One of the applications of plasma skin tightening is upper eyelid tightening. Eyelid tightening using Plasma or Electrical Arcing is becoming more and more popular around the world because:

• it is cost effective,
• it leads to very good appreciable predictable results,
• the results are cumulative, this means that you build upon the improvements already achieved after previous treatments,
• it is generally very easy to carry out, and
• it is also every easy to learn

Localised Skin Tightening using AC Electrical arcing, also referred to as plasma, is applied for upper eyelid tightening with very good cumulative results. Therefore after a few sessions with AC Electrical arcing, your client will enjoy a substantial more youthful look by improving the appearance of saggy and heavy looking eyelids. Upper eyelid tightening has been so successful the world over that this treatment has been sold to doctors by several companies and to patients by doctors as "non surgical blepharoplasty". This is because of the, sometimes, very good short term results which the treatment can produce.

Electrical arcing or Plasma is only one of the several methods used for eyelid tightening. Similar Skin Tightening Effects are accomplished with use of cosmetic lasers (mainly CO2 lasers) and also some electrocautery units properly configured. Generally the power level  required for this type of aesthetic treatments is very low. Additionally similar results can be accomplished with certain specialised cosmetic peels. To summarise, similar eyelid skin tightening effects can be also performed by using:

• Cosmetic Lasers (Mainly CO2)– There are many different devices available on the market which can be set-up at the right wavelengths in order to carry out these types of cosmetic treatments. (Consult the manufacturer's recommendations).
• Specialised chemical peels. (ie Glycolic and or Mandelic peels made in special formulations)
• Specialised radio frequency equipment functioning in electrofulguration mode. Clear protocols are in place, results are consistent and repeatable (Consult the manufacturer's recommendations).

The following are the advantages and disadvantages of eyelid tightening in general using, CO2 lasers, Electrical arcing and specialised cosmetic peels. Please note that although the clients can generally resume their normal activities after this type of aesthetic treatment the perceived downtime of eyelid tightening procedures can be similar to surgery, especially if the treatment intensity is high. This is because of the swelling which usually follows  one to two days after this type of aesthetic treatment. Advantages over conventional surgery:

• These techniques require only topical anaesthetic (i.e. numbing products like Emla) and are very easy to perform. With exception of the use of cosmetic peels which do not require it.
• The skin recovery process lasts normally between 3 to 10 days after every session, depending on the treatment intensity, and other factors including the method or product used.
• Of course bleeding during and after these aesthetic procedures do not usually occur. It can occur with certain CO2 lasers and electrical arcing devices if the power level is set over a certain threshold or if the electrical arcing is applied for longer than a certain period of time during the spot operation, then some minor bleeding can occur.
• The risks of infection are very low compared with surgery.
• No general risks associated with surgery as these are non surgical easy aesthetic procedure.
• No incisions are performed and therefore no scarring is usually left.
• These procedures are extremely easy to learn and can be carried out by any trained beautician.
• The clients are able to resume to their normal activities immediately after every session, provided that this does not increase the risks of infection  (however a certain after-care has to be followed until complete recovery).

Disadvantages versus conventional surgery:

• Eyelid skin tightening brings about minor cumulative improvements in the appearance of saggy eyelids. If the amount of skin to be tightened is considerable in order to achieve the desired results, surgery is the best and most effective method.
• The results of eyelid tightening are not comparable to the blepharoplasty and should not be proposed as an alternative to surgery. This is because dramatic results can only be achieved using surgery.
• Fat cannot be removed by using any skin tightening method.
• More than one session, sometimes several, may be required to achieve the desired results, depending on the amount of skin droopiness and the overall intensity of the treatment.
• If the amount of lose skin is significant,  Surgery may be the best option for those who desire dramatic changes. This is also because there a perceived downtime due to swelling, therefore it is not advisable to attempt several treatments to achieve dramatic cumulative results while exposing the client to several swelling episodes, if a simple blepharoplasty can achieve the desired results in one session only.

As we have discussed electrical arcing is not the effective method used to achieve eyelid tightening. Some conventional surgical lasers or cosmetic lasers (often CO2 lasers) can be set up to carry out eyelid tightening by using standard skin tightening techniques. When using lasers to carry out this type of cosmetic procedure, the client should wear intra ocular laser eye-shields, for protection. In the video below you can see an example of eyelid tightening carried out using an aesthetic laser. The laser is used on the orbital and periorbital area superficially in order to cause mild non harmful burns. This has to be done carefully, because if not set properly, the device could damage the dermis causing permanent scarring to the client. Immediately after each session the area will appear full of tiny burns caused by the laser. The area treated will recover a week after undergoing the session with the skin tightening laser. With a skin tightening lasers, a typical treatment ablates 11-33% of the skin, removing the old or damaged collagen which contributes to laxity. The heat generated in the tissue also helps the surrounding skin tighten, stimulating further collagen remodelling and reducing the skin area (Skin Tightening). For most people with moderate wrinkles or hooding, 4-5 treatments will result in satisfactory results. For those with very early signs of ‘crow’s feet’ and fine lines, 2-3 sessions can help as a maintenance type of aesthetic treatment to slow signs of ageing.

Electrofulguration equipment or AC voltaic arcing specialised equipment are widely used throughout the world for Eyelid tightening. In the video above the a portable radio frequency ElectroVoltaic Arcing device (BeautyTeck)  is used to perform a single session of Eyelid Tightening. Eye protection during this type of procedure is not required like in laser treatments. The use topical numbing products is recommended for the comfort of the client and ease the treatment. Each session usually lasts between 5 and 15 minutes at most, depending on the area to be treated. Also, AC electrical arcing can be used to tighten the skin around the eye resulting in the attenuation of peri-orbital wrinkles, this can be done during the same session of eyelid tightening if required. It is important to avoid reapplying the arc on the area already treated until the area has recovered properly (usually after 4 to 6 weeks). Additionally, although in many cases it is possible to achieve the desired results within few sessions (2 to 3), it is preferable to split the treatment into multiple sessions instead (3 to 5). This is because spreading the treatment allows the aesthetic practitioner to have more control over the outcome of the procedure. This is done by varying the intensity of the treatment. Also, during the skin recovery period, some areas could tighten more than others, therefore it is advisable to perform at least two sessions on every client, even in those cases where the desired results can be achieved within one session only. Usually, during the first session the experienced beauty practitioner will normally cover a wide area of the upper eyelid in order to achieve the best possible results. The subsequent sessions can be used to fine tune and correct any imperfections or unevenness left after the first or previous sessions. In certain cases, due to particularly high client's pain threshold, the whole eyelid tightening procedure can be carried out without the use of any topical numbing product. However the use of an appropriate numbing cream is always advisable to make use the client is at the most ease during the treatment. No medication of any kind shall be applied neither by the beautician nor by the client, other than appropriate antiseptic products to reduce the likelihood of infections during the recovery period. At home the client should only wash and rinse the whole face as usual, dry with a clean cotton cloth, being careful to gently pat and not rub the treated area. No make-up nor other creams should be worn before the area treated with the plasma device has recovered completely. During every session the beauty therapist must always take precautions to minimise any unexpected sudden movements of the client. With Eyelid tightening using the appropriate plasma (or arc generating) device:

• After a number of treatments, the results of eyelid tightening may be resemble those of a Blepharoplasty. However Eyelid tightening will not bring about the same diagrammatic results only achievable with surgery.
• Eyelid tightening can be performed by appropriately trained beauticians, as well as doctors, dermatologists and plastic surgeons as sedation is not required, the procedure is very easy to learn and risks to the client are remote.
• Eyelid tightening with the appropriate plasma device has the added advantage that even minor corrections can be made in a virtually risk free and cost-effective way.
• Each correction made to the client is long lasting.
• No scarring has ever been reported using the appropriate plasma device properly.
• Each session can last 15 minutes at most. It will last longer depending if the user covers a particularly large area.
• Topical anaesthetic is not strictly necessary, but the use of an appropriate numbing product is always advisable for the comfort of the client.
• The client can always resume their activities immediately after each session.
• It is recommended that the desired results are achieved in more than one session, especially if the area to be reduced is extensive.
• The costs associated with the eyelid tightening are reduced by over 60% to 70% compared with conventional surgical procedures.
• Increased business due to many clients being in fear of surgery or higher costs of traditional surgery and also enabling more clients opting in for treatment as it is only minor.

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 10 days in normal circumstances.
• The area treated MUST NOT be covered with any type of make-up, mascara, creams or any other product, until the area has fully healed. Wash gently with soap twice a day. Any other treatment or wearing of any type of make-up could result in unnecessary infections and 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 eyelid tightening procedure.
• Swelling one to three days after the cosmetic treatment is normal and to be expected. It is always better make the client aware of this at consultation stage.
• Eyelid tightening brings about cumulative minor improvements of the appearance of saggy or droopy eyelids. Do not promise the dramatic results which can only be accomplished with surgery.

Patch testing should always be performed before starting a full eyelid tightening treatment.Patch testing is important so that you can demonstrate that if the after-care is performed correctly the skin will recover well and there are no adverse effects to this aesthetic treatment. The patch testing for eyelid tightening has to be performed at the same treatment intensity you intend to carry out the treatment. For example if you would like to use the equipment at a certain power setting, with the spots at a certain distance (say 1 mm apart) and the arc duration a quarter of a second (instantaneous bursts), perform this the treatment at the intensity you intend to carry out the treatment and perform it on a small area behind the ear.

Remove all make up thoroughly by using  normal make up removal procedures. Remove all make-up from the face.  Once  you have removed all make-up, apply an appropriate non flammable antiseptic on a clean cotton pad and gently rub the area you are going to treat with the electrical arcing device (The upper eyelids). At that point you can apply the appropriate numbing product on the upper eyelids.

Eyelid 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. Like with most other aesthetic treatments, it is possible to perform eyelid tightening using electrical arcing without applying any numbing products. However most clients have a low pain threshold, therefore if the area is not numbed properly, eyelid tightening can become a very unpleasant experience for both to the client and the beauty therapist. The unpleasantness of the treatment, may prevent the client from undergoing further sessions due to the discomfort caused by the previous treatment. Also, when the client has an unpleasant experience, it becomes much harder for the beauty therapist, to perform the treatment correctly. This is all easily resolved by using the appropriate numbing product correctly before beginning the treatment. A very common topical numbing product available on the market, in most parts of Europe, including the UK is EMLA. (EMLA is available in 5% formulations from most chemists in the UK).   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 applying the cream on the eyelids and covering the cream with a normal cling film. The same that can be purchased from any supermarket. The cling film is applied in order to cause an occlusion effect which will amplify the effects of the numbing ingredients of 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, although available without prescription form any chemist in the UK, the EMLA formulation requires a relative long wait in order to become effective 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 40 minutes the area will likely not be numb enough, in order to carry out the aesthetic treatment in ease and comfort. Additionally the topical effects of the EMLA formulation end within 5 to 10 minutes from the time the cling film is removed and the EMLA residues wiped off. Therefore the window of time while you can perform the treatment in comfort is relatively brief. Given that the use of numbing products are heavily regulated, EMLA is the main product available over the counter in the UK. Some Medical practitioners can be authorised to use other numbing products. The formulation that has been used extensively and successfully by medical practitioners who use electrical 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 European countries like Italy and Spain this is made by most local chemists who also have an internal licensed laboratory to manufacture these types of products.  In Europe, this type of topical formulation can only be made under medical prescription (therefore under the sole responsibility of the medical practitioner who orders the product).  Due to current regulations, this is a product which 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 electrical arc is applied. The area where this formulation is applied becomes numb within 5 to 10 minute after the application. Please note that these types of products are not meant to be completely absorbed, therefore all you have to do is to apply the cream or gel, on the area you intend to treat and leave the product to do its job. 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 you start the treatment on the client remember to remove the topical anaesthetic on a small area. The common mistake made by beginners is to remove all the numbing product at once. For example if the topical anaesthetic has been placed on both upper eyelids, the untrained beginner usually removes the cream on both eyelids before starting the treatment. The min problem is that the effect of most topical numbing products do not last long (in case of EMLA only 5 to 10 minutes at most). Therefore the effect of the topical anaesthetic could start to fade before the end of the treatment making the procedure cumbersome. In the video below you can see an example of the spot mode operation during of a high intensity treatment (the spots are deliberately applied very tightly in order to carry out a high in intensity treatment). As you can see the topical numbing product is only removed on one upper eyelid and in stages, while it is left on the lower eyelid which is going to be treated as soon as the upper eyelid treatment is over. A custom numbing product applied, no need for occlusion with cling film. The video is fast forwarded. Therefore is is advisable to remove any type of topical numbing product in small patches while you carry out the electrical arcing treatment. This will ensure that the area you will be treating is still numb, ensuring maximum comfort to your client and ease of operation to the beauty therapist. In the video below you can see an example of lower eyelid tightening. the treatment was performed by a trainee. As you can see the topical numbing product is still applied on the upper eyelid. In this way the upper eyelid will still be numb when the beauty therapist will perform eyelid tightening. (Custom numbing product applied, no need for occlusion with cling film) For eyelid tightening and similar skin tightening procedures, using electrical arcing, the use of local injectable anaesthetics must be avoided even if the beauty practitioner is authorised to use them.

The preferred method of performing eyelid tightening is the spot mode or spot operation. This is because, the spot mode or spot operation, is very easy to learn and leads to consistent and predictable results. The spots should be applied randomly without forming any straight line or particular recognisable pattern. One method commonly used to ensure that the spots are applied randomly is to try and apply the voltaic spots in a zigzag fashion.   The distance between each spot varies according to the intensity of the treatment of the specific treatment. This varies between 3 to 4 mm apart for very mild intensity treatment to a very dense spot application which resemble the immediate result of the spray operation.  A smoke evacuator should be used to get rid of the fumes caused by the cosmetic treatment. In the video below you can see an example of overall high intensity treatment. The treatment begins as a low intensity treatment but then the intensity of the treatment is increased by applying more voltaic spots. The treatment was carried out by a trainee under supervision. As we can see in the video above upper eyelid tightening, lower eyelid tightening and crow's feet attenuation can be all incorporated within one session. However this is not advisable in most cases because the overall intensity is increased dramatically. This causes dramatic swelling events and a certain level of discomfort which can be easily avoided by simply spitting the treatment in various different sessions, each dedicated to the particular area to be treated. For example one for the upper eyelids, one for the lower eyelids and another for crow's feet attenuation. Please avoid performing high intensity treatments in any case as this can lead to protracted inflammations and various adverse effects including skin laxity. Therefore always opt for low/medium intensity treatments.

In general the degree of tightening (skin shrinkage) achieved is related to the skin tightening treatment intensity using electrical arcing. As we have seen, in skin tightening,  the intensity of the treatment is related to a number of factors and not only the power setting of the device itself. (Click Here to revise this section). The higher the intensity of the treatment:

• The better the eyelid tightening results once the area has recovered. Therefore the less treatments will be required in  order to accomplish the desired results.
• The more the swelling and blistering after the treatment.
• The more the discomfort levels after the treatment.
• The longer it will take for the swelling and blistering to subside.
• The longer the downtime.
• the higher the likelihood of undesired effects.

The lower the intensity of the treatment:

• milder the eyelid tightening results. The less the eyelids will tighten
• The less the swelling or blistering after the treatment.
• the less the discomfort levels after the treatment.
• The less time it will take for the swelling and blistering to subside
• the shorter the downtime
• the lower the likelihood of undesired effects.

Please do not be tempted to perform high intensity treatments in order to achieve dramatic results within one session.  Most of the times, doing so does not lead to those dramatic results only possible with surgery. In turn the milder the treatments the less the eyelids will tighten after each session.  Therefore more sessions will be required  in order to accomplish the desired results.

Minor bleeding is a rare occurrence when using AC electrical arcing devices for this type of application. Additionally minor bleeding also occurs after the use of lasers for similar skin tightening applications including laser tattoo removal. Bleeding occurrence is particularly rare especially if the intensity of the treatment is very mild. The likelihood of minor bleeding increases as the arc duration increases, the power setting of the device increases or both. Please note that minor bleeding is not an indication that the treatment has not been carried out correctly as this can occur despite of the type of device used, technique or intensity of the treatment itself. However some degree of minor bleeding can occur even at very low intensity treatments in those cases where fine vessels are present on the treated area especially on the upper eyelids.

As we have seen in mole removal or brown spot removal the carbon residues need to be purposely removed in order to accomplish the desired result.This is done by using a cotton pad impregnated with non flammable antiseptic. In the case of skin tightening and especially eyelid tightening, the carbon residues should not be purposely removed.  This is because throughout our extensive experience we have seen that the best and fastest recovery is achieved when the carbon residues are not intentionally removed. This is probably due to the micro traumas caused by rubbing the cotton pad while trying to remove the carbon residues. Therefore while performing skin tightening and especially eyelid tightening, do not intentionally rub the area you treated with the cotton pad as you would do in other aesthetic applications. If you are applying an appropriate sterile topical product soon after the treatment, including antiseptic, make sure you do not rub it on the area you treated. Just apply the product very gently including any the use of any sterile cream. As you can see in the video above no effort is made to remove the carbon residues. This is deliberate. In case you have applied a sterile cream (most commonly a sterile soothing topical product), you will find that the carbon residues will mix with the cream making the cream brownish, this is normal. The carbon residues are sterile anyway as you have cleaned and disinfected the area before applying the numbing product.

The immediate noticeable effect of eyelid tightening is a apparent skin contraction. Please note that this is not permanent and not representative of the end results of the particular session you are carrying out. The results will become apparent only once the area has fully recovered after the swelling has subsided and the scabs have fallen off or the peeling process is over. This apparent immediate skin contraction can result in the fine lines to apparently disappear completely, however this is not a permanent effect because this is simply due to the superficial dehydration effects of the electrical arcing. In the video above, we can see how the skin contraction due to dehydration effects lead to the fine line to apparently disappear. Once again please note that this apparently dramatic effect is temporary and it is not strictly representative of the end results after the area has recovered. Sometimes (in 40% ) of the cases as the arc is applied the area around the skin reddens noticeably. This means that the skin reaction to the treatment can be quite significant and the swelling following the treatment can be quite intense. Swelling  usually starts the day following the treatment.

Swelling is characteristic to eyelid tightening using electrical plasma (or lasers) and it should be always expected after this type of aesthetic procedure. Swelling can be minimised using certain techniques but never completely avoided, because in order to produce the desired localised skin tightening a deliberate controlled burn has to be caused to the eyelids. Also swelling is associated to the perceived downtime because the client prefers to withdraw from social activities until the area looks normal again and make-up can be used as usual. Please note that the swelling should not be cured because it is not a disease and it is a direct transient consequence of the controlled burn caused by the aesthetic treatment. A common mistake made as after care treatment is the use of antihistamines to try and alleviate the swelling. However this type of swelling does not respond to antihistamines. During the downtime some clients can experience a certain degree of discomfort. The degree of discomfort depends on the sensitivity of the skin to the treatment as well as the overall treatment intensity. The higher the treatment intensity the more the swelling and the discomfort which can be experienced by the client during the period of time in which the swelling is most pronounced. As the swelling start to subside so will the discomfort levels. Swelling starts on the following day and usually peaks on the second day. The third or fourth day after the treatment the swelling usually starts to subside slightly and in most cases the swelling will have subsided completely on the fifth day. While the swelling starts to subside the scabs starts to form. Please note the scabs do not always forms however they do in most cases. The scabs will normally have fallen off by themselves on the sixth or seventh day after the treatment. The swelling intensity and discomfort levels are not only dependant on the intensity of the treatment but also the individual skin reaction. In case of high intensity treatments blistering can also develop. The fluid inside blister can also be transferred to the under eyelids (eye-bags). Sometimes the blistered eyelid can give up some fluid during the recovery period. This is when the after-care is very important and it has to focus on avoiding possible causes of infections. This is simply done by keeping the area clean, avoid possible causes of infections, and applying the appropriate antiseptic twice a day. One again, swelling is a normal reaction to to be expected after high intensity treatment and it normally starts to subside three  to four days after the treatment, by itself.

We have investigated all possible ways to reduce the swelling period, consequently the perceived down time and discomfort to a minimum. It is important to emphasise that due to the very nature of this type of aesthetic treatment including those  using lasers, swelling can be attenuated but never eliminated. In order to minimise the downtime after any type of laser treatment for skin tightening, a soothing product is used in order to alleviate the burning feeling  soon after the treatment. Any treatment focused to reduce the burning sensation and later attenuate the swelling has to be carried out  immediately after the treatment to be most effective. Typically within 5 minutes from the time you have completed the treatment. We have found that if the treatment is carried out at minimum/medium intensity and an appropriate numbing product is applied both soon after the treatment and at intervals a few hours after the treatment and the following day,  the swelling is reduced to a minimum. If the treatment is carried out at the right intensity , the skin is not particularly sensitive and the right product is applied  then the swelling is reduced to such a minimum that it is hardly visible and most clients do not feel any discomfort during the skin recovery period. How to perform the treatment with our device:

• set the device at minimum power level (three battery configuration if you are using the earlier version of the BeautyTeck)
• apply the arc in instantaneous bursts (approximate arc duration, one quarter of a second).
• only increase the intensity of the treatment by reducing the distance between spots to a minimum. You can apply the spots one beside the other as shown in the video above.
• do not use a higher power setting than the one recommended here otherwise the swelling will be substantial despite the soothing product or soothing technique used.
• do not treat an area larger than the one shown in the video above.
• apply the suitable soothing product immediately after the treatment. Please bear in mind that this is the most important application of the soothing product. This is when the skin will be most receptive to the soothing treatment. Make sure you do not deliberately remove the carbon residues and you do not rub the area too hard (as this could cause micro traumas which could delay the recovery process). Keep spreading the soothing product very gently until the gel or the cream has been completely absorbed.
• instruct the client to reapply the product before going to sleep in the same fashions as you have done at your premises. The product then has to be reapplied the next day, first thing in the morning, in the afternoon and before going to sleep. This soothing product has to be used also the the second day after the the treatment three ties a day. The soothing treatment can be discontinued the third day after the treatment once (if they form) the scabs start to become apparent.

Please bear in mind that certain skin types are particularly sensitive and reactive to the treatment, therefore, in these cases the clients may show the normal signs of swelling despite the method used in order to soothe the area after the treatment. This particular type of skin reaction is predictable especially if the immediately surrounding area you have treated reddens visibly a few minutes after the treatment. About the soothing product to be used. There are several soothing products on the market and this is not a heavily regulated product type, therefore you have a wide selection. Please make sure that the products you use are sterile and are suited for purpose. Some products although advertised as soothing skin products do are not suited for this particular purpose, therefore check with the manufacturers before selecting each specific soothing product. Please be aware that using products that are not manufactured using appropriate methods and hence not suitable or packaged appropriately can increase the likelihood of infection.  Therefore make sure the soothing product you are using is fit for purpose. We have made a specific product for this particular application, for more information please click here. Please bear in mind that the most effective application of these soothing products (or solutions) is right after the aesthetic treatments are carried out. The subsequent applications are effective but not not as effective as those applied immediately after the aesthetic treatment has ended. Use of intense cold as a soothing solution. Some beauty practitioners use ice packing as a soothing solution. This is an effective option used soon after burns of any type to soothe the part and decrease the adverse effects of the burn, and this is also most effective immediately after the burn has occurred. Hence, intense cold, is most effective if applied immediately after the aesthetic session has ended (within 5 to 10 minutes). The use of ice or ice packing on the eyelids can be useful however once again, it is important that this is done using only the cleanest possible procedures in order to avoid dirt getting into the treated area. The use of inappropriately dressed cold packing on the eyelids can increases the likelihood of contracting an infection. If applying cold treatments as a soothing option the following day this has to be done immediately after the treatment.

As swelling subsides, normally scabbing develops. It usually develops in place of the voltaic spots which you have previously applied during the aesthetic treatment.  In certain circumstances, especially when particularly low intensity treatments are carried out, scabbing may not develop. As the scabbing develops also the feeling discomfort will be replaced by minor itchy feeling which will slowly fade away as the scabs start to fall off by themselves. If scabs develop, it is important they are not picked by the client. Picking the scabs may not only delay recovery period but also may lead to long term marks on the skin.

Once the scabs will have fallen off by themselves the area which has been treated will be slight pinker, this is a  normal reaction to most skin resurfacing treatments including voltaic arcing skin tightening. This is because the new skin formed after the treatment has not enough melanin to match the rest of the skin. Amongst all professional skin resurfacing devices or products, this also occurs with most professional skin peel products. After a while the pinker skin will gradually develop the normal skin colour of the surrounding skin. This is happens gradually over the following weeks.

The use of any type of make up (including mineral make-up or make-up products advertised as suitable after laser treatment) is strictly forbidden after until all the scabs have fallen off by themselves. This is for two reasons:

1. most make up products are not sterile and it has been shown that their use clearly jeopardise the healing processes or also referred to skin recovery. This leads to adverse effects including infections, which can lead to scarring . Often the use of make-up before the  permanent marking of the skin including long term hypo-pigmentation.
2. even if sterile appropriate sterile products are used, the area becomes occluded for an extensive period of time, and this can increase the likelihood of bacteria proliferation inside the area that is supposed to be recovering in the fastest possible way. This delays the normal skin recovery process and increases the chances of developing undesired long terms effects including hypo pigmentation.

The use of sun screen  (preferably physical protection) is mandatory for at least three months after every treatment. Physical total UV protection must be worn only after the scabs have completely fallen off by themselves and the area has completely recovered. UV protection must be worn, on the treated area, in the morning before going out and in the early afternoon. Exposure to UV sources have been shown to increases the likelihood of developing long term hyper pigmentation not only after the use of skin tightening by using voltaic arcing but also after the use of glycolic acid peels, lasers and other skin tightening procedures including skin resurfacing in general.

The long-term effects of eyelid tightening by using electrical arcing is a long-term targeted tightening of the eyelids. This improves the appearance of saggy eyelids. The skin tightening effects are cumulative therefore repeating the treatment leads to very good results long term results. The treatment can be often repeated after 8 weeks provided that no adverse effects have been reported and only low/medium intensity treatments were carried out. Although high intensity treatments should be avoided. in case they have been carried out then the wait time between treatments should be 6 months. Ask the client if the treated area feels tender to the touch or over sensitive. If this is the case do not repeat the treatment until the area feels normal again. Different people have different skin reactions to the treatment and the beauty therapist has to ensure the area has recovered fully. If the area is somewhat tender to the touch or particularly sensitive then this means that the treated area is still undergoing some recovery or regeneration process. Once the recovery is completely over, the skin will feel normal again. By "skin recovery" we do not refer to the downtime (the period while swelling or scabs are still present, while the area looks unsightly and make-up cannot be worn). The skin is still recovering and forming new collagen a few days and sometimes weeks after the scabs have fallen off.

Despite the heavy advertising as completely safe and carefree treatments, plasma eyelid lift treatments are never completely risk-free despite the device used or the way the treatment has been carried out. This is not a topic covered in the literature as this puts the interest of manufacturers at stake. The potential adverse reactions are:

1. Hyperpigmentation. This is only due to the exposure of the area to UV radiation while the long-term healing process is taking place. This is never due to the type of device used or the way the treatment has been carried out.
2. Pink Aptrophic spots (where the spots were applied) which last up to 6 months after the treatment. It is not completely clear what causes this long-term adverse reaction however so far this has ultimately subsided on its own over the log term. It is thought this is likely due to the use of makeup or inappropriate products during the short-term healing process.
3. Protracted long-term healing process coupled with inflammation of the area. This adverse effect has been reported only after high-intensity treatments. Also, for this reason, it is highly advisable to only carry out low or medium intensity treatments.
4. Protracted periods of skin laxity on the upper eyelids where high intensity treatments were carried out. The laxity is also associated with a mild feeling of discomfort on the area treated. This adverse effect has been reported after treatments with all devices especially after high-intensity treatments.

Points 3 and 4 are due to the overall intensity of the treatment, therefore it is highly recommendable to avoid high-intensity treatments in all cases. As mentioned earlier the slight advantages of performing high-intensity plasma treatments on the upper eyelids are seldom worth the protracted swellings, pain discomfort and the increased likelihood of protracted long-term healing and skin laxity. This can easily discourage clients from undergoing further treatments.

Eyelid Tightening and a Rare case of Hyperpigmentation due to UV Exposure

Some manufacturers are advertising plasma eyelid tightening as non surgical blepharoplasty. We have had the opportunity to use those devices and we have noticed the common trait with all other plasma devices for similar intended used on the market. The real results of plasma eyelid lift is a minor improvement of the appearance of the saggy skin and after several trials with those devices it is believed it is not practical to achieve the same results as surgical procedures using electrical plasma. Although the long-term results after a number of eyelid tightening treatments may be good this is seldom comparable with the result of any surgical blepahroplasty intervention. The temptation of making these claims is easily understood given the large demand to achieve surgery-like results without surgery, however seldom plasma treatments can match the results of surgical procedures despite the techniques and device used. The claim which seems more appropriate and has been more widely accepted is: "Plasma Eyelid lifts leads to a minor  improvement in the appearance of saggy eyelids." It is recommended to all aesthetic practitioners to make realistic claims in their advertising plasma procedures despite promises made by others. It has now been accepted  that people are willing to undergo these treatments even if the claims made about these treatments are realistic. Reviews of these types of Voltaic plasma procedures made by professionals without vested financial interests in selling these types of devices or the treatments all have felt the it would not be realistic to expect results which are equivalent to surgery in cases of a great amount of loose skin to be removed. Every time one undergoes a plasma treatment he/she will go through the healing process and the long terms healing. During the healing process (both long-term and short terms) a number of adverse reactions could take place, therefore if the improvement sought by the individual is dramatic, surgical procedures should be the recommended way forward.

Not all cases are suitable for these procedures. Although several people would like to  have the same results as surgery with the use pf Plasma eyelid tightening, in case of considerable the skin laxity this procedure should not be recommended. This is because a several number of sessions may be required in order to achieve the results desired by the client. Every time the client undergoes a plasma eyelid tightening treatment he/she undergoes a number of potential adverse reactions, therefore repeating the treatment a number of times exposes the individual a number of times to the same potential adverse effects. Therefore the higher the number of treatments to higher the likelihood  of an adverse reaction to occur. For this reason plasma treatment should not be replacing surgical dramatic improvements. On the other hand if the improvement sought is only minor then medium mild intensity treatments can be far more advisable to surgical interventions in the first place. One to two treatments can achieve the desired results like in this case presented below where the tightening was satisfactory after only two treatments. People with minor laxity are the perfect candidates for these types of aesthetic procedures. This is because one or two low/medium intensity treatments are usually sufficient to achieve their desired results and they will not be exposed  to the inherent risks of the procedure several-times.

（TOPIC COMING UP SOON.）

Do not use any type of injectable anesthetic as a numbing solution for eyelid tightening. The main after-care principle after eyelid tightening are:

1. Avoid infections. The skin will recover on its own accord without any product, provided that no infections develop. The use of inappropriate products including make-up or unsuitable creams before the scabs have formed can be detrimental and lead to undesirable effects.
2. Appropriate broad-spectrum protection must be worn every day.  While the use of broad-spectrum total sunscreen increases protection against the possible adverse effects of rays exposure, these adverse effects are still possible even using broad-spectrum protection. Hence, direct or indirect exposure to ray sources must be purposely avoided whenever possible. Any form or tanning including artificial must be avoided for at least three months after the last treatment.

Do not use any medicinal products. Only use those sterile products suggested in the after-care product list of the manufacturer. If you would like to use different after-care products, consult with the specific manufacturer whether their products are suitable to be used after this type of aesthetic treatments. If in doubt do not use any products other than mild antiseptics. No antihistamines, swelling is not an allergic reaction. Swelling is a normal and "to be expected" reaction to the superficial burn caused by the electrical arcing treatment. Do not use topical antibiotics as a precautionary measure. Remember that antibiotics are used to cure infections and they are not supposed to be used to prevent them. It has been shown that indiscriminate use of antibiotics will eventually lead to bacterial resistance to the specific antibiotic used due to bacteria natural selection process. Avoid the treatment on those clients with herpes simplex even if there are no flare-ups at the time. If the Herpes Simplex is dormant the client should undergo an antiviral therapy before any eyelid tightening using either lasers or electrical arcing. Do not use plasters of any type. No other forms of occlusion like bandaging shall be used during the downtime.