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The Grades of Aging

By: Sam Dhatt, MD
Posted: June 29, 2009, from the July 2009 issue of Skin Inc. magazine.
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page 4 of 5

Professional care. Professional care should be given in a higher level, and requires an enzyme facial first in conjunction with the appropriate home care to balance the skin and prepare it for more assertive treatments. This client should also have a six-treatment series twice a year of higher acid resurfacers (30–40%). If the skin responds well to the first three treatments, a one-pass microdermabrasion treatment can be added to the service. This client’s skin will also respond well twice yearly to a peel that contains low percentage trichloroacetic acid (TCA) and other exfoliants in a three-treatment, one-per-month series. Between series, this client needs to have deep cleansing enzymes added to the deep cleanser step of their facial, followed by a highly moisturizing mask with antioxidants and dermal-building ingredients.

Home care. Home care should be the same as Grade 2, with an antioxidant cleanser in the morning and an exfoliating cleanser every evening. Treatment products should contain higher-grade dermal-building ingredients, such as the peptides. Exfoliants are very important to this client because the skin has slowed its sloughing rate and AHAs speed up the cell turnover rate. The home care program should contain AHAs or retinols for two to four weeks, according to the client’s Fitzpatrick classification, before the higher level resurfacers. A lightening product is usually also important for this client, especially if there is a history of excessive sun exposure. DNA repair products are even more important and eye area home care should be even more moisturizing, building and, if hints of shadows or puffiness under the eyes exist, include the use of an ingredient to address those issues, as well.

Grade 4

Developed wrinkles; deeper nasolabial folds and definite forehead lines; hyperkeratotic areas; loss of firmness and elasticity in neck, lower face, eye area and forehead. This client needs repair and higher level exfoliation to get the skin to a lower grade of aging as soon as possible. With appropriate products, services and cooperation, you should be able to reduce the client to a Grade 3 readily, and possibly even a high Grade 2.

Professional care. Professional care should consist of two series per year of higher acid resurfacing treatments, or a one-time 25–30% TCA peel yearly or bi-annually. A monthly facial is a must for this client so the esthetician can observe any changes on the skin, such as hyperkeratosis, actinic keratosis or melasma, allowing the esthetician to restructure and intensify the professional treatments and home care. This type of damage control should initiate a quick response to the changes so damage can be arrested and repaired.

Home care. Home care should begin with a balancing program that is intensified with retinoids or AHA products in order to speed up exfoliation and dermal development. It is recommended the pre-peel or -series home care program contains AHAs or retinols for two to four weeks, according to the client’s Fitzpatrick classification, before higher level resurfacers and a TCA peel are administered. Of course, the moisturizer should be high in hyaluronic acid and other ingredients, as well as antioxidants and building ingredients. Peptides of appropriate percentages can be used for maximum results, and products containing DNA repair ingredients remain important. Copper is a key ingredient for this grade, also. Usually, a lightening product is important for this client due to hormonal changes and sun damage. The eye area home care is moisturizing, building and should have an ingredient for treating shadows under the eyes.

Grade 5