FULL POWER PORTRAIT® PSR³ FOR RESURFACING

Plasma resurfacing using the new Portrait® PSR³ is a procedure completely unlike laser resurfacing or any procedure that uses light, radiation, or radiofrequency (RF). Portrait® PSR³ 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, scarring, 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® PSR³ 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® PSR³ 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

Full power - One treatment session

Full face - $2850

Periocular (around the eyes including eyelids and crows feet) - $1200

Perioral (around the mouth including lips) - $1200

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 Dr. Coverman is required. There is a fee for this visit. At that time Dr. Coverman will discuss your wishes and needs. He will review prior treatment of your scars or wrinkles. He may suggest ongoing therapy to precede, compliment, and augment your resurfacing, and give you a plan for long term care. Other options for correction of your wrinkles such as Botox® Cosmetic, Collagen, Restylane, peels, FotoFacial and microdermabrasion might also be discussed if appropriate. A treatment plan will be outlined.

A. Less than three days notice 100% of my advance payment will be refunded.

B. Less than 48 hours notice 75% of my advance payment will be refunded.

C. Less than 24 hours 50% of my advance payment will be refunded.

PRETREATMENT

It is critical to start bleaching creams and Retin A one month prior to your treatment. We will discuss this with you. Prescriptions will be written and an extensive written "cookbook" of pre and post-operative care will be given to you. All items on this will be discussed with you.

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 for 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

Prior to the procedure, you will be given 5-10 mg of oral Valium (diazepam) and an intramuscular shot of Demerol (meperidine). Please let us know if you are allergic or have any specific problems with these medicines.

Depending on the location, we will give you appropriate injected local anesthesia.

You will be lying down, and the procedure will begin. You shouldn't feel anything. If you do, more local numbing medicine can be used which will work instantly. The actual procedure takes about one hour.

You will be wide awake but perhaps a bit groggy. You can talk to our staff during the procedure.

At the conclusion, you may relax in one of our examination rooms, and family members may join you. Most patients leave the office one hour after the procedure is finished. It is imperative that someone drive you home. Please make sure we have their cell phone number.

POST TREATMENT

Adequate oral pain medicines will be prescribed, and you will probably want to take those during the first day after the local anesthesia wears off. A stronger pill can be used for the first few nights, mainly to help you sleep. Usually after the first night, there is not much discomfort.

There will be weeping and oozing and your face will be red and swollen for at least the first week. You will want to stay indoors. You will be wide awake, functional, and you can pretty much do what you want. You just won't look very pretty. Extensive and detailed instructions for care will be discussed and you will receive written confirmation.

By the end of the second week, at the 14th day, most female patients are able to go back in public wearing full make-up. They are usually able to attend all work and social events. There may be persistent redness (not much worse than a weekend sunburn) which may last several weeks or months afterwards, but that is usually fading every day. With the make-up off in the evening, it should look no worse than a sunburn.

Plan your work, school, travel, and social activities accordingly.

DO NOT PLAN ANY EXTENDED TIME OR VACATIONS IN THE SUN FOR AT LEAST THE FIRST TWO MONTHS AFTER YOUR PROCEDURE. Although you will be healed, and you will of course be wearing sunscreens, we wouldn't want to take any chances. 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.

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.

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 is 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.

There is no guarantee of percentage of improvement per area or overall. This is variable. There are no free touch-ups.

There can be hair loss at the treated sites. Very rarely this could be permanent.

FOLLOW-UP

For full face treatments we perform this procedure on a Monday. We will see you each day that week. We will then see you the following Monday, Wednesday and Thursday of the second week after your procedure, and the following Monday and Thursday again at the third week. There is no charge for any of these visits as long as other medical problems are not discussed. By your last visit he will prescribe a maintenance program for you, often involving typical treatments to prevent further aging such as Retin A, sunscreen, vitamin C serum, and alpha hydroxy acids. All visits after that will be at normal office visit charges.

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