Rental bowling shoes beside a bowling ball on a polished lane, a light metaphor for a first-timer's first treatment.
By Alexander E. Bonato, MD — Board-Certified in Internal Medicine · Medically reviewed November 2026.
TL;DR: Here's what a plasma (PLEXR) treatment is actually like: most of the appointment is the numbing. The treatment itself is quick, and in two small studies of the eyelid and crow's-feet areas, people rated the discomfort around 3 out of 10 with numbing cream alone. The part to plan for is the one to two weeks afterward, with swelling that usually peaks in the first day or two, crusts you can't pick, careful wound care, and strict sun avoidance. Those studies are small and uncontrolled, so treat the numbers as a floor and not a promise.
I rented the shoes, and for about thirty seconds I looked like a professional bowler. A guy on the next lane asked if I was in a league. Then I threw the ball.
By the drive home I was explaining the loss in clinical terms. Poor follow-through. Inconsistent release. Probable noncompliance on the part of the ball.
Anyway. That's the lesson of any first time at anything: the outfit tells you nothing about how it goes. If you've never had a plasma treatment, here's what it's actually like, minus the shoes.
Before You Come In
Most of what makes this go well happens before you sit down. Strict sun avoidance for four weeks is the big one, with a mineral SPF 30 every morning, because a fresh tan raises the risk of pigment change. About a week before, stop topical retinoids, exfoliating acids, vitamin C serums, NSAIDs, and non-prescribed aspirin. Acetaminophen is fine. If you take a prescribed blood thinner, don't stop it on your own.
Tell me early if you get cold sores, because I may prescribe an antiviral and I won't treat over an active one, and tell me if you've taken isotretinoin, because some treatment modes need a six-month washout. On the day, come with a clean face, no makeup or sunscreen, a light meal in you, a button-up top, and a ride home. We go through all of it at your consultation.
The Numbing Is Most of the Appointment
Plan on roughly an hour to an hour and a half in total, and most of that is the numbing. A numbing cream goes on first, and the studies I read used it for 30 to 60 minutes before treating.1,2 So you'll spend a good chunk of the appointment with a face that feels like it belongs to someone else, which is a perfectly good time to catch up on your texts.
The numbing isn't a courtesy, because an uncomfortable patient moves. In a four-person pilot of a different plasma device, 30 minutes of numbing-cream hydration even changed how deep the heat injury went, with no difference between 30 and 60 minutes.3 That's tiny and abstract-only, so I'm not building a case on it. If the cream isn't enough, we have a cold-air cooler, and I can do a nerve block if it's needed.
What It Feels Like
In a retrospective series of 135 people treated for crow's feet with a voltaic arc device, patients described very mild discomfort, averaging about 3.45 on a scale the paper describes inconsistently, so I'd read it as roughly 3 out of 10. Each application lasted under two seconds.2 In a study of 60 patients treated with PLEXR on the upper eyelids, 60 percent described minimal, tolerable discomfort, and the pain they recalled months later averaged about 3 out of 10.1
Both studies were small, neither had a control group, and both used numbing cream on small areas, so this is a floor and not a promise. I'm not going to tell you it doesn't hurt. A trial of a different device, radiofrequency microneedling, found patients rated the pain 4.6 to 6.7 out of 10 while the manufacturer's materials said "little pain."4 That's a good reason to be skeptical of anyone who promises it won't hurt. If it's more than you want, say so and we'll adjust.
The Half-Face Stop
Once you're numb, there's a ritual. I take ten standardized photos first, five angles, each with your eyes open and again with them closed. Everyone in the room wears eye protection for any work near the eyes, you included. Then I treat one side and stop. I compare it with the side I haven't touched, and I match the pattern, pressure, and energy on the other side. You can see the difference in the mirror while it's happening.
I usually start a first-timer at the lowest-output handpiece and use clinical judgment from there. In bowling terms, it's a calibration shot. The difference is that it works. None of this is a study finding. It's how I do it.
The Morning After
You leave pink, a little puffy, and with tiny dark crust points where the plasma touched. That's the expected look, and it's the correct one. Swelling usually peaks in the first day or two, not that night. Around the eyes it settles over a few days to about a week, and in the eyelid study it resolved within three to five days.1 So treat the first morning like picture day you're skipping, and don't schedule anything you'd like to look normal for.
The First Two Weeks: What the Crusts Are For
The crusts are the asset. They act as a biological dressing while new skin forms underneath, so your one job is to leave them alone. Picking one disrupts healing and raises the risk of scarring and pigment change.
Healing runs by area. Around the eyes, the crusts separate in about five to seven days. Cheeks and forehead take seven to ten. The neck, chest, and hands take longer, because they have fewer of the oil and sweat glands that new skin grows out from. Plan on seven to fourteen days of looking like you've done something. The studies fit that: in one, the surface had healed in all 135 patients by day seven, and in the other the scabs lasted five to fourteen days.1,2
You go home with written instructions, because verbal ones fade. The short version: soak the area three or four times a day with distilled water, or the dilute acetic acid or hypochlorous acid spray named in your instructions, pat it dry, and apply a thin layer of plain petrolatum. No antibiotic ointments, which commonly cause allergic reactions that get mistaken for infection. No makeup until the crusts have separated, and no sauna, steam, hot tub, or swimming until it's fully closed. Keep strict sun protection up for at least four weeks, with a mineral SPF 30 once the skin has healed.
When to Call Us
Call us if the pain is increasing. Pain should get better after the first day or two, and increasing pain is the earliest sign of a healing problem. Also call for blistering or a cluster of small bumps, pus or redness that spreads, fever or chills, an area that had healed and reopened, unusual darkening or lightening, or a crust that has come off.
Pigment change is the risk I take most seriously. Neither small study reported it, but both were small, and I would never describe that risk as low. It's higher in darker skin, and for some skin tones I may recommend against certain treatment modes.
What You're Signing Up For, Result-Wise
Results are modest, build over three to six months, and don't last forever. In the crow's-feet series, patient satisfaction slipped from 4.15 at one month to 3.25 at one year.2 The evidence is in our posts on the PLEXR non-surgical eyelid lift and plasma for skin and collagen.
Frequently Asked Questions
Does it hurt?
There's numbing cream, a cold-air cooler, and a nerve block if it's needed. The small studies rated the discomfort around 3 out of 10 with cream alone, and that's a floor. Tell me if it's too much. Nobody gets points for bravery.
How long will I look like I've been through something?
Plan on seven to fourteen days of crusting and redness, with swelling that usually peaks in the first day or two. Redness can linger a few weeks around the eyes and longer in other areas. That's the honest range, and it's why the week before a wedding is a poor time to start.
Do I really need a ride home?
My protocol says to arrange one, especially for a full-face treatment, and I'd follow it. You'll be numb, a little puffy, and probably wearing sunglasses at dusk.
Come Look at It With Me
If you've been curious, come in and we'll go through it together. Bring your questions and your history. We're in Medford, and patients come from Ashland and Grants Pass too. Book a consultation, or read about PLEXR plasma treatment in Medford first. No rental shoes required.
References
Karapantzou C, Vale JP, Haubner F, Canis M. Plasma Exeresis Technology for Rejuvenation of the Upper Eyelid. Arch Clin Med Case Rep. 2022;6(1):78-90. doi:10.26502/acmcr.96550454 (An uncontrolled observational study of 60 patients treated with PLEXR on the upper eyelids. Outcomes were mostly patient questionnaires completed 6 to 18 months later, and some figures are inconsistent within the paper. No funding or conflicts declared.)
Scarano A, Inchingolo F, Amuso D, Scogna G, Amore R, Lorusso F. Static Crow's Feet Treated with Voltaic Arc Dermabrasion (Atmospheric Plasma): Post-Operative Pain Assessment by Thermal Infrared Imaging. J Clin Med. 2021;10(14):3074. doi:10.3390/jcm10143074 (A retrospective series of 135 patients, no control group, by the developers of the technique, with some inconsistent figures. A different voltaic arc device.)
Sanderson AR, Wu EC, Liaw LL, Garg R, Gangnes RA. The effect of topical anesthetic hydration on the depth of thermal injury from the plasma skin regeneration device. Lasers Surg Med. 2014;46(2):127. (Abstract only. A pilot of 4 patients undergoing facelift surgery, using a different (nitrogen) plasma device.)
Bonati LM, Quatrano NA, Sadeghpour M, Arndt KA, Dover JS. Setting appropriate pain expectations: lessons learned from a clinical trial. Lasers Surg Med. 2019;51(4):318. (Abstract only. A retrospective study of 30 subjects treated with radiofrequency microneedling, not a plasma device.)
