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Photodamaged skin of the hands occurs as a result of chronic exposure to ultraviolet light and is characterized by roughened surface texture, dyspigmentation, telangiectasias, rhytids, and skin laxity. Although several different noninvasive procedures have been advocated for hand rejuvenation (Table 47.1), many are characterized by an unattainable balance between effectiveness and morbidity. The necessity of epidermal removal during most skin resurfacing treatments leads to significant morbidity during the reepithelialization process, particularly in areas such as the hands, where limited pilosebaceous glands are present.
Plasma skin regeneration Technology
Plasma skin regeneration is a novel process that involves the generation of plasma through the use of ionized energy that thermally heats tissue. A pulse of ultrahigh-energy radio-frequency (RF) from the device generator (Portrait plasma skin regeneration) converts nitrogen gas into plasma within the handpiece. The plasma emerges from the distal end of the device handpiece and is directed onto the skin area to be treated. Rapid heating of the skin occurs as the excited gas transfers heat to the skin, resulting in increased fibroblast activity during dermal regeneration. The retained necrotic epidermis effectively serves as a biological dressing for the efficient formation of a new stratum corneum and epidermis.
The essentially instantaneous generation of plasma with controlled application of RF energy produces individual plasma pulses that heat tissue. Adjustment of RF power and pulse width enables control of tissue effects by altering the amount of energy delivered to tissue per pulse.
The American Law Institute (ALI) test stated that a defendant is insane if he lacks substantial capacity to appreciate the criminality of his conduct or to conform his conduct to the requirements of the law. Courts have historically viewed the use of impulse control deficits as a defense with a degree of skepticism. Patients with kleptomania have significant impulsivity and may have high rates of comorbid mood disorders, anxiety disorders, eating disorders, and personality disorders. When using a profiling technique in an attempt to determine if a defendant accused of theft suffers from kleptomania, the expert must use caution. Not every kleptomaniac will fit the typical psychological profile, and not every shoplifter who seems to meet the profile will have kleptomania. The kleptomaniacs did rate higher than the shoplifters on the feeling of inner tension before theft.