SCALPA FIBROBLAST - MODULE 1
Plasma Skin Tightening is a non surgical cosmetic enhancement designed to shrink the skin using a sterile, disposable probe.
Fibroblasts are the collagen producing cells in the skin. Fibroblast treatment is performed with a device called a plasma pen, which is used to produce plasma waves. The waves are directed as tiny light spots along the wrinkle lines. The tip of the pen never touches the skin (and the needle like attachment is a sterile, disposable, one-time use product).
The pen is held above the skin and a tiny plasma arc connects the tip of the device to the surface of the skin. Using plasma waves, the old collagen is removed by sublimation (evaporation), and fibroblasts are stimulated to produce new collagen. The targeted skin contracts and is essentially eliminated without any cutting, which results in the tightening and shrinking of the targeted skin.
This advanced procedure helps to revive natural levels of collagen, hyaluronic acid and fibronectin needed for fresh youthful skin. A series of tiny brown spots are strategically placed to attain the desired result. The skin around the dot tightens instantly, pulling the cells closer together.
The word “plasma” has two different meanings for this procedure. During Fibroblast Treatment, the pen creates an electric plasma arc. These tiny arcs of plasma are created by an electrical discharge between the tip of the pen and the skin, singeing the surface and tightening the underlying tissue. The technology involves the use of plasma, formed through the ionization of atmospheric gas, which then works to stimulate the contraction, shortening and tightening of skin fibers. This results in the reduction of the skin surface.
Plasma also refers to the colorless fluid in our blood. The liquid called plasma makes up about half of the content of blood. Plasma contains proteins that help blood to clot, transport substances through the blood, and perform other functions. Blood plasma also contains glucose and other dissolved nutrients. When isolated on its own, blood plasma is a light-yellow liquid. Along with water, plasma carries salts and enzymes. The primary purpose of plasma is to transport nutrients, hormones, and proteins to the parts of the body that need it.
Let’s talk about the importance of scabs in Fibroblast Plasma Skin Lifting.
The key role in scabs are cells in the blood called platelets. When your skin is cut or scraped, you bleed. As blood is exposed to air, platelets rush to the scene and begin sticking together. They work with proteins called fibrin and other substances to form a scab, which is essentially a blood clot on the skin.
When the clot hardens, you're left with a scab. During the healing process, connective tissue cells below the scab contract and pull the edges of the wound together, like stitches. When the wound is healed, the scab falls off to reveal healthy, repaired skin. This will help you to begin to understand why the procedure causes retraction and tightening to the area of skin we are treat.
The evaporated old collagen is seen as tiny brown scabs on the treated area. The tiny "micro-dot"/ brown scab is a protective crust or carbon crust on the surface and will fall off on its own in approximately 3-7 days. This could take longer in some cases and with slower healers.
This is very safe, low-risk, and highly eﬀective treatment for skin tightening. As with most cosmetic treatments, a consultation with an experienced, trained practitioner prior to service, as well as a strict aftercare routine, is required to promote proper healing and to help you achieve the maximum results.
Prior to starting the treatment, you are required to read through, initial and complete the consult record, thus giving absolute consent to treatment. Additionally, you agree to fully disclose your full medical history, which will allow determination as to if you are a suitable candidate to receive this treatment.
Within this module, you will learn the necessary steps for the basic client communication process. The key to this process is the pre-treatment consultation. The consultation not only acts as an important sales tool, but also ensures that both the client and technician understand what is required. There are some important considerations to understand prior to commencing treatment that you will learn in this section. We will also introduce you to some non-standard scenarios that you will likely come across during some of your consultations.
The consultation is a valuable tool for both the client and the technician. For the client it provides them with the perfect opportunity to ask questions about Scalpa Fibroblasting, how the process works and about longer term implications, including aftercare. For the technician, they can assess the client’s current situation and calculate approximately how many treatment hours will be required. Of course, the consultation is also the primary opportunity for the technician to secure a confirmed treatment booking from the client.
All treatment begins with a consultation during which the practitioner asks the client a series of questions about how they are feeling, medical history, and why they have requested this treatment. This is an opportunity for the therapist to ensure that there are no reasons why it would not be advisable for the client to have a treatment, ruling out any contraindications.
It is important that you keep fully detailed client records for every single client you have.
Client Record Cards/Consultation Forms should be completed on every visit the client makes to you. Scalpa will provide these forms at the end of the training course. On their first visit, you will need to have a full consultation to ascertain if the client has any problems, and following the consultation, when you have fully recorded the details, you need to ask your client to sign the form to confirm that the details given are correct.
Following this, on each visit that the client makes to you, you should mark on their client tracking form what the treatment undertook was, and ask the client to sign the form to say that he/she is happy with the treatment. The consultation is an opportunity to learn more about the client. This can include but is not limited to:
• Full details of skin type and history e.g. does the client sunbathe, use Retin A etc.?
• Ensure the client has realistic expectations
• Ensure the following information is explained and allow the client the chance to ask any questions they may have
• Explain the treatment the aftercare and downtime
• Explain the frequency of appointments
• Treatment costs
• To ensure that the client is not contraindicated in any way
• To ensure that the client gets the best, safest and most successful treatment possible
Use Scalpa's client forms provided at the end of the course to keep the consultation structured, and to ensure both the client and yourself enjoy a constructive consultation experience. Below we have provided some of the things that should be covered during your consultation, although bear in mind that the consultation should be individually tailored to the needs of the client. Follow our recommended format, but allow the direction of conversation to be led by the client. This enables you to ascertain what questions and concerns they may have, increasing the likelihood of the consultation resulting in a booking. If your client is proceeding with treatment, make sure they see a copy of our pre-care guidelines.
No cutting of skin
No stitches required
Very low risk procedure
Minimal side effects and far less downtime
Quick & easy procedure
No risk of blindness as there is with surgery
No thinning of the skin
Significant cost saving
After treatment, clients should expect redness and swelling. Application of ice packs or hydrating masks can soothe, and help reduce swelling. We also recommend the use of Scalpa Rehab and cold packs directly after treatment to reduce the swelling in the area and speed up recovery. Information and purchase of these products can be found on our website under the Fibroblast training page.
In extreme cases, (especially if the client has failed to follow aftercare advice), swelling can last several days and may initially interfere with vision. Anti-inflammatory medication and/or anti-histamine medication may help.
Initially after treatment and for a day or so afterward, there may be occasional weeping. This is simply plasma and is a natural healing response. This will flake off after a few days but in some cases can take over one week. DO NOT pick, pluck or scrub at this crusting or scabbing as it can lead to infection or scarring. Likewise, it is important to keep the treated area clean and dry.
We recommend the following information is given to the clients to ensure optimum treatment outcome:
No Sun Exposure
No Botox, Collagen Injections or Dermal Fillers
Do Not Use Anti-Aging Creams
Do Not Use AHA’s, Glycolic or Retinol
Do Not Use Exfoliating Products
A minimum of SPF50 must be applied and exposure to the sun should be avoided
Regular moisturizing with either an all natural moisturizer or hyaluronic acid is vital to replenish moisture and prevent the skin from becoming dry and peeling
In the case of post fluid blisters after fibroblast, and after any procedure that uses heat to wound the skin in order to promote healing, we may encounter blistering from time to time. Blistering is the body’s auto response to assist in healing and protecting the area. The body is collecting fluid in tiny sacs and essentially incapsulating it to help cool that area of the skin down. It’s a healing response! Most blisters heal on their own within a few days.Blisters also provide a safe space for new skin to grow. As new skin grows, your body will slowly reabsorb the fluid.
It’s important to assist the area in healing by using something like aloe Vera. Instruct your client to use aloe Vera over the area until the scabs falls off.
I know many practitioners with this procedure prefer dry healing, however I’m a firm believer in moist healing to prevent scaring and hyper or hypo pigmentation later on. I believe the longer the scabs stay in place the better results you will get.
1. Make sure to test your pen setting. Look for nice coloring in your dots. Not black.
2. Keep your arc time to 1 second or less
3. Make sure to inform your client to remain out of sun three days prior to procedure if they are sun or bed tanners.
I want to convey that it should not cause you alarm should blisters occur. When any type of mole or dark spot is removed, blistering or puckering of skin around the area can happen as it’s simply the body rushing to heal the area, and protect the surrounding skin from infection. Never pop small fluid blisters in a case like this (after fibroblast or any skin procedure that uses heat), but rather let the blisters and area heal on its own.
Burning sensation will soon reduce and anti-inflammatory/antihistamine medication can help.
You may have some swelling, especially around the eyes. Swelling usually only lasts a few days.
Ice packs and hydrating face masks can soothe and help reduce swelling.
Formation of brown/black crusts on the skin surface. DO NOT pick!
Scabbing will fall off in few days.
Keep treated area clean and dry.
Clean alcohol swabs provided.
Use sunscreen if out and about.
Do not cover with plasters or occlusive dressing.
Contact for advice if the area becomes hot, red or weeping pus.
Treatment review from 1 week onwards.
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.
If best results of procedure are not guaranteed, it is recommended not to proceed. If you are at all unsure, you should suggest that the client visits his/her GP to have the matter checked before you provide the treatment. We will provide a form at the end with thorough explanation of procedure to provide your GP with if needed. Below we have provided general contraindications pertaining to this procedure.
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 GP approval prior to commencing treatment
Any active infection
Diseases such as a history of recurrent Herpes Simplex, Systemic Lupus Erythematous or Porphyria
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)
History of bleeding coagulopathies or use of anticoagulants
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
Alcohol or Drug Abuse
Cuts and abrasions
Any active infection
High or low blood pressure
Immediately after pregnancy
Liver disease and/or any medication that affects the liver function
Metal implants/plates or pins
Open wounds/ulcers/sores (on treatment area)
On regular prescription medication - requires GP approval
Poor circulation (blood and lymph)
Pregnancy or breast feeding patients
Recent scarring to treatment area
Thyroid disease or other hormonal disorders
Under 18 years of age
This is an autoimmune disease resulting in hair loss. Sufferers may be more sensitive to treatment but there should be no problems treating alopecia sufferers with Plasma Pen.
Anaemia is a condition characterized by a deficiency of the hemoglobin content of red corpuscles. These clients will bleed more profusely and will take longer to heal.
Usually a reaction would be due to the base or preparation that the anesthetic is found in, such as the cream or the gel. Scalpa Plasma Fibroblast practitioners will use the Numb cream and patch test for reactions. If different types of anesthetic are used then patch test for those will be performed as well. Patch test results will determine whether client is allergic to the ‘caine’ used in anesthetics. If that is the case, the treatment can still proceed without an anesthetic if client elects. A cold compress or a freezing or cooling unit, such as the ‘cool spot’, could be used instead.
Asthma is characterized by inflammation of the air passages resulting in the temporary narrowing of the airways and making it difficult to breathe. Asthma often requires the use of an inhaler to ease breathing. Regular use of an inhaler will cause thinning of the skin andincreased vascularity. If you have asthma, you may bleed more easily and sometimes bruise. Your skin may be more sensitive and take longer to heal.
BIRTH MARKS AND PORT WINE STAINS:
These cannot and must not ever be treated with Plasma Pen.
Excess fat and skin are surgically removed from the upper and lower eyelid. If a patient has had blepharoplasty (and our technique is often referred to as non-surgical blepharoplasty), you must wait for 3 months post-blepharoplasty (or longer if there is still pronounced redness in the area) before a Plasma Pen treatment.
It is recommended to wait at least 21 days after BOTOX injections. It is preferable to have your Plasma Pen treatment performed prior to BOTOX being administered or when the BOTOX is just about due for a top up.
BREASTFEEDING: The Plasma Pen treatment cannot be performed on breastfeeding mothers.
BROW, FOREHEAD, OR SURGICAL FACELIFT:
Please allow three (3) months after your brow, forehead, or surgical facelift to determine your suitability for Plasma Pen treatment.
BRUISING OR BLEEDING EASILY:
Bruising or bleeding easily may indicate an underlying health problem, and if you are prone to bruise or bleed easily, you may take longer to heal from your Plasma Pen treatment.
If you are undergoing radiotherapy or chemotherapy then we must allow leave 5 weeks either side of treatment to be treated with Plasma Pen. If you are undergoing cancer treatment, you should check with your oncologist to find out when your blood count is most suitable to receive treatment. If the cancer is terminal, we may proceed with a doctor’s written consent.
Scalpa Practitioners may perform the Plasma Pen treatment with a doctor’s written consent (if treating the eye area).
Contact lenses must be removed before any treatment close to the eye, and must not be used for up to 72 hours post-procedure. We cannot begin to stress the importance of ensuring contact lenses are removed pre-treatment.
Diabetics have a tendency to both bleed and bruise easily, so you may find it more uncomfortable and the healing process may be lengthier. Some clients may need to wait longer between treatments.
During a treatment, we may use more eye lubricant and saline solution throughout the treatment to keep you comfortable. We also ask that the client keep their eyes always closed because of the sensitivity to carbon smoke.
If it has been two years since your last seizure, we may proceed with the Plasma Pen treatment. Plasma Pen treatment may trigger an epileptic event, and we will request that you complete a consent form as well as have someone come with you to your appointment.
EYE LASER SURGERY (LASIK):
If you have recently undergone any laser surgery for the eye, such as LASIK, it is recommended to wait 8-12 weeks post-surgery.
If your eyes are red, watering, puffy or the skin is inflamed and red, your practitioner will recommend delaying the Plasma Pen procedure until symptoms have passed.
Hemophilia is contraindicated for Plasma Pen treatment, and not safe for hemophiliac patients.
Herpes Simplex is a viral infection commonly referred to as a cold sore or fever blister – usually around the mouth. If you have ever had a cold sore, you are more likely to have an outbreak after Plasma Pen treatment in that area. We suggest that you ask your physician for an antiviral treatment, such as acyclovir at least 5 days before treatment and 5 days after treatment.
HIV / AIDS / HEPATITIS:
Plasma Pen is not safe for individuals with HIV / AIDS / Hepatitis or other immune disorders.
HYPER-PIGMENTATION:This is an over-production of melanin which has permanently damaged the surface of the skin. It is more commonly seen in Afro-Caribbean, Mediterranean, Asian and Latin skin types. It presents as darker patches of skin. Unfortunately, Plasma Pen is not appropriate for anyone with hyper-pigmentation or having skin types 3-5 on the Fitzpatrick scale.
INJECTIONS / FILLERS:
It is recommended to wait at least 21 days after the filler has been administered before doing a Plasma Pen treatment. It is also common for lips with large amounts of filler or fat in them to have slower or compromised healing. In some cases, the lips can become infected more easily during the healing process after working close to the lip.
KIDNEY OR LIVER DISEASE:
We request written consent from a doctor if you have kidney or liver disease.
Due to the inflammation and swelling associated with lupus, the Plasma Pen treatment cannot be safely performed.
MITRAL VALVE PROLAPSE:
If a you require antibiotics when you visit your dentist, then you will need to do the same prior to any Plasma Pen treatment.
Like any cosmetic procedure, the Plasma Pen treatment comes with the risk of complications, including infection. These infections can cause risk to fetal health and even cause the loss of the baby. For these reasons, our practitioners will not perform Plasma Pen treatments on women who are pregnant or breastfeeding.
Retinal Detachment is where the retina peels away from its underlying layer of support tissue. Initial detachment may be localized but without rapid surgical treatment the entire retina may detach, leading to vision loss and blindness. We ask that if you have experienced retinal conditions, that you obtain a written consent form from your ophthalmic surgeon prior to commencing Plasma Pen treatment in the eye area.
SKIN DISORDERS (E.G. PSORIASIS, ECZEMA, DERMATITIS):
All skin disorders can make the skin exceedingly dry and treatment more uncomfortable because the skin is usually thinner and more sensitive. It is not recommended to treat any areas with Plasma Pen that are affected by any of these skin disorders.
SCARS (HYPERTROPHIC, KELOID):
This type of scar is raised instead of being flat and does not grow, and remain within the perimeter of the original wound and flatten over time. When new, they are often purple/pink becoming more pink/white as they mature. Unfortunately, Plasma Pen is not an appropriate treatment for hypertrophic scars.
Please wait 6 months after a shingles outbreak before undergoing a Plasma Pen procedure.
STIES OR CONJUNCTIVITIS:
If you suffer from sties or conjunctivitis, please wait at least 6 weeks following treatment prior to undergoing your Plasma Pen procedure. It is possible that the Plasma Pen treatment may cause the condition to recur if having the eye area treated. In some cases we may request written consent from your physician prior to commencing Plasma Pen treatment.
If you suffer from under-active thyroid, you may find that your healing time is slightly longer than typical.
If you are prone to picking, the Plasma Pen treatment may not be appropriate due to the increased risk of infection and hyper-pigmentation associated with additional trauma to the skin caused by trichotillomania.
Unfortunately, clients with vitiligo are not good candidates for Plasma Pen due to the risk associated with outbreaks in other areas of the body or face.
Although blood thinning is not considered a listed contraindication in this procedure, it can impact the results.
There are also “natural” blood thinners that you may be digesting which can also impact the results of this procedure.
To name a few:
When the blood is thinner two things can happen; we can have more bleeding occur because the skin becomes more sensitive, and is therefore prone to bruising. This entire procedure centers around plasma.Also, because the blood is thinner we may not get a real good plasma lift (plasma coagulation) in the skin or the carbon crust (dot), which can lead to lack of good results. We don’t want our newly placed carbon dots to bleed out, so if you ever find that a client bleeds a lot during this procedure, chances are they may be on some sort of blood thinner or digested one of the listed blood thinners. Always make sure to send out your pre-procedure and post-care instructions prior to the appointment so they can be fully prepared.
Make sure to have your clients stop alcohol intake for 3 days prior for the reason of thinning blood and dehydration. We need the skin and body to be well hydrated with good oxygen flow.
“Can you” and “should you” are really different questions. To answer the question, yes, but let your client know you can’t guarantee their results, and you, as the one performing the procedure, would prefer them to seek their medical doctor’s opinion on stopping their medication if possible for a few days prior to their appointment.
We at Scalpa believe that when it comes to fibroblasting, any person where we must question good results because of health issues, we would rather turn to another procedure to accomplish great skin tightening results. Why put a client through the pain and long healing process with fibroblasting when we are unsure how they will respond to the treatment? These suggestions are for your consideration.
Disclaimer of Medical and Legal Liability: Scalpa training courses are intended to provide the general knowledge to perform procedures but is not intended to be a substitute for medical advice, diagnosis or treatment. Reliance on the information in this training course for procedural purposes is to be used at your own risk. If you have questions or concerns, contact a medical professional prior to treatment. Scalpa is not held responsible or liable for risks involved with this procedure.
Scalpa strongly advises each member or student to research their local legislation. It is your sole responsibility to check and clarify all rules and regulations pertaining to your country, state, city and county if you are planning on performing our training program procedures as a professional. Because Scalpa is offered worldwide, we cannot guarantee this information. Please check with your local health department, governing boards and FDA regulations regarding performance of any Scalpa course procedure. Scalpa is not held responsible or liable for legal encounters regarding licensing, regulations, or other legal aspects pertaining to procedural operation.