LAM FACIAL PLASTICS

Dr. Lam
Thanks again for taking the time out to answer all these questions. With plasma resurfacing can it be used for spot treatments it improve areas with skin texture and mild scarring? Also what is your opinion of this laser to help with larger pores and light hyperpigmentation.

thanks

i have pretty extensive experience with plasma among other types of treatment modalities for the skin so let's review where plasma excels and where it does not:
1. as far as pores, texture, and tone, i think plasma resurfacing is almost hands down the smoothest result that i have seen. that being said, there are two important caveats: first, women in particular see things too closely so even if there is an improvement they may not see it to their level of satisfaction (sorry, no offense if you are female. part of my job is understanding how the XX chromosome sees the world compared with the XY chromosome). second, i cannot guarantee that it will do the job in every case. in most cases, i have seen significant improvement in texture and tone. sometimes it is less than ideal but still significantly improved. just want to set up expectations that are appropriate. i truly think this is the major differentiating factor from a chemical peel since a peel will do well with surface color and unevenness but start to lose its steam on anything deeper. in fact, after the first few months, the peel starts to disintegrate, whereas the deeper textural issues start to greatly improve over the next few months to a year with plasma as the collagen starts to shape and smooth.
2. i think plasma is only okay for wrinkles, especially around the mouth and especially deep ones around the mouth. i know that many women are obsessed with wrinkles around the mouth but plasma provides more limited gains. i usually touchup wrinkles at 6 months with a dermabrader as need be at no extra charge to make the result as good as possible (only if need be). you can't dermabrade around the eyes. unfortunately, to get these deep wrinkles, you need a bazooka like phenol peel or CO2 laser, both of which are too strong in my opinion.
3. as far as scarring is concerned, there are new protocols to treat scarring, specifically acne scarring using high double pass settings. the photos that the company sends looks good but then again they have very unrealistic perioral (around the mouth) photographs of improvement so i am not convinced. it is worth trying on those who want to do it in conjunction with skin rejuvenation if the scarring is mild. if the scarring is raised then that is not indicated to treat.
4. if the hyperpigmentation is superficial (not going to the dermis) and reflective of sun damage, then plasma and even a standard 35% TCA chemical peel can do the job. if it is deep melasma, hormonal pigment, then it will not work that well. in fact, very few lasers can truly impact that. repeat IPLs and long pulsed Nd:YAG lasers can make some impact but bleaching creams, sun avoidance, and hormonal balancing are preferred measures.
5. as far as spot treatments, i have never done plasma as a spot treatment. it does not make sense to do that. you should do it evenly. i tend to prefer the heavy duty setting with a week of downtime to truly get the changes you are looking for. for those who do not want any downtime or have limited pathology, i do have my aesthetician use a very low setting without any downtime. but you need 6 treatments, and the results are far less than what i can do if you let me do it at high settings. anyone with significant sun damage needs me to do it. for younger women/men who have a little pathology, then the VLE (express) settings can be adequate.