How does plasma skin tightening work? [Updated]

We explore the science behind plasma technology, treatment benefits, common contraindications and the training required.  

Plasma claims a non-invasive route to results that rival cosmetic surgery and last just as long. Originally developed for medical applications, plasma emerged as an aesthetic treatment around 2017. More recently, its adoption by salon brands has seen the technology transition into more mainstream use. However, not all plasma is the same. Devices vary largely in energy output and results, and with so many now on the market it’s important to understand the differences in capabilities and risks of each.

Plasma is often referred to as “the fourth state of matter”, after solid, liquid and gas. It is created when electrostatic energy mixes with an ionised gas. When the thermal energy from a plasma device reaches around 1mm from the skin, it mixes with oxygen and nitrogen in the atmosphere and creates a plasma arc, which vaporises upon contact with the skin.

“In doing so, we force immediate contraction of the skin tissue at the surface and cause thermal disruption within the dermis below, especially to the fibroblasts,” explains Louise Walsh, chief executive of PlasmaPen by Louise Walsh International. “The precision trauma we cause to the epidermis makes the skin dry superficially into tiny carbon crusts, which fall off within a few days, leaving new, rejuvenated skin at the surface.”

Who can have the treatment?

Plasma is generating a lot of attention because it offers a non-surgical alternative to blepharoplasty (eyelid surgery). “There’s really no equivalent treatment out there for the eyes outside of plastic surgery. We can work all around the periorbital region,” says Walsh.

Other indications include frown lines, crow’s feet, nasolabial folds, jawline augmentation, the backs of hands, and loose skin on the arms, stomach, neck and décolleté.

“Most indications will only require one treatment, but it is affected by the depth of the indication,” says Josh Yardley, director of The Smart Group, which distributes the Accor Cosmetic Corrector plasma pen in the UK, adding: “80% of all Accor treatments are individual treatments.”

The Accor pen has built-in NF+ technology, which means “the intensity of the thermal energy diminishes the further down into the skin it goes”, explains Yardley. This low-frequency delivery is intended to keep the treatment area superficial but allow the device to work safely on a larger area, reducing swelling and redness.

What are the contraindications?

There are, however, contraindications for aesthetic-grade devices, and because the technology is still relatively new to this arena, it’s likely that more will emerge as the devices become more widely used. “We have a very broad and constantly updated list of contraindications that our technicians work to rigidly,” says Walsh.

The first is that PlasmaPen can’t be used on skins darker than a Fitzpatrick 3 because of the risk of post-inflammatory hyperpigmentation. Meanwhile, Accor lists the following contraindications to plasma treatment with its Cosmetic Corrector:

• Pregnancy
• Nursing mothers
• Metal implants
• Pacemakers
• Fever or current infections
• Anti-acne medication
• Skin lesions in the area being treated
• Cancers
• All forms of hepatitis
• Varicose veins in the area being treated
• Bone disease
• Epilepsy
• Autoimmune disease
• Diabetes
• Keloid predisposition
• Filler, thread-lift or botulinum toxin in the area being treated.

As with any tech, each device will have slightly different contraindications, so always check with manufacturers before investing. 

What are the risks?

There are a few other important considerations to be aware of before adding plasma treatments to your menu. Most devices require post-treatment downtime of at least a week, with clients encouraged to let the skin go through its natural healing process for seven days and just use sun protection. Tracie Giles, founder of Tracie Giles Bespoke Permanent Make Up, instructs her plasma clients to send her a picture of their eyes every morning for 10 days after blepharoplasty to check how they’re healing.

“However prepared a client is, if they’re having plasma around the eyes, they’re going to get massive lymphedema and that can be quite scary,” she says. 

Giles also patch tests every client: “I patch test so clients can experience how it feels and how their skin is going to heal,” she explains. “It’s also about checking for compliance with the aftercare advice I give them for the skin we tested.”

It is important clients are aware that aesthetic-grade plasma treatments are painful and require topical anaesthetic: “It’s a really painful treatment and there’s no getting away from that,” says Giles.

However, devices like the Crystal Clear Plasma Lift, which uses nitrogen from a built-in tank in the machine, have a much lower energy output than their aesthetic counterparts and are generally less painful.

It’s also imperative to make sure the device you’re thinking of investing in has a CE registration and certificate of compliance that indicates product liability insurance, says Yardley, in light of the influx of cheap, nontraceable plasma devices entering the market from overseas. He advises to “check the output of the device and its effects on the epidermis” beforehand, adding, “In the wrong hands, it can cause scarring and bleeding.”

It’s even possible that some of these imported pens or machines aren’t actually plasma devices. “Some actually burn the skin upon touching it, which means they’re not plasma at all but cauterising devices,” says Giles, and of those that are plasma, “a lot of them are uncalibrated, so there’s not a safety standard for it to adhere to.”

What training do I need?

All the brands we spoke to for this feature stipulate a minimum Level 3 qualification for therapists to train in and take on their plasma device. 

However, insurers may operate on a case-by case basis. Walsh says, “Insurers each have their own requirements and Level 3 is not always essential, depending on other training, techniques and each practitioner’s background.”

Accor will only supply “clinically experienced” therapists of Level 3 and above, with a firm understanding of anatomy and physiology, who have worked in salons or clinics for a minimum of three years.

“We have a duty of care to the consumer so as a manufacturer or supplier we must pass that on to our practitioners,” says Yardley of Accor’s training programme. Practical training is done by one trainer to two students and they’re mentored by a trainer with a minimum of five years’ experience as well as a master trainer. Practitioners comalso have the support of fellow Accor users through a Facebook network.

Since plasma has started to generate interest in the beauty world, Giles tells of clients contacting her for help after experiencing bad treatments, prompting concerns that the technology should be reserved for Level 5 and above. “They’re left with little indentations in the skin because the spot was held on for just a fraction too long. My feeling is that it’s a Level 5 treatment and nobody below that should be offering it,” she says.

Giles is particularly concerned about the targeting of plasma devices towards semi-permanent make-up (SPMU) artists on social media platforms: “My concern is that some SMPUs aren’t even Level 3 trained, and while the pens are very similar to SPMU pens, the application of the technology is entirely different. It’s quite a scientific treatment and there’s a lot of physics, physiology and anatomy involved.

“Plasma is an alternative to surgery and we mustn’t lose sight of that. It’s an unbelievable treatment – the results are life changing for some people – but it has to be delivered in competent hands,” she says.

Plasma jargon explained

• AC: Almost all aesthetic-grade plasma devices on the market use an alternating current (AC) that creates a tiny spark. An AC device can only be used on skins up to a Fitzpatrick 3 or 4 because of the risk of causing post-inflammatory hyperpigmentation (PIH) on darker skins. 

• DC: Direct current (DC) devices such as Jett Medical’s Plasma Lift Profi can treat the full Fitzpatrick scale because it creates a longer arc and doesn’t damage surrounding tissue, meaning it’s less likely to cause residual PIH.

• Sublimation: This is the process by which plasma technology works, by instantly vaporising a solid into a gas.

• Sublative: Ablative procedures are invasive and break the skin’s basal layer. Generally, only medical professionals can use ablative devices. Most aesthetic-grade plasma devices are sublative, referring to the tiny holes created in the epidermis.

• Nitrogen plasma: These devices feature a gas tank and convert medical-grade nitrogen gas into plasma energy. Nitrogen plasma delivers controlled heating of skin tissue without epidermal vaporisation. Instead, they work on modifying the skin’s structure and improving tone, texture and laxity. The gas requires replenishing on an ongoing basis.

• Neon plasma: This type of plasma uses electrically charged inert neon gas to create a plasma field, which heats the skin sub-dermally. It generates less heat than nitrogen or oxygen and, like nitrogen plasma, doesn’t cause vaporisation. These devices usually require a course of treatment and can be used over the whole face in one session.