth or fifth day. You may go back to work the next day if you don’t mind, but it will look like a bad sunburn. Certain jobs, depending on sun exposure and exposure to dirt, etc, will require more waiting. Always use COMMON SENSE! Avoid excess sun exposure and smoking.

DO NOT PLAN ANY EXTENDED TIME OR VACATIONS IN THE SUN FOR AT LEAST THE MONTH AFTER YOUR PROCEDURE. Although you will be healed, and you will of course be wearing sunscreens, we wouldn’t want to take any chances. We recommend Elta MD UV Physical SPF 41 sunscreen. This is chemical free and won’t burn, sting, or run. It is very adhesive to your skin. Specifically do not plan trips that would involve visits to the coast or the beach or activities such as snow skiing. If you are just going out of town for business or routine pleasure, that is fine. Once your skin is healed and you are back wearing sunscreens, you will of course be using common sense and wearing broad brimmed hats as you should anyway. Normal activities can be resumed.

POST-TREATMENT PAIN

For normal post-operative pain following most of the procedures that we perform in our office, we do not recommend nor prescribe any of the stronger pain medicines including hydrocodone (Lortab; Darvocet N100; Mepergan Fortis; Ultram). We feel that a combination described below of over-the-counter medicines will be enough. This is what we recommend:

Take one Aleve or Advil pill every 4-6 hours with food. Wash it down well with liquid. Breakfast, lunch, dinner and bedtime snack.
Do not take Aleve or Advil if you are allergic to aspirin, ibuprofen, naproxin, these pills, or have any type of aspirin sensitivity or the syndrome of nasal polyps, allergies, atopic eczema, and aspirin-allergy. Likewise, do not take this if you have any bleeding problems, or have ever had any ulcer disease or similar stomach disease.
We also recommend that you take two Extra Strength (500 mg) Tylenol tablets every 4-6 hours as well at the same time.
Please remember that the side effects of Tylenol have nothing to do with the side effects of Aleve or Advil, thus these may be taken together.

If you have any liver disease or potential liver problems, do not take the Tylenol. Do not take Tylenol if you are allergic to it or acetaminophen. DO NOT DRINK ALCOHOL WITH THIS REGIMEN! Otherwise, follow the schedule below:

8:00 a.m. - Breakfast
One Aleve or Advil with breakfast and plenty of water.
Two 500 mg Tylenol for adults.
Noon to 2:00 p.m. - Lunch
One Aleve or Advil with lunch and plenty of water.
Two more 500 mg Tylenol.
6:00 p.m. - Dinner
One Aleve or Advil with dinner and plenty of water.
Two more Tylenol.
10:00 p.m. to midnight - Bedtime
One Aleve or Advil at bedtime and plenty of water.
Two more Tylenol.
Benadryl (diphenhydramine) 25-50 mg for sleep.

The Benadryl is a great idea. It is the main component of most over-the-counter sleeping pills. (Tylenol PM), and is not addicting. Never drink alcohol before or with this, and plan on going right to sleep and sleeping 8 hours. DO NOT take with any other sleeping pill, anti-depressant, MAO inhibitor, or anti-anxiety drug (Xanax, Valium, etc.). Do not drive or operate dangerous equipment.

Thus, in any given day you should never take more than the total of four Advil or Aleve or eight Tylenol total (two every four to six hours).

Normally you should be able to safely do this for one to three days - but never more. If the pain ever worsens or this fails to control it - call our office during normal office hours or the medical exchange (458-1121) after hours.

This combination of Aleve or Advil plus Tylenol is safe, covers you around the clock, and allows you to take two different pain medicines whose side effects don’t cross react with each other assuming you are not allergic to either.

COMPLICATIONS

This treatment can be ablative. There will be a heat delivered to your skin. With any ablative procedure there can be pigmentary changes (whether lighter or darker), mottled pigmentation, scar, flare of underlying herpes, or infection. There is no guarantee what percentage of wrinkles or scars will be removed whether per lesion or overall. This will be variable due to the depth of any individual treated area. There can be a line of demarcation where the treatment stops and normal skin begins. Normally we try to "feather" this so that it becomes much less apparent if at all. At the hair line we soften the beam and spread it out a bit such that it blends into your hairline, and along the angle of the jaw we try to do the same thing. We also try to "tuck" the treated area underneath the jawline so the area of demarcation doesn’t show. In lighter skin people this will be less obvious. Nonetheless, this remains a risk which is impossible to avoid or predict.

FOLLOW-UP

We STRONGLY recommend three treatments! Remember.......three milder treatments are comparable to the one "full power" treatment, but you must complete them! We take no responsibility for anything less. Always schedule these three in advance!

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