1. Webinar Christopher Zachary, MD Professor and Chair Department of Dermatology University of California - Irvine

2. Chris Zachary’s take on plasma Early on –> … “I blew off the technology!” & Now… “Portrait plasma actually delivered on the cosmetic outcomes that were claimed, as they were based on an extensive series of preclinical and IRB-controlled studies by reputable physicians across several aesthetic specialties Furthermore, now there is proven long-term patient results out over 5 + years. With high energies, you can get very nice skin tightening, excellent reduction in pre-cancers and very nice color and texture and tone Portrait technology provides a highly effective mechanism for patients requiring skin rejuvenation across a spectrum of indications. This technology is safe, reliable and effective. I am personally delighted to see this technology back in harness!”

3.  Plasma (ionized gas) is the 4 th state of matter (solid, liquid, gas, plasma)  99% of the visible universe is plasma, including most of the matter in the sun, stars and the region of space around Earth  Portrait plasma formed by combining pulsed nitrogen gas and UHF energy (no UHF energy delivered to the skin)  N 2 plasma (diatomic molecule-strong bonds)  chosen for controlled, predictable thermal energy delivery to the skin’s architecture  heats all tissue components  not chromophore dependent  Bottom line: thermal energy from the plasma generated is delivered at 5mm and absorbed by the skin architecture, resulting in both immediate and long- term tissue effects and skin regeneration Portrait ® plasma – what is it?! Aurora Borealis Sun

4. Plasma Zone of Effect of Portrait Nitrogen Plasma Inner Zone = Zone of Thermal Damage Outer Zone = Zone of Thermal Modification Gaussian distribution of energy delivered to the whole skin architecture Non-fractionated, non- chromophore dependence provides full coverage Thermal (plasma) energy delivered to the skin Predictable, non ablative impact at all energy levels

5. Portrait’s 3Dimensional Thermal Effects on Skin Architecture Note the depth of heating effect at ~ 70°C for triggering neocollagenesis in 100% skin architecture 3D Thermal heating within skin architecture

6. Portrait System and Delivery System  No need for safety eyewear/ special room prep  110/220 VAC single phase; <10A  N 2 gas C-cylinder  Portable

7. Unique Features of Portrait Plasma Skin Regeneration Works at and below the surface of the skin to modify the skin’s architecture generating new collagen and elastin Non-ablative at time of treatment, leaving the skin intact Stimulates the body to regenerate the sun-damaged structural elements of the skin Clinical improvements in skin tone, texture and laxity are seen immediately and improvement continues up to a year Creates a tremendous zone of regeneration filled with many times the normal amount of cells that create collagen and decrease of elastosis Versatile treatment options: lunchtime treatment through high-end results comparable to CO 2 laser but with fewer complications and less downtime “Portrait creates a natural, intact, and uninterrupted biological dressing that sheds naturally. The patient’s own protective dressing could retain growth factors, accelerate healing, and diminish the chance of scarring.” Dr. Suzanne Kilmer

8.  Millisecond pulses of nitrogen plasma  Pulses applied adjacently with slight overlap  Energy Range: 1- 4 Joules (.1 J)  Rep Rate: 1-2.5 Hz (.5Hz)  Optimal delivery distance: 5mm from skin surface  Portrait Express/VLE (0.65 J) delivery distance 25mm from skin surface at 1J energy setting Non-Contact Plasma Pulse Plasma is formed inside disposable nozzle connected to the handpiece

9. Day 0 following treatment (at 3.5 J) Day 4 Day 10  100% treatment of skin architecture  100% intact architecture Highly reactive dermis Vacuolation occurs at high energy  Developing line of cleavage between Zones of Thermal Damage and Modification  New Stratum Corneum under line of cleavage  Regenerated Epidermis  100% regenerated epidermis with residual activity in basal layer  Zone of Thermal Modification: intense fibroblast activity, neocollagenesis & neovascularization regenerating the reticular dermis Portrait Plasma Treatment Histology

10.  Stratum Corneum & Epidermis intact during Tx  Post-Tx dehydrated cell contents still present  Cytoplasmic or nucleic viral proteins will remain within the intact cell wall which sheds 3-4 days following Tx Immediate Pre-Tx Immediate Post-Tx: 3.5 J Retention of Cellular Contents — Portrait Plasma Pulse “A wound response without an open wound…unique…” Dr. Eric Bernstein, upon analyzing the study histologies No ablation or vaporization of cellular material

11. Portrait Unique Energy Dependent Effect 0.65-1.0J1.0-2.0J3.0-4.0J Above this line of cleavage, the skin will shed after new architecture is regenerated

12. Portrait Treatment Protocols Full Spectrum of Treatments For regional treatments (i.e., peri-orbital, -oral) Demarcation lines not seen with regional area treatments (i.e., eyelids) or around the jaw line for full face FDA-cleared for treatment of:  rhytides (of the body — on/off face)  acne scars  actinic & seborrhoeic keratosis  benign skin lesions  viral papillomata

13. A Retrospective Analysis of the Safety Profiles of a New Plasma Skin Regeneration Device Compared to CO 2 Lasers Kenneth O. Rothaus, M.D. 1, Richard Fitzpatrick, MD 2 1 New York Presbyterian Hospital, New York, NY; 2 La Jolla Cosmetic Surgery Centre, San Diego, CA Background and Objective: Although the CO 2 Laser is considered the industry gold standard for laser resurfacing, many physicians have abandoned the technology due to the complications and prolonged recovery. Portrait ® Plasma Skin Regeneration (PSR) is a new non-ablative technology which when used at high energy, approaches CO 2 results, has a higher safety profile, and faster recovery time. Plasma’s thermal energy is delivered to 100% of the skin and can safely be used as an adjunct procedure for patients undergoing rhytidectomies and blepharoplasties to enhance aesthetic outcomes. In addition, PSR is not a laser or light source targeting specific chromophores, and does not require a dedicated operating facility, sedation, or specialized safety equipment. This report analyzes the safety/efficacy profiles of Plasma Skin Regeneration in comparison to the CO 2 laser. Materials and Methods: A review of current literature regarding patient outcomes (~1100 patients) from CO 2 laser resurfacing was done. In addition, a retrospective analysis of high energy PSR patients over the past two years (120 patients) at two sites was performed. Results: The incidence rate of the following complications was assessed: hypopigmentation, hyperpigmentation, persistent erythema, scarring, and bacterial and viral infection. For CO 2 patients, the most common adverse effects noted were hyperpigmentation (transient and other 21-34%), bacterial and viral infection (7- 8%) and prolonged erythema. Reports of late hypopigmentation range from 8-20% of CO 2 patients evaluated. Scarring was rare. Average initial recovery time for CO 2 patients is 2 weeks; however, erythema lasting 2 – 6 months was common. Conclusion: Due to the risk of complications and prolonged recovery many physicians have sought alternatives to CO 2 laser resurfacing. Plasma Skin Regeneration is a new non-ablative technology that does not create an open wound. Used at high energy, PSR approaches CO 2 results in terms of wrinkle reduction and tightening with further improvement in the tone and texture of the skin Of the 120 PSR patients evaluated, half of those patients were over a year post-treatment, and the others were at least 6 months. Patient and physician rated improvements with the PSR vary based on energy level used (3.0 to 4.0 Joules) and ranged from 30-70%. CO 2 PLASMA Healing Time Erythema PIH Hypopigmentation Infection 2-3 weeks4-7 days months2-3 weeks 21-34%3-4 % 8-20 %0 % 7-8%<1% The complication rate with Plasma Skin Regeneration is extremely low, has a high safety profile, short recovery period and represents a technological advancement in resurfacing for the aesthetic surgical patient. Pre-treatment1 Month Post PSR Photos courtesy R. Fitzpatrick, M.D. Poster#: P3001

14. Pre-treatment 30 days Post-treatment Photographs courtesy of Suzanne Kilmer MD Portrait: High Energy Single Treatment

15. Photographs Courtesy of R. Fitzpatrick, MD 1 Year Post-treatment Portrait Long-Term Results - Eyes and Eyelid Tightening

16. Photographs Courtesy of Dr. William F. Groff Portrait High Energy Single Treatment

17. Portrait High Energy Single Treatment 3.0 Joules Double Pass on Deeper Rhytides Before4 Weeks Post-treatment Photographs Courtesy of V. Gurvits, DO

18. Portrait ® : Peri-oral Rhytides High Energy Single Treatment Photographs Courtesy of R. Fitzpatrick, MD

19. Photos Courtesy Roy Geronemus, M.D. Before After No Botox! Portrait High Energy Single Treatment

20. BeforeAfter Photographs Courtesy of R. Fitzpatrick, MD Portrait High Energy Double Pass Single Treatment

24. Neck, Chest & Hands (40-60% patient rated improvement) Portrait Results: Non-Facial Treatment Photographs Courtesy of V. Gurvits, DO Pre-treatment 6 Months Post-treatment MK-00-BA-061, Rev. A

25. Pre-treatment4 Months Post-treatment Photographs Courtesy of V. Gurvits, DO Portrait Results: Non-Facial Treatment

26. Pre-Treatment6 Month Post Portrait ® Plasma Single Treatment - 3.5 J 1st pass, 4.0 J 2nd pass Photographs Courtesy of N. Uebelhoer, DO Portrait Results: Acne Scars

27. 1 month laterPre-treatment Photographs courtesy of Dr. Hong, Korea Portrait Low Energy Single Treatment Of Ethnic Skin

28. Before One Year Photographs Courtesy of R. Moy, MD Portrait Results: Long Term

29. Portrait ® Results: Long Term Before 13 mos Photographs courtesy of S. Bentkover, MD

30. Photographs Courtesy of R. Fitzpatrick, MD “We get great tightening results especially around the eyes with Portrait. The only technology that compares to these results is full strength multi-pass CO 2. Portrait is predictable and delivers 100% coverage. The thinner skin of an eyelid is very well suited for plasma treatments.” Richard Fitzpatrick, MD Portrait Long-Term, 1 year Results - Eyes and Eyelid Tightening