Editor’s note: As always, Skin Inc. magazine recommends that skin care professionals obtain the proper training before offering any new treatments in their skin care facilities.
Beautiful skin doesn’t have to be expensive, and going under the knife is not the only way to capture that youthful appearance. As a matter of fact, skin peels provide an effective, less expensive and less invasive alternative.
Peels, when properly administered, are some of the most powerful nonsurgical skin improvements available. They remove cellular buildup, stimulate skin regeneration and reduce wrinkles, fine lines, large pores and oiliness. They also help clear blemishes, treat hyperpigmentation, and improve overall texture and tone.
Acid peeling is more than just a science; it’s an art form. As such, learning an art evolves with understanding and experience. The journey, however, along with the results skin peels produce, tends to spark passion and enthusiasm in skin care professionals as they get deeper into the art of skin peeling.
Apprehension often surrounds peels, much of which stems from the many myths and misconceptions surrounding the process. Skin care professionals who render peels, or are planning to, should have an understanding of some of these misconceptions to be better equipped to talk with clients about them.
One common misunderstanding is that one treatment is all that’s needed. The truth is that typically several applications must be administered over multiple months or years, depending on the skin damage. As the skin care professional, it’s up to you to evaluate and determine what is best for your client’s skin. In some cases, layering technology with acids and enzymes is beneficial because it provides more control. Watching the skin closely allows you to stop if the skin frosts or shows any signs of unusual erythema, rash or swelling. Blending and sectioning are techniques that create more specific results. It allows the esthetician to customize the treatment to each client’s needs.
Another common myth is that skin-peeling will cause scarring. If a trained skin care professional performs the peel, permanent scarring will not be an issue. Redness and peeling are normal with deeper peels, but numerous superficial options are available, as well as advancements in cosmeceutical formulas that reduce inflammation, and rebuild and heal the skin. The long-term effects of the peels are healthier, smoother, more youthful-appearing skin.
Finally, it is a common belief that chemical peels are contraindicated for those with rosacea, pigmented or higher Fitzpatrick skin types. Various levels of superficial chemical peels are the answer. Most skin types, including those with pigmentation issues or darker skin, respond well to progressive treatments. In fact, peels can have a very positive effect. Acid blends, such as 10% trichloroacetic acid (TCA) and 20 % lactic and salicylic, along with L-ascorbic and azelaic, work well with these skin types. Some acids are geared toward rosacea/sensitive skin more than others, such as salicylic acid and retinoids, while using ingredients with added lighteners supports pigmented conditions, such as kojic acid and azelaic acid.
To determine what will work best for sensitive or highly pigmented skin, professionals should follow guidelines from companies that offer skin peels, as well as advanced education and personal experience.
At the core of a peel treatment, highly specialized acid and enzyme solutions are applied to remove damaged layers of cells from the skin’s outer surface—revealing more glowing, youthful skin. Treatments vary in intensity, and a client’s skin type and desired results will dictate which peel treatment is best. Intensities include progressive, mid-depth and deep peels.
Progressive peels. Typically the mildest course of treatment, progressive peels usually do not cause immediate exfoliation because they only remove the stratum corneum. Repeated services will create mild sloughing with cumulative effects. The result is a refining, mild peel with no downtime.
Best practice. Perform a series of three to six treatments one to two weeks apart.
Mid-depth peels. Mid-depth peels affect the intraepidermal layer with exfoliation occurring within two to three days of application. Rejuvenation follows little to no downtime. Peeling usually consists of light flaking similar to a sunburn peel.
Best practice. May be performed monthly for as long as needed.
Deep peels. Restore and renew skin with the most dramatic results by using deep peels. The skin undergoes considerable peeling rather than flaking, because deep peels affect the deepest intraepidermal layers. Typically three or four days after application, the skin may become temporarily brown and crusty. The entire process takes about seven to 10 days.
Best practice. Administer peels six weeks apart. It is not recommended to do more than three or four per year.
Peeling agent applications
A wide variety of formulas exist, ranging from those strictly for medical use to those for esthetic use. For skin care professionals offering skin peeling treatments, knowledge of the types of agents available is essential. While duration, Fitzpatrick classification and technique all play a role in determining peeling depth, the peeling agent used is one of the most important factors. There is an art to preparing acid formulations, and it requires a very specific understanding of acids.
Medical peeling agents. Medical peeling agents create deep chemical peels that require longer healing times and also increase the potential for complications as they penetrate much deeper than superficial peels, which work at the epidermal level. Some of the most commonly used include the following.
- Baker-Gordon formula—A combination of phenol, croton oil, septisol soap and distilled water.
- Medical TCA—A high-strength TCA performed in medical settings. There is fast absorption, immediate cell necrosis, and it penetrates to the dermal level.
- Phenol acid (88% solution)—A very intense solution that can lead to irreversible hypopigmentation because of its melanotoxicity. It is not advised for dark skin.
These agents are intense formulas only recommended for medical use. Extreme caution must be used with phenol products as they are very toxic and pose considerable risk. Cardiac arrhythmia and toxicity of organs have been known to occur.
Esthetic peeling agents. Esthetic peeling agents certainly come with their cautions, but they are not as extreme as the medical-use agents. These superficial epidermal exfoliations also offer variety and the ability to create very customized results. Each has a specific purpose and effect on skin cells and tissue regeneration. Some of the most commonly used acids include the following.
- Alpha hydroxy acids (AHAs)—Naturally occurring, nontoxic organic acids. The most commonly used include glycolic (from sugar cane) and lactic (from milk). Others include malic (apples), tartaric (grapes) and citric (citrus) acid.
- Azelaic acid (up to 15%)—A lightening, lifting and antibacterial agent created by oxygenating oleic acid, an unsaturated fatty acid found in milk fats.
- Flower acids—Obtained from hibiscus chalices and characterized by their high level of AHA-like citric acid (10%) and pyruvic acid (5%), flower acids are classified as second-generation AHAs because of their hydrating qualities and ability to increase cell turnover without irritating the skin.
- Jessner’s—A combination of lower-strength acids (salicylic, resorcinol and lactic, all at 14%), which synergize to produce an efficient exfoliating agent with less risk.
- Red wine vinegar (acetic acid)—A natural acid with high antioxidant content, some studies have shown red wine vinegar to produce exfoliation with less free-radical damage and thus, less potential injury to the skin.
- Retinol—A vitamin A derivative that converts to retinoic acid and is a DNA-regulator that assists in the synthesis of collagen, retinol aids in the formation of blood vessels and encourages healthy cell formation.
- Salicylic acid—A relatively safe, low-risk beta hydroxy acid extracted from wintergreen and birch that produces a drying and lifting effect. Although it is self-neutralizing, repeated applications in high-strength doses can result in systemic toxicity.
- TCA—Nontoxic, self-neutralizing and keratolytic that penetrates only if it used in an aqueous base, TCA is very effective in low strengths, and can be used alone or in tandem with other acids.
Every skin care professional considering working with acids should expand their knowledge on the types of agents available. It will prove to be the most important component in any chemical peel practice. With the proper knowledge of the most commonly used agents, skin care professionals can help their clients achieve optimal results with minimal complications. A skin history form is absolutely essential before rendering a peel treatment. It will help prevent complications and help skin care professionals determine the current state of their client’s skin and how best to achieve her goals.
Accelerating the process
Blending enzymes with acids and other treatments will provide a deeper cleanse and begin the skin rejuvenation process. For example, it’s common to add an AHA, such as lactic or glycolic, to certain enzymes to give it a boost. Enzymes, when used alone, fall into the progressive range of skin rejuvenation. Never discount the value and necessity of good enzymes; they are wonderful for providing exfoliation, as well as antioxidant and anti-inflammatory support. Many of the formulas are also rich in vitamins and flavonoids, which stimulate collagen activity.
Enzymes are proteins typically derived from fruit, vegetable, dairy or other animal origins. They produce a chemical change in the skin by way of digesting the stratum corneum. Today, enzymes also provide valuable nourishing and skin-building qualities.
Some fruit enzymes include extracts from cherry, pumpkin, pomegranate, tomato and red grape. There also are lactose enzymes derived from pure cultured sour milk. These provide hydration and digestion to leave the skin glowing for days. Pepsin, papain (derived from papayas) and bromelain (from pineapples) also are widely used to digest keratin protein and smooth skin.
Caution must be taken with this process depending on the strength, pH and the type of enzyme, however. Heat is not recommended when blending acids and enzymes. It requires a clear understanding of both products and the potential of each when blending products.
Pre- and post-peel care
Proper preparation of the skin will mean the difference between a great peel and an average peel. This step readies the surface of the skin by reducing lipids to ensure absorption of the peeling solution. Although the prep varies by client and peel treatment, three steps should take place for most clients.
- Cleanse. All great treatments begin with proper cleansing. The goal is to remove all surface residue and create a very clean surface without agitating or stripping the skin.
- Granular scrub. This optional step provides a second phase cleanse and begins surface exfoliation. Not all skin types require it, but when appropriate, a scrub will lift away dead surface cells.
- Subsurface prep. This is a must-do! Degreasing fats and lipids is vital to a successful peel. A variety of pre-peel solutions may be applied depending on the client’s skin, such as fruit acids, L-lactic acids, alcohol camphor solutions—and the list continues.
Following any corrective procedure that uses acids or intense enzymes, a post-care plan is absolutely essential. The purpose of a post-care system is to support the skin, encourage proper healing and eliminate complications.
Although the post-care will vary by client and type of treatment rendered, some good support and skin-building ingredients include shea butter, occlusive salves, epidermal growth factors, omega-6 essential fatty acids, and a mineral-based sunscreen with an SPF of at least 30.
A thorough understanding of peels unlocks the mysteries of this nonsurgical alternative. Although peels are considered advanced skin rejuvenation treatments and do require proper training, skin care professionals who offer them have more tools at their disposal to create specific results for their client’s skin. Continuing education classes and workshops that focus on corrective skin care are available. Look for advanced classes and workshops with paramedical courses and master programs, as well as online videos, DVDs and books. Education is absolutely essential in this industry and, if the line being used in the treatment offers advanced learning, it’s a great place to start. Trade publications and websites are also valuable tools. The ability to fulfill clients’ needs and offer specialized services will make you indispensable and set you apart from the competition.
Rhonda Allison is the founder and CEO of Rhonda Allison Cosmeceuticals and RAW Skin Care for Men. She is also an author and internationally known speaker with more than 30 years of esthetic experience and can be contacted at 866-313-7546 or via e-mail at [email protected].