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Viewpoint: Exfoliation: Right or Wrong?

By: Ben Johnson, MD
Posted: July 23, 2008, from the August 2008 issue of Skin Inc. magazine.
facial involving exfoliating mask

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If you have ever used a peel on a client who developed telangectasias post-peel, that is a definite sign that their dermis is thinner than when they started. The 2% penetration issue is quite problematic because few ingredients that actually create new layers of collagen rarely get used when they are stuck in the epidermis. Remember that acids typically create new collagen because the new collagen is allocated primarily to the burned areas. There is little evidence to suggest that new collagen formation reverses aging in any way due to glycolic and TCA peels. That means skin care professionals may be aging the skin of clients temporarily, resulting in no net gain.

A new idea

So why do people keep coming back for more? It is a valid question. Does the skin look better with some of these exfoliants? Often times, yes, but that needs further explanation. AHAs, retinols and vitamin C are classic examples of ingredients that exfoliate and plump. Exfoliation is often discussed, but plumping isn’t. Plumping occurs when 98% of these ingredients sit in the epidermis and cause irritation, resulting in edema, or swelling. Edema makes lines look better. The problem is, the lines are not actually better, and the inflammation starves the skin even more. If you don’t use acids or retinols for one to two weeks, you probably will see the skin deflate to its actual state. You will notice more lines, more laxity and a dullness that is reflective of a skin that has been in survival mode for too long. As soon as you start back on these products, everything looks better almost immediately, which should be your first clue that the plumping isn’t new collagen formation. Because these products are epidermal and aging is dermal, it only makes sense that they have not been preventing the skin from aging.

I know that many are upset at the suggestion that what has been done for so many years is potentially damaging. However, as with any aspect of medicine, things change and it is important for skin care professionals to be open to new ideas.

Lasting effects

The aging process occurs primarily in the dermis. Almost everyone acknowledges that the vast majority of anti-aging treatments have little to no impact on the dermis, so to get visible results, new ways have been created to plump the epidermis. The problem with this strategy is that the plumping usually makes the skin work harder and starve more. Advances in dermal delivery ingredients, such as phosphatidylcholine, make reaching the dermis possible and have the added benefit of restoring the barrier instead of stripping it. In addition, there are a handful of research-proven fibroblast stimulators that do not work through trauma: niacinamide; GHK copper peptides; 1,3 beta glucan; avocatin; chlorella;, retinaldehyde; retinoic acid; R-lipoic acid; and L-ascorbic acid. My goal is to change the focus of skin care from the temporary effects of epidermal plumping to the more lasting effects of dermal remodeling.