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Chapter 3 - Adept Beauty
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How the Procedure Works

 

Young, elastic skin depends on the number of structural proteins such as collagen and elastin. These proteins help the skin resist temporary changes such as stretching, folding, or wrinkling. As we age, one’s body produces less of these structural proteins, making the skin more prone to show signs of aging, such as fine lines and wrinkles. 

A mild superficial controlled burn by using voltaic/plasma arcs or Lasers induces a skin tightening effect which helps the skin restore more of its natural elasticity. This occurs because a localized excitation, stimulates the skin's regeneration response, resulting in firmer, tighter skin between the wrinkles and hence the reduction in the appearance of wrinkles and fine lines. Similar results are also possible by using other skin rejuvenation methods, like AHAs (alpha hydroxy acid) based cosmetic peels, however the use of voltaic arc or cosmetic lasers are generally more selective because it can be applied exactly where required, therefore inducing the skin tightening exactly where the client needs it, with a higher degree of precision. We refer to this type of skin tightening as "localized skin tightening" or "targeted skin tightening".

There are two types of plasma arcing. Electrofulguration and Electrodessication

Plasma Fibroblast Therapy works by way of electrofulguration. Skin tightening using voltaic arcing also referred to as PLASMA, produce mild appreciable cumulative improvements in the appearance of fine lines and reduces the appearance of sagging skin. 

In Fulguration Configuration above, the electrode does not touch the skin or tissue and once the spark occurs the current flows from the tip of the electrode down to earth following the path of least resistance.

When the equipment is set up in electrofulguration mode the electricity flows from the tip of the electrode through the body (which at medium/high frequency reacts as a Faraday cage) down to earth, and a return pad is not usually needed. Because the current flows superficially to earth, the result is a very superficial carbonization of the superficial part of the skin (epidermis), lesion or benign mole.

Because of its higher degree of precision in tissue carbonization, electrofulguration is used in aesthetics for:

→ Benign moles and benign skin lesions removal in general.

→ Tattoo removal.

→ Permanent Makeup removal.

→ Brown spot removal.

→ Skin tightening … and more 

 

The Uses of Electrodessication (when the Equipment configured with a return pad) are usually:

→ Permanent epilation.

→ Red vein coagulation for aesthetic reasons.

→ Benign skin lesions removal in General.

3.01

An Introduction to the Instruments

 

The Plamere Device 

You will notice in your kit that the device contains multiple tips. For plasma fibroblast therapy, we will be using 3 of the tips. The remaining tips are discussed briefly and used for other service treatments.   

 

Starting your device: Charge your Plamere device using the USB cord provided. It’s important to keep your device charged so that you do not lose power mid-treatment.  The full charge takes 3 hours. I know we’ve all heard at some point to let your battery due for optimal battery life. But it’s actually the opposite! For optimal battery life, do not let the device’s battery completely die. The device should be kept clean with a hospital grade cleansing wipe applied before and after each client. When replacing the tips unscrew the white collete thoroughly, and then pull the metal tips out of the device and replace with the next one.

3.02

 
 

3.03(a)

3.03(b)

3.03(a)

3.03(b)

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Numbing Products

 

Plasma fibroblast tightening is not the only aesthetic treatment when the use of numbing products is recommended. Tattooing, laser tattoo removal, lasers skin tightening, moles removal procedures and several other aesthetic treatments require the use of some numbing products to put the client at ease during the aesthetic treatment. 

A very common topical numbing product available on the market, in most parts of the United States, is EMLA. (EMLA is available in 5% formulations from most chemists).   This is a product which can be purchased and used without a medical prescription. Because of this, EMLA is also the preferred numbing product used by tattoo artists for tattooing and performing body piercings. 

EMLA is used by 1. Applying the cream on the treatment area, and 2. Covering the cream with a normal cling film, such as Saran Wrap.  The cling film is applied in order to cause an occlusion effect which will amplify the impact of the numbing ingredients in the EMLA numbing cream.  The area is then left to rest for approximately 40 to 45 minutes in order to achieve the desired numbing effects. 

Unfortunately, EMLA’s numbing properties leaves the client waiting a long while for the area to numb and it is not generally very effective if a cling film is not applied on top of the cream. If you attempt to start the aesthetic treatment before the client has been numbing for at least 40 minutes, the area will likely not be very numb and the procedure not very comfortable for the client. Additionally, the topical effects of the EMLA formulation end within 5 to 10 minutes from the time the cling film is removed and EMLA residues wiped off. Therefore, the window of time while you can perform the treatment in comfort is relatively brief. We suggest using the fractionated tip to open the surface cells for better product penetration. 

Given that the use of numbing products is heavily regulated, EMLA is the main product available over the counter. Some Medical practitioners can be authorized to use other numbing products. The formulation that has been used extensively and successfully by medical practitioners who use plasma arcing devices for aesthetic purposes is a topical custom formulated product. 

Formulation active ingredients are: lidocaine 20%, prilocaine 5%, tetracaine 5%.

This topical product is either made in a gel or cream formulation. In the U.S., this type of topical formulation can only be made under medical prescription at a compounding pharmacy (therefore under the sole responsibility of the medical practitioner who orders the product). 

Due to current regulations, this is a product that can be used by medical practitioners only or under their direct supervision. The main advantage of using this type of formulation is that the desired numbing effects are achieved almost immediately and are so good that the client will only feel a tickling sensation when the plasma arc is applied. The area where this formulation is applied becomes numb within 5 to 10 minutes after the application and may turn pink. Please note that these types of products are not meant to be completely absorbed; therefore, simply apply the cream or gel, on the treatment area and leave the product to take effect. With this formulation, there will be no need to apply a cling film because the product itself will be strong enough to achieve the desired numbing effects. 

Whenever beginning the treatment on the client, remember to remove the topical anesthetic on a small area. The common mistake made by beginners is to remove all the numbing product at once. For example, if the topical anesthetic has been placed on both upper eyelids, the untrained beginner usually removes the cream on both eyelids before starting the treatment. The main problem is that the effect of most topical numbing products will not last long (in case of EMLA only 5 to 10 minutes at most). Therefore, the effect of the topical anesthetic could start to fade before the end of the treatment, making the procedure cumbersome.   

3.04

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Instructions on Procedures and Methods

Most procedures will all begin in the same way; we will describe how to begin the treatment below. 

Make sure client has signed all consents and is fully aware of the course of treatment, healing expectations, before and aftercare, desired results, possibility of additional treatments, etc. 

Take before and after photos. This is a very important step. The area treated will continue to improve for up to 3 months: It is a slow process and some clients will state no difference is noticed, until you present them with a comparison photo. 

Provide clients with a disposable bonnet or spa facial headband to keep all hair out of the treatment area. Offering a face mask will also help with reducing odors from the procedure. 

We start with cleansing the skin of all makeup, oils and debris using our oil-free makeup remover. We recommend Beau Ideal House of Beauty’s Oil-free Makeup Remover. It is gentle, fortified with vitamins and chamomile for soothing properties. It is important to stress the use oil-free makeup remover, because any residual oils will interfere with the numbing product absorption. Next we cleanse and disinfect the skin with Chlorhexidine Gluconate. Use the fractionated tip, on pulse mode, setting of 3-5 (whichever setting is comfortable for the client) to stamp the area of skin being treated for a few seconds, making sure to cover the entire treatment area. Apply the numbing cream to the treatment area and then occlude it with the plastic film for better product penetration.

The only treatment we would not use the fractionated tip and numbing for would be to treat active acne. Acne scarring would start with the above prep as well.

3.04(a)

Spot and Spray Techniques/Methods

 

Skin tightening using plasma arcing can be accomplished in two main ways: 

  • Using the spot technique. 

  • Using the spray technique. 

 

Both methods deliver the required heat into the skin needed to cause a very localized skin tightening. This localized skin tightening, in turn, reduces the appearance of saggy skin and fine lines. In particular, the fine lines are improved by the pulling effect of the skin tightening effect applied between the lines. The spot mode is the preferred method to apply skin tightening by using plasma arcing, on various parts of the face. It is the preferred method because it delivers consistent and repeatable results and it is very easy to learn especially for beginners. 

These are placed randomly and between the wrinkles and never inside the wrinkles folds. The tighter the spots the higher the tightening effects. 

 

We should feather out the treatment as we move away from the tight wrinkles. In other words, the spots are applied in a tighter fashion where the wrinkles are deeper.  As we move away from the tight wrinkles we then distance the spots slightly further apart. 

Also note that, in case of fine lines, the wrinkles tend to disappear while applying the spots. This is not a permanent effect. This is a normal immediate reaction of the skin to the dehydration effects of the superficial carbonization caused by the plasma arcing. 

The spot mode is carried out in the following way: 

  • By applying short bursts between the wrinkles and not inside the wrinkles' folds. Applying the spots inside the wrinkles could worsen the appearance of fine lines instead of improving them. 

  • The bursts must be placed randomly, without forming lines or patterns of any type. Applying the spots randomly ensures the most uniform skin pulling effects.  

  •  

The spray mode is not normally used for skin tightening; instead, it is commonly used for: 

  • Tattoo Removal. 

  • Permanent Makeup Removal. 

  • Mole Removal, inclining Xanthelasma, Seborrheic Keratosis, Syringoma Removal and most of the other benign lesions and hypertrophic skin imperfections removed for aesthetic reasons. 

  • Skin resurfacing to improve the appearance of hypertrophic scars.  

 

One of the ways to increase the treatment intensity is decreasing the distance between the spots.  When first starting to use the device for skin tightening, it is best to gain confidence in stages and over a number of sessions. First practice using the device on a test product, such as an orange, and have enough confidence in your ability to generate the arc when the device is set at the minimum power level. Also, the very first time using the device for skin tightening, do so in the mildest way possible, at the very lowest intensity. Then, as you see the results after each treatment, progressively gain confidence with the use of the equipment for this particular aesthetic application. 

Because the spot technique leads to consistent results and it is very easy to learn, the best way to start using the device for skin tightening by using plasma arc is by applying the spot technique with the device set at minimum power, distancing the spots at least 3 to 4 mm apart. Also, the duration of the application of the arc at each spot needs to be brief, resembling a short burst (average maximum duration one-quarter of a second). Confidence is gained by seeing the results of the mild aesthetic treatment: Then slowly start to increase the intensity of the treatment by increasing the spot duration, and/or decrease the distance between the spots or the power setting of the device etc.

3.04(e)

 
 
 
 

Pre-Procedure

 

What to tell the client before treatment: 

  • WAIT until all the scabs have fallen off. Although clients can resume their activities immediately after each session, they will not look their best during the healing process which lasts up to 7 to 21 days in normal circumstances. 

  • The area treated MUST NOT be covered with any type of makeup, mascara, until the area has fully healed. Wash gently with soap twice a day. Any other treatment or wearing of any type of makeup could result in unnecessary infections, skin tattooing or undesired effects. 

  • The treatment could be uncomfortable to the client; therefore, numbing products shall be used for ease of treatment and comfort reasons during the plasma tightening procedure. 

  • Swelling one to five days after the cosmetic treatment is normal and to be expected. It is always better to make the client aware of this at the consultation stage. 

  • Plasma tightening brings about cumulative minor improvements of the appearance of saggy or droopy eyelids. Do not promise the dramatic results, which can be accomplished with surgery. 

Pre-Procedure Consultations

Contraindications & Managing Expectations

 

 

Confidentiality is an important part of the therapeutic relationship between a client and a therapist. Whilst carrying out a consultation it is important for you to stress that all personal information relating to the client will remain completely confidential, and that information will not be disclosed to a third party without the client’s written consent. 

Contraindications are conditions that may be present on a client and are such that you would not be allowed to proceed with the treatment, unless they have written confirmation from their General Practitioner that it is safe to do so. 

It is essential that you not only look for these problems, but you should have already asked your client if they were aware of any issues when you did your consultation. 

It is vital that you check for contraindications - should you ignore them so that you can do the treatment and get paid, you could find that the treatment makes the problem worse. If you are at all unsure, you should suggest that the client visits his/her General Practitioner to have the matter checked before you provide the treatment.

The client must be in good health at the time of the treatment, with no underlining chronic health conditions. If the client displays signs of cold or flu the treatment must be postponed. 

The client must not display any tanning at the time of the treatment. This is especially important for tattoo removal or permanent makeup removal. 

  • Contraindications are conditions that may be present on a client and are such that you would not be allowed to proceed with the treatment, unless they have written confirmation from their General Practitioner that it is safe to do so. 

  • It is essential that you not only look for these problems, but you should have already asked your client if they were aware of any issues when you did your consultation. 

  • It is vital that you check for contraindications - should you ignore them so that you can do the treatment and get paid, you could find that the treatment makes the problem worse. If you are at all unsure, you should suggest that the client visits his/her General Practitioner to have the matter checked before you provide the treatment 

  • The client must be in good health at the time of the treatment, with no underlining chronic health conditions. If the client displays signs of cold or flu the treatment must be postponed. 

  • The client must not display any tanning at the time of the treatment. This is especially important for tattoo removal or permanent makeup removal. 

  • If the client wears a pacemaker, avoid treatment with electrical arcing.  

  • Current or history of cancer, especially malignant melanoma or recurrent non-melanoma skin cancer, or pre-cancerous lesions or after recovery from cancer till off medication for 6 months and have General Practitioner approval prior to commencing treatment 

  • Any active infection 

  • Diseases such as a history of recurrent Herpes Simplex, Systemic Lupus Erythematous or Porphyria The client must not display herpes simplex and not have had herpes simplex in the past even if dormant at the time of the treatment. In case of clients with herpes simplex, a full antiviral course should be completed before starting the aesthetic treatment. 

  • Use of photosensitive medication, and/or herbs that may cause sensitivity to such as, tetracycline or St. John’s Wart 

  • Immunosuppressive diseases including AIDS and HIV infection or use of immunosuppressive medications 

  • Diabetes unless under control 

  • History of bleeding coagulopathies or use of anticoagulants 

  • History of keloid scarring 

  • A history of heart disease (Angina, heart pacemaker, taking anti-coagulant drugs) 

  • Use of oral or topical Roaccutane or Retin A, vitamin A or other such products in the previous 3 months for the treatment of acne or other dermatological conditions 

  • Surgery in the past 6 months

Treatment of Skin Tightening

Since our main focus of this class is for skin tightening, we will explain thoroughly now.

Our recommended process for performing this procedure is to start with the Fractional tip. 

 

After installing the fractional tip, set the device to continuous(C) mode and the output intensity to 3-5, depending on how the client responds to the sensation.  

 

The device should be applied to clean, dry skin in a tapping motion on the area to be treated. This allows plasma to be generated at the multi-points of the fractional tip to create tiny openings that will allow the numbing agent to be more efficiently absorbed. Perform the tapping motion for up to 5min, depending on the size of the area being treated. Turn device off when complete.

 

  1. Apply numbing cream to treatment area. 

  2. Switch the tip of the device by loosening the white head cap, removing the fractional tip, and replacing with the Permeating tip. Set device to continuous(C) mode with an output strength of 5-7, depending on your clients’ response to the sensation. Move the tip in circular motions over the numbing cream, in the treatment area for up to 5 minutes, depending on the size of the area treated. Turn device to OFF when complete. 

  3. Apply plastic wrap to treatment area to occlude the numbing cream. This will allow for faster and more thorough product penetration. 

  4. Remove head cap as well as the Tip collet, replace with the needle collet. Insert needle tip, replace and tighten head cap. 

  5. Select continuous(C) mode. We have found that the optimal output level for creating the plasma arc, 1mm away from the surface of the skin, is 7-8.  

  6. When pressing the shot button with the tip of the probe 1mm away from the surface of the skin, the device will fire a plasma arc.  

  7. Create your dot pattern slightly above and slightly below the wrinkle you intend to treat.  

 

Low intensity treatment: 

  • Use only short bursts, with a duration of less than a 1/4 of a second.  

  • Distance the spots between 3 to 2 mm apart. You can also distance them 4 mm apart if you wish. 

Medium intensity: 

  • Once you have performed your first low-intensity tightening treatment and you have seen the results, then you can move to performing medium intensity treatments. Normally medium intensity treatments are performed by only changing the duration of the plasma arc slightly and reducing the distance between the spots. Also, the area treated will increases slightly. 

  • The distance between the spots is decreased slightly and ranges between 1 to 2 mm between the spots. 

  • The duration of each spot is in the region of 1/4 to 1/2 of a second. 

  • High-intensity: 

  • After witnessing the results of low and medium intensity treatments, there may be the temptation of performing high-intensity treatments in order to achieve far better results. Please remember that the results of plasma tightening cannot be rushed.  Also, the improvements achieved cannot overcome what is realistically and physically possible. 

  • The problem with high-intensity treatments is that while the results may be marginally better than low and medium intensity treatments, the immediate reactions and increased likelihood of potential longer-term adverse reactions can discourage clients from undergoing further plasma tightening treatments. 

  • Additionally, it has become clear that high-intensity treatments do not bring significant improvements compared to medium intensity treatments. In other words, high-intensity treatments do not bring about proportional skin-tightening improvements. In terms of results, high-intensity treatments only bring about a minor long-term improvement compared with the long-term results of medium intensity treatments. 

  • The immediate transient adverse effects of high-intensity treatments are: 

  • Major swelling, which is inevitable after high-intensity treatments, even using appropriate soothing products. Soothing products can sometimes help alleviate the severe swelling. 

  • Pain following the first 24- 48 hours after the treatment. 

 

This does not mean that low or medium intensity treatments do not lead to the same short-term swelling and pain, however, any unsightly discomfort is far more moderate than what occurs in high-intensity treatments. 

 
 
Chapter 3 - Section 4 - Adept Beauty
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3.05(a-c)

 

Introduction to the Products

Placental Cream

Placental Cream is a luxurious, regenerating, anti-wrinkle, heavy cream. Wheat Placenta does not contain animal ingredients, but it offers the same effect of increased cell renewal and is a scientific substitute for animal Placenta Extract. It effectively helps improve elasticity, while nourishing the skin. Pharmaceutical-grade Placenta Extract (wheat origin) has shown to be very effective in helping restore elasticity and moisture to the skin. Marine collagen, a soluble protein, effectively helps diminish wrinkles and age-lines, while also helping to restore elasticity to the skin. This product contains Pentapeptides for improved collagen and elastin production, to further reduce and slow the formation of new lines and wrinkles. Witch Hazel, Hops, and Ginseng Extracts, combined with Aloe Vera Gel provide soothing and healing properties. Lecithin, Mango Butter, Olive Butter, Glycerin, and Squalane protect from moisture-loss and provide nourishment to the skin. Glycosaminoglycans, Retinyl Palmitate and Ergocalciferol show skin renewal properties and help calm inflammation and refine pores. It is recommended for all types of non-oily skin as an immediate post treatment cream. For specifically dry skin, it can be used during the day, under makeup. 

Directions: After cleansing, gently smooth over the face. use as many times daily to remain moist, as needed. Most apply a thin layer every 4-5 hours until carbon dots have fallen away. 

Ingredients: Aloe Vera Gel, Caprylic/Capric Triglyceride, Squalane, Sorbitan Tristearate, Steareth-2, Cetyl Alcohol, Glycerin, Polysorbate-65, Sweet Kernel Oil, Witch Hazel Extract, Hops Extract, Ginseng Extract, Tocopherol, Stearth-20, Palmitoyl oligopeptide, Palmitoyl tetrapeptide-7, Retinyl Palmitate and Ergocalciferol, Beeswax, Lecithin, Mango Butter, olive Butter, Phenoxethanol, Marine Collagen, Glycosaminoglycans, Wheat Extract (Placenta), Fragrant Oil, Potassium Sorbate, Sodium Benzoate, Citric Acid. 

Caution: Avoid contact with mucous membranes. Keep out of reach of children. Use only as directed.

 

 

Sun Protective Cream

Sun Protective Cream - SPF 30 is a moisturizer for all skin types. It contains sun filters for protection against UVA and UVB rays. Cocoa Butter and Glycerin help protect the skin’s moisture balance. Green Tea Extract, Allantoin, and Aloe Vera possess soothing and healing properties. This product helps improve skin’s suppleness, elasticity, skin tone, and hydration.  

Directions: Apply after cleansing, before sun exposure. Reapply every two hours as needed. 

Active Ingredients: Avobenzone 1.5%, Octinoxate 7.5%, Octisalate 5.0%, Oxybenzone 5.5%. All ingredients purpose is sunscreen. 

 

Inactive Ingredients: Water, Glycerin, Octyl Palmitate, Camellia Sinensis, Aloe Barbadenis Leaf Juice, Glyceryl Stearate, Cetearyl Alcohol, Stearic Acid, Methyl Gluceth-20, c12-15 Alkyl Benzoate, DEA Cetyl Phosphate, Tocopherol Acetate, Ergocalciferol, Retinnyl Palmitate, Phenoxyethanol, Green Tea Extrct, Mixed Tocopherols, Cocoa Butter, Propylene Glycol, Allantoin, Panthenol, TEA Carbomer, Micronized Titanium Dioxide, Methyl Paraben, Propyl Paraben, Butyl Paraben, Diazolidinyl Urea. 

CautionDo not use on damaged or broken skin. When using this product keep out of eyes.  Rinse with water to remove. Stop use and ask a doctor if rash occurs. Keep out of reach of children.

 

Fading Gel

Fading Gel is a light, oil-free gel recommended for all types of non-sensitive skin. Its water-based formula is ideal for oily skin types. This formula uses the superior brightening properties of Kojic Acid, Niacinamide, and Bellis Perennis Flower (Daisy) Extract, Alpha-Arbutin and Glucosamine to help improve pigment abnormalities. Glycerin and Sodium Hyaluronate help protect the skin’s moisture balance. Aloe Vera and Yarrow Extracts possess soothing and healing properties. This product helps improve skin tone and hydration and is great for lightening sun spots, age spots, freckles, and pigmented scars. Repeated use helps reduce the appearance of dark spots and discolorations. Use of sun protection is required to achieve desired results. 

Directions: Apply after cleansing, twice daily, to prevent post inflammatory hyperpigmentation. 

IngredientsAloe Vera Gel, Glycerin, Kojic Acid, Niacinamide, Bellis Perennis (Daisy) Flower Extract, Salvia Officinalis (Sage) Leaf Extract, Panax (Ginseng) Root Extract, Achillea Millefolium (Yarrow) Flower Extract, Sodium Hyaluronate, Hydroxyethyl Cellulose, Alpha-Arbutin, Phenoxyethanol and Caprylyl Glycol and Ethylhexylglycerin and Hexylene Glycol, Glucosamine HCl, Algae Extract, Saccharomyces Cerevisiae Extract, Urea, Polysorbate 20, Citric Acid. 

 

CautionAvoid contact with mucous membranes. Some users may experience a mild stinging or mild skin irritation. Discontinue use if irritation becomes severe. Keep out of reach of children. Use only as directed.

 

Chapter 3 Quiz
1. Because of its higher degree of precision in tissue carbonization, electrofulguration is used in aesthetics for:
2. Swelling __________ after the cosmetic treatment is normal and to be expected. It is always better to make the client aware of this at the consultation stage.
3. Contraindications for plasma fibroblast therapy are the following, EXCEPT:
4. Oil-free make up remover is used to clean the skin, as our first step. Why?
5. When treating with the spot technique, the bursts must be placed randomly, without forming lines or patterns of any type. Why is this true?
6. The higher the intensity, the better result?
7. We have found, once comfortable, medium intensity treatments give the best results. What is a medium intensity treatment?
8. Wheat Placenta does not contain animal ingredients, but it offers the same effect of increased cell renewal and is a scientific substitute for animal Placenta Extract.

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