Chemical peels have been provided by skin care professionals for a while, and they have come a long way due to advancements in technology, ingredients and techniques. The spa market, and the beauty market in general, is trending toward personalization. How do we harness these together to deliver personalized results with peels for our clients? This article will first discuss what is in our chemical peel toolbox before detailing how this toolbox works with the anatomy of skin and providing ways to use peels in facial sections to work best for each of your clients.
The Peel Toolbox
There is no single peel or product chemistry that works for all clients. This will not be an exhaustive discussion of peels. Phenol peels are generally deep peels that will not be discussed here.
AHAs. Glycolic acid and AHAs primarily remove skin from the surface. Their job is to smooth texture, and they can start cellular rebuilding of collagen and elastin through injury response depending on the pH and concentration. Lactic acid can change the behavior of the stratum corneum and set up an enhanced barrier function, which may yield a more hydrated surface for some time after the peel.
BHAs. Salicylic acid can work in several ways depending on dose and pH. It can act as an anti-inflammatory, an exfoliant and an oil suppressant.
Trichloroacetic acid (TCA). Depending on dose and pH, TCA can smooth skin, remediate fine lines and wrinkles, and slowly start to depigment skin.
Peel Additives. Retinoids (retinol or retinoic acid) can help to normalize epidermal skin turnover. It is also used to facilitate the “sheet peeling” effect in some peels. Hydroquinone is used to lighten skin as it decreases melanin.
Case Study Client
Now that we have established the tool box, how do we use this to provide a personalized experience for clients? It involves an understanding of skin anatomy.
Facial, neck and décolleté skin varies in thickness and sensitivity to peels. The roughest part of the skin in appearance is usually in the forehead. The thinner and more sensitive parts of the face include the eye area, neck and parts of the décolleté.
Most oil tends to be produced in the sebaceous glands, which are in the lower chin, sides of the nose and glabella area between the brows. Pigmentation, in general, tends to affect the bridge of the nose across the cheeks and the upper forehead on both sides.
Peel Selection Checklist
Before choosing which peel to apply on a certain section of the face, first go through the following checklist:
- Ensure that the peels (not deep peels) are self-neutralizing peels (superficial or mid-depth). These are the easiest and most effective in sectional peel techniques.
- Choose your peels based upon the condition you will be treating. It is important to select peels that have a fairly narrow focus of product chemistry (glycolic, salicylic, etc.). The reason for this is that when you decide to perform sectional peels as part of a personalized program, you want to be able to treat different parts of the face in different ways. Choosing a peel that tries to do all things at one time will limit your options in sectional peel techniques.
- Know the pH of your peel. Different manufacturers use different formulation techniques for their peels. Some buffer their peels, so while they may say 30% or 70% glycolic acid, the buffering process reduces the effective acidity of the peel and results in a lower efficacy peel. This is also important for safety.
- Know your acid concentrations. You can mix and/or match manufacturers of the peels, but it’s important to know pH and acid concentrations.
- Check expiration dates of the peels. They can become more acidic, less acidic and can even build up pressure in their packaging if unstable. Be careful!
Case Study: Closeup of Cheeks/Nose
Match Your Peel with the Client
The first step is always to perform a personalized consultation to ensure you and your client have the same expectations. Ensure that you update your health records with the client relative to any new health conditions that may have arisen, including pregnancies or any other condition which could exclude her from a peel. Pay special attention to any skin changes you can observe or measure with imaging equipment or other types of skin biometric equipment.
One thing to be clear on when analyzing skin is the difference between client-reported dryness and actual skin hydration. Remember, a client is not dry or oily, but rather hydrated, not hydrated or has varying levels of hydration (moisture in or on their skin). The client also has varying degrees of oil on their skin. These properties are separate and distinct. Many people report having dry skin to their skin care professional when it is fully hydrated but has no oil on it when analyzed through biometric means. This condition means the skin lacks the ability to be flexible and supple because there is no oil to provide lubricity. This gives the client the impression that her skin is dry.
Once you have made the proper determination of current facial properties, then you can select the proper personalized peel protocol.
Client Case Study
Image Analysis of Pigment
See the before image of the client that we are using for this case study. She wants to manage several different aspects of her skin in the same peel process, including uneven tone, rough texture, enlarged pores and small pigment spots on her face. Do you do a glycolic peel, salicylic peel, combination peel or TCA peel? Of course, you are going to perform a sectional peel on her to provide the most comprehensive and personalized experience and result for her.
You have discovered the following through your analysis and observations:
- Pore size is significantly enlarged due to chronic oil deposition into her pores without proper maintenance (extractions) over time.
- Her skin is exhibiting a bit of hyperkeratotic behavior, which has led to a fair amount of dead skin accumulating on the surface.
- She has several obvious dark spots and some underlying pigmentation as seen on imaging analysis.
- She has slight darkness around the eye area, which has been identified as genetic melanin banding.
You have decided to select a 10% salicylic acid peel, a 70% glycolic peel and a lactic acid peel, but why?
Peel 1: Salicylic peel. The 10% salicylic acid peel will be applied on the inside of the cheeks and across the nose as well as the chin and nominal forehead. This will be the first peel applied and done with three layers according to the client’s tolerance. The salicylic acid peel will suppress the oil glands from overproducing oil on the skin as well as clearing the pores from the residual sebum plugs that remain over time.
Peel 2: Glycolic peel. The glycolic peel will be performed across the forehead and on the rest of the face slightly overlapping the salicylic peel areas, which have been previously completed. Again, three layers are applied, paying close attention to the client’s tolerance level. This will remove several layers of the stratum corneum revealing a younger surface that is smoother, with more even tone and texture. It will also lighten the pigment on the surface.
Peel 3: Lactic peel. Lastly, the entire face will have the lactic acid peel applied in the same three-layer process as before. The lactic acid will deeply hydrate the skin for several days while the skin desquamates from the salicylic acid and glycolic acid sectional peel.
You can see in the after picture that there is a dramatic improvement in pore size. The tonality of the skin has improved overall in the face, and the textural aspects of the face have improved significantly. If a single acid or a multiple acid peel was applied, these results would not have been as significant, because one peel cannot accomplish what multiple peels can. In the closeup of the cheeks and nose, you can see the improvement in the center face showing pore size and textural improvement.
A special camera was used to see many layers below the surface and identify the condition of the live keratinocytes. In these before-and-after photos, you can see pigment spots and overall pigment presence has improved dramatically as well.
It is important to note that the efficacy or success of a peel is not dependant on how much peeling takes place or if the client “sheet” peels. Clients like to see peeling after a peel, but it is important to let them know that the amount and type of peeling will be different for everyone and that it does not predict the ultimate success of the peel.
Care needs to be taken in post-care to apply the proper sunscreen. Depending on the Fitzpatrick level of the skin, post-inflammatory hyperpigmentation (PIH) should be assessed on or around day 10 of the peel. If PIH starts is present, depigmentation procedures should be started.
It is critical to understand the chemistry of your peel—concentation, pH and buffering. It is also important to understand the skin anatomy and physiology to know where and how to apply each peel. Finally, treat each client in a personalized way with regard to her skin. Use all the techniques and tools you have been given to optimize the look and esthetic of your client.