In this module we will advance some of the information you have already learned during this AMA course. We have covered the most important fundamentals involved in providing the Plasma Fibroblast Skin Tightening procedure. We learned how to create basic lifting patterns, how to properly outline wrinkles and how to treat secondary areas for additional tightening and lifting. We have also learned much about the science behind plasma arcs. You are now equipped with many of the essentials skills you will need in order to start increasing your business' profitability with the Plasma Fibroblast Skin Tightening treatment.

If you want to have a more comprehensive technique that can address a wide range of concerns, our Fibroblast Patterns are critical for advanced tightening theory. Here at Aesthetic Medicine Academy, we decided that it was best to add an entire module on patterns in great detail. This lesson will go beyond the basics of plasma pen tightening. You will discover new possibilities and techniques in treating shallow wrinkles, closing acne scars and effectively diminishing the look of stretch marks. By learning more detailed grid patterns you can efficiently treat multiple skin issues simultaneously. You'll also discover new ways to better manage your client's pain level. You will learn new ways to treat and lift areas of the body and not just the face.

Tightening Theory 

In this module we will learn more about patterns and grids for fibroblasting. For optimal results, you need to choose the right pattern for your client's specific concern. By the time you finish this course in Plasma Fibroblast Skin Tightening, you will be able to create the perfect pattern on any area of the body and achieve the best results possible for your client! 

A well executed pattern serves to efficiently tighten a particular area of the body or face we are treating. It is important to learn how many dots we need lay down for our treatment area, how far apart those dots should be spaced and how we should pattern adjacent skin areas. In this course we will be covering the following: 

• Creating a complete patterns

• Dot placement 

• First objective 

• Second objective 

• Combining areas 

Creating complete Patterns

The first step to creating a great fibroblast pattern is to identify your first objective. The first objective is the client's top priority. During the consultation you should ask the client what area they desire to see tightened and lifted and what sort of change they are hoping to achieve. Ask about the surrounding areas and if there are any concerns they want to address there. Questions will allow you to get the client’s perspective and be able to tailor the treatment so they are fully satisfied. Don't forget that your perspective as the professional practitioner is just as, if not more so important. What areas can you identify that would be first objective treatment areas? What complementary sites can be treated to assist in bettering the results of the first objective sites? We refer to those areas as the second objective sites. We will discuss second objective sites in greater depth later in the course, but for now it is most important for you to know that in creating your pattern you must always incorporate a first objective site and second objective site. This will ensure that you as the professional, did everything you could to achieve maximum aesthetic results for your client. 

Let's talk actual patterns. As mentioned, your dot placement will encompass your first and second objective sites. For example, if you want to treat the nasolabial fold, you would create a pattern that treats those smile lines directly as your first objective. Instead of just outlining those creases with your dot pattern, your second objective would include a pattern based on another area of the cheek that would lift and reduce sag in the smile lines even further. You will want to pull and stretch that wrinkle out as much as possible. This grid plan would be called a "complete pattern," a protocol that consists of incorporating two areas for maximum results on the first objective site.

Your dot placement spacing will vary in length from about 1/16 inch to as much as 1/4 inch. The further out your pen is from the first objective site, the greater the space between your dots. 

For pronounced wrinkling and deep folds in the skin, lay down a minimum of four tight (1/16’) dot placement lines on each side of the wrinkle or fold. You may find that you can place more than four 5-Point Method patterns along the crease if the area is large enough. A good rule of practice is to place at least four along the crease borders.

PLASMA Dot Placement For Maximum Results

With each client there are a few questions that you will need to ask yourself. How close should I place my dots? How dark should the dots be? How long should my arc time be? These are questions that will have different answers based on each client you treat. This is why we believe testing each client with a few dots prior to treating the entire area. If you have a concern about performing on a particular client, you would have them come in a week prior to their appointment to test the area you plan to treat by laying down a few dots. You would observe the arc time needed for a light brown dot and the intensity level required to achieve a quick arc. The quicker you can move along, the less pain for the client. Performing a patch test well before the appointment also serves to reveal their healing time. You'll find out how quickly their scabs heal and flake off and how well their skin responded to the plasma pen treatment. Since you are only testing a few dots on the skin, no numbing solution is required. 

Fanning out your dot placement produces a softer result. You never want to end a pattern in a straight line. The plasma pen causes a very dramatic tightening effect. Sharp lines between treated and untreated areas will lead to future puckering, wrinkles and unsightly folds in the skin. We will cover these issues more in the section about skin darts. 

What would be the best length of time to arc for when creating a your pinpoint grid pattern? The arc time is best determined by thickness of the skin to be treated. The eyelids and underneath the eyes in the tear trough area is extremely sensitive because of how thin the skin is. Using a much lower setting is called for, starting at perhaps level 4 and adjusting the intensity from there. When using a lower intensity you can hold the arc time for up to a full second at the most. Err on the side of caution and adjust according to how your dots look. They should range in color from pinkish red to light or medium brown. Anything that looks almost black in color is too high and will damage the skin. 

In the image below you will see where you should not place plasma fibroblast dots in red. You will also see the primary treatment area in tan and the secondary treatment area in light pink. In the tan section you should have a solid grid patten and the secondary light pink section you should have some fanning occurring and more dot spacing. 

Identifying Your Primary Treatment Area (1/16 inch)

The first objective site is the one that your client specifically tells you they are looking to treat. This will be determined during consultation. Keep your dot pattern very dense with about 1/16 inch space in between your placements.

Identifying Your Secondary Treatment Area (1/8 inch to 1/4 inch)

Areas adjacent to, or that indirectly affect the firmness of the skin in the primary treatment area are the locations you'll focus on for secondary treatment area sites. The grid will be characterized by dots interspersed about 1/8 inch to 1/4 inch apart, in a gradually fanned out manner. Remember, we never want to have any straight lines in our first or second objective sites. The outer dots will be more zig-zag shaped in placement. With this complete pattern you are giving your client additional pull and lift without overtreating the main area and creating an unnatural result. 

Wrinkle Lines 

Begin placing a 5-Point Method on both edges of a deep wrinkle, fold or crease. For fine lines that are not much deeper than the rest of the skin, you can place your dots directly within the wrinkle.


• Creating a complete pattern involves using first and secondary treatment sites

• A complete pattern can even include three different areas

• At least four 5-Point Method patterns should be placed down the side of a deep wrinkle or crease

• Straight lines or abrupt stopping points lead to skin puckering and folds

Let's Talk Patterns!

Treating the eyes and lower face

The Plasma Fibroblast Skin Tightening Treatment is sometimes called a nonsurgical blepharoplasty or eyelid lift. For example, your client may express that they want to lift their droopy eyelids. If you notice they have crows feet, you will want to suggest also treating this outer eye area to get more lift to the upper eyelid. In some clients you may not notice much wrinkling of the outer eye area, but perhaps they have lax skin on the forehead. Again, if sagging upper eyelids are the first objective, treating the area above the brow and into the forehead will also help lift the first objective site. Communicating with the client about the cosmetic enhancement they want to achieve and examining the structure of the areas surrounding the treatment site will lead to greater satisfaction with the service for your client. Make sure the client is aware that the eyes have the thinnest skin on the body and this area will have pronounced swelling and longer healing time than any other treatment area. It is possible to need more than 7 days time for dots to fully shed in the eye region for some individuals, but most will heal within 7 days. 

In this example, the client has heavy crows feet and severe volume loss in the upper eyelid region. A good pattern would border the crows feet, avoiding placing dots within the crease. The under eye area should be fully treated, staying a few millimeters away from the bottom lash line. When working on the upper eyelid, stay away from the lash line also because this area is too sensitive. They will still get lift in the lash line area simply by treating the areas near it. Place a finger on the inner corner of the eye when working on the upper eyelid. For plasma pen treatments the inner corner of the eyes are not typically treated due to sensitivity. The brow bone is generally already taut, so focus on the loose and crepey skin of the upper eyelid, but fan out the edges. You can create a triangle-shaped pattern at the arch of the brow for increased lift to the eye. For the "11's" and other forehead wrinkles, follow the same technique for bordering the wrinkles with the 5-Point Method.

In the lower part of the face the main wrinkles to border are vertical lip lines or smokers lines, and the nasolabial folds, sometimes referred to as marionette lines. For the rest of the lower face you can cover it with the 5-point method. As a reminder, be careful of covering too much skin in one visit if you are working on an elderly client. Older ones heal much more slowly and the dryness of the skin can make the carbon crusts more itchy and uncomfortable while healing. Depending on your client's age and healing response, you may want to divide treatment among multiple sessions.


Forehead lines are more challenging to address because they are dynamic wrinkles. Dynamic wrinkles are caused not simply by degraded collagen and elastin, but from muscle movement. One of the reasons Botox is a popular treatment for forehead wrinkles is because it blocks muscle movement. Another difficulty is that dynamic wrinkles create shallow impressions on the skin no matter how hard you pull them apart even with your fingers. In basic training we teach you to outline wrinkles to help pull them apart. Many forehead wrinkles are treated just like this and you will get some results. However, these wrinkles will return more quickly than other facial wrinkles due to being aggravated by the muscle movement. Be sure your client is aware that the results in this area are not as long lasting, but it can provide significant improvement.

For your forehead grid patterns you will always treat the entire forehead. This will not only give you the most lift but can help improve the look of the eyes and brow area. When you come across a fine line, a wrinkle that is too shallow to spread apart with fingers, treat directly within the crease. Zapping right into the fine line is the best technique to treat it. For the deep furrows, work around the edges and avoid the center. 

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