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Illustration of the surface breakdown of the epidermis with acid product.
The pH and hydrogen ion concentration as it relates to acidity and basicity.
Gül Ç. Zone answers common questions from skin care professionals about the education behind offering chemical peels.
Q: What type of training is involved in learning how to perform peels?
A: Both theoretical and hands-on training is recommended. Peel certification classes should be a part of every esthetician’s continued education courses. Reading about peels is just the first step in learning how to work with peels. More importantly, it is imperative to gain the hands-on experience. The same peel may have a different effect on two similar skin types. Another focus in advanced continued education classes is also how to customize results by combining different peel modalities.
Q: How should peels be performed?
A: Individually: Single treatments performed with intervals greater than two weeks. Recommended for maintenance. Progressive: Series of treatments spaced 7-10 days apart where each service is progressively stronger. Recommended for corrective clinical applications.
Q: Who should have a peel?
A: Every individual can have a peel. The key is to match the correct peel to the skin type and lifestyle of the individual. Even the most sensitive skin types can benefit from peels. Always perform a patch test to check compatibility. Always fill out a skin analysis and health intake form before performing a peel.
Q: Is there anyone who should not have a peel?
A: A peel is, by definition, the controlled, superficial wounding of the skin using chemical substances. Therefore, any individual who already has “wounded” skin, whether from an acne lesion, waxing, cosmetic injections or any other aggressive skin care treatment modality should not have a peel. Any person taking isotretinoin or using topical applications of tretinoin or retinoic acid should not have a peel. If concerned with any medical issues, request a release from the client’s doctor.
Q: How do you prepare skin for a peel?
A: Prepare the skin by placing clients on a corrective regimen 1–2 weeks prior to their peel to maximize skin health and precondition with daily exfoliating elements, including mild peeling agents and retinoids. Also, start the regeneration process prior to a peel with a good corrective home care regimen.
Q: How do you take care of skin post-peel?
A: The post-peel regiment should include healing treatments that help the skin repair itself. We know the skin’s natural repair mechanisms slow down considerably with age. It is critical to provide as much aid as possible to the skin that we intentionally wound. A good post peel regimen will have bioactive elements that heal the skin from the inside out, as well as provide a temporary barrier to protect the skin from UV and help retail the skin’s natural moisture.
Words of caution: As a professional, make sure that you have peeling and healing products in your treatment room and on your retail shelves for the client to take home. Often, skin care professionals focus only on the peeling and want to skip the healing. This is a big mistake as the best results are associated with the best healing. When you have what you need at your fingertips prior to performing a treatment, there is never any guessing or substituting at the time of the peel. A peel can be safe if the esthetician has the proper training and products to perform the treatments. It is also imperative that the skin care professional educate their client to ensure maximum compliance pre- and post-peel. This education should be given both verbally and in writing.
Chemical peels remain some of the most effective, efficient and financially feasible skin care treatments available, and understanding the science behind them allows skin care professionals to most effectively manage, market and take advantage of this powerful, lucrative tool.
Skin, like any material, is subject to wear and tear, chemical and photo degradation, and absorption of chemical pollutants, not to mention microbial invasion. Fortunately, this natural “material” has the benefit of re-building itself through an influx of new cells from the basal layer of the epidermis. However, with age, this constant supply of new cells slows, and a degraded and disorganized skin surface becomes more of the norm. This is where chemical peels—both acid and nonacid—work their magic. Beginning by simply removing the top layer of the epidermis, the skin will exhibit some of its former luster and uniformity, much as the light sanding of an old wooden surface will return some of its finish and surface quality. As a peel works deeper into the epidermis, the lower skin layer loosens and the basal layer of the skin is stimulated to produce new cells. The appearance of new cells can replace aged, oxidized and hyperpigmented skin. The end result is more cellular bulk, offsetting the epidermal thinning that comes with aging; hydrating skin; and improving color uniformity and smoothness.
The most common types of chemical peels are acid peels, which work to remove the cells of the top layer of skin’s upper epidermis by breaking weak chemical bonds that hold together the epidermal skin cells, termed “corneocytes” or “keratinocytes.” Depending on the strength, pH and delivery agent of the peel product, upon application, the skin cells delaminate and lift away. (See Figure 1.) As the peel process proceeds, or upon subsequent treatment, it can penetrate further into the thickness of the epidermis to interact and weaken the bonds holding together the cells of the lower layers of the epidermis.
The strength of an acid peel is based on several factors:
The concentration refers to the amount of free acid found in the peel, as determined by an analytical method called titration. As the concentration of the acid increases, the strength increases. This strength is characterized by the pH of the product, a chemical parameter that defines the acidity or basicity of an aqueous solution. The lower the pH of the product, the stronger the acid, which is counterintuitive. By definition, the lower the pH of an acid system, the more it wants to release its hydrogen ion (H+), which can then interact and react with the chemical bonds that hold the skin cells together. Conversely, the higher the pH an acid exhibits, the more the acid will tend to hold its hydrogen ion, and it is considered more basic. As shown in Figure 2, the pH scale shows the range of pH values, with 0 being the most acidic, 7 being neutral and 14 the most basic. Most acid-based chemical peels have pHs ranging from 1.5–4.0.