If there is one single aspect of this procedure that you should be most aware of when offering it to clients it would be contraindications. What are contraindications? Contraindications are factors or situations in which a treatment should not be used on someone. Knowing contraindications is important for maintaining your business’ reputation and preventing liability. 

During your consultation you can specifically ask them if they have any conditions that may be of concern while doing this procedure. Even if there are reasons why plasma fibroblast skin tightening would not be a good idea for a client, you may have other services that are safer options for them. 

It is better to err on the side of caution than risk damaging a client’s skin. You want to offer them a viable skin treatment option that will improve their appearance, not make it worse.If there are some doubts as to the safety of this procedure on a client, you may even request that they be cleared by their general practitioner first, before proceeding with the therapy. 

•  Current or history of malignant melanoma cancer, or recurrent non-melanoma skin cancer or precancerous lesions 

•  Any active infection

•  Diseases such as 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 or use of immunosuppressive medications

• Diabetes unless under control

• History of bleeding problems or use of anticoagulants 

• History of keloid and hypertrophic scarring

• A history of heart disease (angina, heart pacemaker, taking anticoagulant drugs)

• Use of oral or topical Accutane, Retin A or other vitamin A derivatives

• Surgery in the past 6 months     

•  Alcohol or drug abuse

•  Breastfeeding or pregnancy

•  Deep bruising

•  Fever

•  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 or cuts on the treatment area

•  On regular prescription medication - requires doctor approval

•  Phlebitis

•  Poor circulation (blood and lymph)

•  Recent scarring to treatment area

•  Skin disorders

•  Thrombosis

•  Thyroid disease or other hormonal disorders

•  Under 18 years of age


If a client's allergies are giving them red, watery eyes or irritated skin, it may be best to postpone the procedure until the inflammation dies down.


Alopecia is a common autoimmune disorder that causes hair on any part of the body to fall out in patches. There should be no issues in performing this treatment on a client with alopecia.


Anemia is a deficiency of red blood cells. It can be caused by a variety of factors, the most common being a lack of the nutrient iron. Clients that are anemic may bleed more heavily and experience longer healing times.


Topical anesthesia can be a source of an allergic reaction from either the active or inactive ingredients in the solution. If the base of the cream or gel contains a substance in the ingredient list that the client is allergic to, you need to have an alternate anesthetic on hand. Sometimes the active ingredient itself may be the culprit. An allergy to lidocaine usually will mean the client cannot use any anesthetizing agent in the ‘caine’ family, such as prilocaine or tetracaine. Use a patch test before continuing on to the treatment. This procedure can be performed without a numbing agent if the client is willing to do so. A fan, cooling unit or cold compress can be used in lieu of topical anesthetic to provide more comfort.


Clients with asthma may use inhalers and other medications that result in thinner skin tissue and increased vascularity. Because of this, they may not only bruise more easily but experience heavier bleeding. These clients may take longer to heal from the plasma pen procedure.


Birth marks and port wine stains should be avoided. A port wine stain (nevus flammeus) is characterized by malformed blood vessels. The risk of excessive bleeding might increase if such tissues were treated with a plasma pen. These lesions should only be handled by a laser specialist. You can customize your client's treatment to only address the skin around these areas. 


A blepharoplasty is a form of cosmetic surgery that removes excess skin to tighten the eyelid. This procedure can be done if 3 months have passed from the date of the blepharoplasty surgery. The area must be sufficiently healed before a plasma pen can be used on the eyelid area. Since this procedure when used around the eyelids is referred to as a nonsurgical blepharoplasty, waiting to perform the procedure will prevent over-tightening of the upper eyelid area.


It is recommended to wait 3 weeks from receiving a Botox injection before having this type of treatment. It is preferable to get this type of treatment prior to a Botox injection.

BREASTFEEDING and pregnancy:

The Plasma Fibroblast Skin Tightening treatment cannot be performed on pregnant or breastfeeding mothers.


Allow 3 months after a brow, forehead, or surgical facelift to determine suitability for plasma pen treatment.


Bruising or bleeding easily may indicate an underlying health problem. Those who are prone to bruise or bleed easily may take longer to heal from this treatment.


Cancer patients actively being treated with radiotherapy, chemotherapy or other modalities must wait 5 weeks after their last session to be able to receive this procedure. A cancer patient with too low of a blood count would not be a good candidate for this procedure. Terminally ill patients that want to receive Plasma Fibroblast Skin Tightening can do so with written consent from their physician.


Cataracts are cloudy areas on the eye lens that may affect a person's vision. If a client is receiving the treatment in the eye area and they have cataracts, it is advisable to have consent from their physician before providing the service.


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 heal much slower than completely healthy individuals and may also bleed more. For this reason it may be best to allow more space between treatments to allow for proper healing.


Clients with dry eye can receive this procedure, but steps should be taken to provide them with the greatest possible comfort. Using moisturizing eye drops and making sure the yes stay closed to keep carbon smoke from irritating the delicate tissues of the eye are helpful techniques to help alleviate discomfort. 


Epilepsy is a serious condition that can be triggered by a variety of situations. If it has been two years since a client's last seizure and they have someone accompanying them to the appointment then the treatment can proceed. Be sure to have the client sign the consent form and be aware of the potential of this treatment to trigger an epileptic event.


Any client that has had eye laser surgery should wait a minimum of 8-12 weeks before receiving this service.


Hemophilia is contraindicated for Plasma Fibroblast Skin Tightening. Due to the fact that hemophiliac patients have issues with their blood clotting properly, this procedure would not be safe.


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 five days before treatment and five days after treatment.


Plasma Fibroblast Skin Tightening is not safe for individuals with serious immune disorders such as  HIV, AIDS and hepatitis.


Hyperpigmentation is when excess melanin pigment is deposit on areas of the skin. It is usually seen as an inflammation response in those with more pigmented skin, such as individuals of Mediterranean, Asian, Latin and African heritage.  Unfortunately, Plasma Pen is contraindicated in those with a Fitzpatrick skin type of V or VI. Darker skin types have a tendency to scar pink or white (hypopigmentation), or with a darkened area at the site of treatment (hyperpigmentation).


It is advisable to wait 3 weeks after receiving filler to perform the Plasma Fibroblast Skin Tightening treatment. When performing the lip flip service or other treatment near lips that have received injections, the level of healing may be compromised. Advise the client that healing may take longer in these areas and that there is a greater risk of infection when working close to the lip.


We recommend that your client receive written consent from their doctor if they have kidney or liver disease.


Lupus is a serious contraindication for plasma pen treatment. Due to the inflammation and swelling associated with lupus, the Plasma Pen treatment cannot be safely performed.


If your client suffers from mitral valve prolapse and requires antibiotics when they receive dental work, they should take this same precaution prior to their Plasma Fibroblast Skin Tightening treatment.


Due to possible infections and risk to fetal health practitioners should not provide this service to any female that is pregnant or thinks they may be pregnant.


If your client suffers from retinal detachment or other eye conditions, it is best to obtain written consent from their eye doctor prior to treatment in the eye area.


Any type of skin disorder will make your client experience more irritation and dryness. The entire treatment process will be more uncomfortable since skin is likely to be thinner and already inflamed. It is best to avoid treating areas with eczema, psoriasis, dermatitis or any other similar skin conditions with a plasma pen.


Hypertrophic scars are a result of a collagen imbalance at the site of a cut, piercing or other trauma to the skin. These raised scars contain excess collagen. Keloids are a type of hypertrophic scar that is more severe, growing outside of the original wound site. The plasma pen would not be an appropriate therapy in treating these types of scars. 


If your client has had shingles, they should wait a minimum of 6 months after a shingles episode before undergoing this treatment. It is not known what triggers a shingles outbreak, so the client should be aware of the potential risks in receiving any treatment on their skin.


If a client has eye conditions such as sties or conjunctivitis a waiting period of 6 weeks from their last treatment for the condition should be observed before receiving this skin tightening treatment. Treating the eye area with plasma pen may cause the condition to flare up. It may be advisable to receive written consent from their physician prior to service.


Thyroid imbalances will create a longer healing time for some individuals, but the treatment can still be performed.


Trichotillomania is a compulsive urge to pull at the hair and skin. If a client is susceptible to picking at the skin they could increase their chances of infection or hyperpigmentation in the treated area, in which case this treatment may not be right for them.


Vitiligo is characterized by a lack of melanin pigment in patches of skin. Because this condition can spread, using the plasma pen on clients with vitiligo would not be appropriate. 

Special reminders for Treating Cancer Patients

Cancer patients and survivors often turn to those in the field of medical aesthetics for a boost in the way they look and feel. Plasma Fibroblast Skin tightening is useful in rejuvenating areas of lost skin tissue that may have occurred during the course of their sickness. Radiation treatments leave the immune system weakened, so there is a risk of infection and healing will be much slower. However, the plasma pen can be used on cancer patients, provided they follow pre-treatment and aftercare instructions to the letter. Once they have the "okay" from their physician that it is safe for them to receive minimally invasive cosmetic treatments, there is generally no problem in treating these clients. 


Blood Thinning Supplements and Medications

• Ibuprofen

• Turmeric

• Ginger 

• Cayenne peppers

• Vitamin E

• Dong quai

• Feverfew

• Garlic
• Cassia cinnamon
• Ginkgo biloba
• Grape seed extract

• Aspirin

• Niacin

How do blood thinners impact fibroblast treatment?

There are two main concerns with blood thinning substances. First, bruising is more common in individuals with thinner blood. Second, thinner blood may affect plasma coagulation which could affect healing and lead to less pleasing results. 

Without proper plasma coagulation the carbon dots will not crust and scab over as effectively and may bleed out. If you find that a client is bleeding more than usual, they may have consumed a natural or medicinal blood thinning substance. Send out your pre-treatment instructions well before the appointment so that the client can avoid blood thinning substances. Some clients are prescribed blood thinners for specific medical conditions, so you will need to proceed with caution in determining whether to perform this procedure on them.

Many people are surprised to learn that alcohol thins the blood. Your pre-treatment instructions should include information telling them to refrain from alcoholic beverages for 3 days prior to the treatment. Avoiding caffeine the day of treatment and for 24 hours before treatment will enhance healing capability. Caffeine is a vasoconstrictor that will affect blood pressure and interfere with plasma coagulation during the plasma pen procedure.

Can you perform this procedure on someone who is taking blood thinners?

Blood thinning medications or supplements will not rule out this procedure, but can increase the time needed to heal. If a client takes blood thinners, make sure they are aware of the increased downtime and extra healing period needed for optimal results from this treatment. If possible, discontinue blood thinning medications or supplements 3 days prior if their doctor indicates it is safe to do so. There are many other minimally invasive treatments that may be able to address the cosmetic issues of the client without the added concern of bleeding. You and your client will need to assess each situation and whether you feel it would be safe to move forward with the procedure.

plasma Fibroblast skin tightening Protocol:


Being prepared and having a proper table set up is key to professionalism and a successful procedure. We will lead you through each of the steps along with all you will need to be prepared prior to procedure.

1. Wash your hands throughly for at least 1 minute 

2. Clean skin by removing all makeup, sunscreen, moisturizer and other products with a pH balanced cleanser. 

3. Clean your plasma fibroblast pen with rubbing alcohol and use a disposable cover.

4. Insert a clean needle probe into the fibroblast pen. 

5. Put on a face shield and sterile gloves and begin wiping down the skin with rubbing alcohol. The face shield will keep carbon smoke from irritating your eyes.

6. Apply a numbing agent to treatment area and cover with clear plastic wrap for 30 minutes, then remove.

7. Turn on the power and adjust the intensity settings based on skin type and the area to be treated. Perform a patch test and further adjust the level of intensity of your pen based on the client’s response.

7.  Begin laying a grid pattern of evenly spaced dots on the treatment area.

9. Work in small sections and only wipe off the numbing cream in the area you are working on. Leave the other sections covered in plastic wrap until you are ready for them, otherwise the numbing effect will wear off prematurely.

10. For clients experiencing severe pain, once you lay down a few dots you can apply numbing solution over the area you just treated to lessen discomfort.

What to do in the case of blistering

A blister is your body's response to injury. It most often occurs in reaction to heat trauma. The reason is this; a blister is simply a fluid filled sac. It helps cool and provide moisture to the burn area by creating its own encapsulated environment, optimal for healing. The skin will regrow in a protected environment and the fluid will be reabsorbed by the body over time. If a client blisters, a red LED light treatment will help them heal faster.

Aloe vera can safely be applied to a blister and will further soothe the inflamed burn area. Whether your client blisters or not, instruct them to keep the area moist. The moisture will allow the scabs to stay in place longer, providing more time for the skin to heal and reducing the chance of hyperpigmentation or hypopigmentation.

How To Avoid Blistering:

1. Make sure to test your pen setting on an area of the client's skin before engaging in the procedure. Look for a pink, red or light brown coloring in your dots. Black colored dots will indicate the setting is too high.

2. Keep your plasma pen arc time to no more than a second to avoid excessive heat.

3. Have the client stay out of the sun and away from tanning beds for 3 days prior to the treatment.

Blistering is not ideal, but it is not a cause for panic. Any type of skin trauma, especially when heat is involved is likely to cause a blister response as the body is doing what it does best-- repair itself. Never pop small fluid blisters or this could lead to infection, scarring and pigmentation problems. Rather, let the blisters heal on their own.  

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