Why the Plasma Pen Is So Divisive | RealSelf News

Face & Neck/Skin

Deanna Pai Updated on Oct 17, 2023 7 min read

The world of medical aesthetics is ripe for questionable devices and risky procedures, many of which can lead to serious side effects for your skin and wallet alike. But the Plasma Pen is different. While the procedure has been banned entirely in Canada due to the potential associated health risks, including pain, swelling, redness, sagging skin, hyperpigmentation, and more, it’s available in medical spas and doctors’ offices across the United States—although to date, there are no FDA-approved devices. Its Worth It Rating is currently 50% among RealSelf members who’ve tried it, making it squarely average but not necessarily terrible. Some doctors like it, while others don’t recommend it at all. What’s the deal?

It’s complicated. The Plasma Pen relies on a method called fibroblasting, named for the fibroblast cells that synthesize collagen. As with microneedling and laser skin resurfacing, it inflicts controlled damage to activate the fibroblasts in your skin—and, in the hands of an expert, can do a lot for the complexion. “It’s a minimally invasive procedure that kick-starts your body to generate collagen in the treated area,” says Beverly Hills, California, board-certified plastic surgeon Dr. Michelle Lee.

It’s commonly used on the abdomen, to treat stretch marks; on the upper lip, to lift the lip and give it a fuller appearance; and to tighten lax skin around the eye area. “It is great for patients who have enough fine lines that [their appearance] bothers them but are not ready for a more invasive procedure,” says Dr. Lee. Compared to more temporary measures, like Botox, the Plasma Pen can last up to three years, according to Miami board-certified dermatologist Dr. Loretta Ciraldo. She relies on it primarily to treat lines around the lips, wrinkles around the eyes, lower cheek wrinkles, and deeper lines from sun damage.

Related: 8 Ways to Get Rid of Under-Eye Circles—From Makeup to Medical Treatments

“The Plasma Pen causes tiny, superficial injuries by burning the skin in order to stimulate collagen production and skin regeneration,” explains Dr. Lee. The pen converts electrical energy into a plasma stream made of oxygen and nitrogen (here, plasma refers to the state of matter created by the tool and has nothing to do with blood). Once that reaches the skin’s surface, it heats up the dermal layers to the point of inflicting microtrauma, which triggers the body’s healing response. This damaging effect is twofold: it shrinks the existing collagen and elastin fibers and stimulates the production of new collagen, ultimately tightening and smoothing skin. The procedure creates rows of uniform burn marks, giving the effect of tiny dots across the treated area.

In the best-case scenario, you need only one or two treatments to see results. “When used properly, the results are consistent within a range,” says Dr. Ciraldo. “For example, a younger person will see more results after one treatment than someone 20 years their senior, who will almost definitely need two treatments for more dramatic improvement.”

The results of the Plasma Pen are relatively impressive, even after just one treatment. “I don’t believe that there are really any better treatments for certain areas, including lip lines, under-eye skin, and lines that are too close to the brows for Botox,” says Dr. Ciraldo.

The tool is also ideal for areas too small to microneedle, since it can better get into those contours. “The treatment area for the microneedling is a cassette of needles that is about an inch across, whereas the plasma devices have a pinpoint treatment area,” says Dr. Ciraldo. “So when you want to treat areas like lip lines or crepe-like skin under the eyes, you can actually target the exact lines and get more easily into contours than you can with the microneedling device.”

The Plasma Pen comes with one major risk, which is a change in pigmentation. Both hyper- and hypopigmentation (the indiscriminate darkening and lightening of skin color, respectively) can occur with the device. “Dark skin tones have a much higher risk of discoloration and therefore are not ideal candidates for the Plasma Pen,” Dr. Lee says. Those who have a Fitzpatrick Skin Type of 4 to 6 face too high a risk of pigmentation issues to get the Plasma Pen and are better off with microneedling.

Related: The Ultimate Guide to Understanding Collagen for Your Skin

A few RealSelf members who’ve had a Plasma Pen treatment rated it “Not Worth It,” due to a lack of improvement in what they originally set out to treat, while the majority said that it was painful or experienced hyperpigmentation. And among those who did consider it “Worth It,” some members mentioned that the healing process is longer than expected. (It typically involves five or six days of scabbing.)

Results from this procedure can vary wildly, depending on the provider and their level of expertise. “The Plasma Pen lacks any controls,” explains Santa Rosa Beach, Florida, board-certified otolaryngologist Dr. Steven Weiner. “The spot size, pulse duration, density, and depth are highly variable and are completely up to the user.” Dr. Weiner prefers treating patients with medical devices that have built-in safeguards, to reduce or prevent human error; Plasma Pens do not.

Furthermore, if your provider can’t accurately assess your skin tone and either prep skin before treatment with hydroquinone or determine that you’re not a good candidate for the Plasma Pen at all—both of which are possibilities, if you have a dark skin tone—you’re far more vulnerable to permanent discoloration or even burns. “No one wants to trade pigmentation issues for more collagen,” says Dr. Lee. “For elective procedures, it is critical to minimize the risks, to the best of our abilities.”

If you’re interested in the Plasma Pen, the first step is to find a trusted provider. The technique—of laying down the Plasma Pen dots, knowing which areas to treat, and being able to handle any complications that may arise—requires a certain level of mastery. “It seems that some salons are offering this treatment, and I would not suggest going to a salon for this—it is quite invasive, causing hundreds of crusts to form on the skin,” says Dr. Ciraldo. “The best advice is to ask your trusted, board-certified cosmetic physician, whether it is your dermatologist or plastic surgeon, if they are doing this in their practice or if they can refer you to a physician they trust.”

No matter who you choose, ask to see before and after photos. “If the before and after photos look more like the person had surgery with marked skin tightening, I would be wary,” says Dr. Ciraldo. “In my experience, the best results come after two treatments—so when you see photos that show dissolution of lines or tightening of jowls and the office tells you this is from a single treatment, I would search for another provider.”

Also, prior to the treatment, Dr. Lee recommends asking your provider to perform a few small “test dots” in a more inconspicuous area that’s close to the area you want to treat. “This is often done in our office so that we can best assess patients’ risk of hyper- or hypopigmentation.”

Related: 5 Risky Cosmetic Procedures to Avoid—and What to Get Instead

Finally, vet the device itself. “There are millions of devices out there that practically anyone can get their hands on, so it’s never a bad idea to ask, ‘What kind of Plasma Pen do you use?’ and do your research,” says Dr. Lee. A Google search turns up various fibroblast plasma pens any non-provider can purchase, ranging in price from $30 to $2,000, but experts strongly warn against DIY-ing this procedure. There can be a huge difference between the various devices, as some don’t control the amount of energy emitted while others do. Dr. Ciraldo uses the Plasma Elite Plasma Pen in her practice; Dr. Lee uses the Plasma Pen by Louise Walsh International.

The safest devices deliver a “consistent and controlled amount of energy, which allows the providers to safely and precisely tackle each and every fine line or wrinkle,” Dr. Lee explains. These devices also ensure the most consistent results. Checking all the boxes may seem like a lot of legwork—and it is—but when a procedure comes with the risk of permanent side effects, as the Plasma Pen does, it’s worth the effort.

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