- The aesthetician’s first point of difference to make a great client.

- The backbone of your professional services proceeding skin treatments and product dispensing

- Photo-dermatology skin analysis

- Photo-dermatology analysis two-step approach

- Analyzing the skin for Photo-dermatology analysis

- Educating your client about the enemies of the skin

- Nutrition and Photo-dermatology skin assessment

- Circadian rhythms

- The New Skin of Color

- Pets and your client’s skin

- The Second professional point of difference to make a great client

- Best aesthetic treatments achieved

- The “Mac Facial” attitude of yesteryear.

- The clinical treatment room.

- The third point of professional difference to make a great client.

- Education and sales

In addition to the aforementioned, age appraisal also incorporates the lifestyle, ethnic history, SPT type, and Glogau classification of a client.

Glogau photo-aging classification is defined by four different categories. This assessment is not so much “age related” as it is “sun linked” and should be cross-referenced with SPT /Skin Protection Type for an accurate appraisal of the skin.

In Glogau type I, a client in their 20s or 30s can show mild, early photo-aging consisting of mild pigmentary-oxidation changes, absence of keratoses and minimal wrinkles. Although your client usually requires little or no make-up at this Glogau stage, a prudent approach for an effective anti-aging program requires a selection of a high pigment foundation. This proactive and preventative action will not only increase protection from further radiation assaults but will enhance the skin’s beauty from the treatments you are providing.

For Glogau type II, the client exhibits "wrinkles in motion" (i.e., wrinkles that appear when making facial gestures or other dynamic facial muscle activity – for instance, when the client smiles and crows feet appear around the eyes). Early-to-moderate photo-aging is recognized by early senile lentigines (age spots), possible keratoses not yet visible to the naked eye, but detectable under a woods lamp, and the emergence of parallel smile lines. The client’s age is in the 30s or 40s. Also noteworthy here is, most women clients in this type II stage usually wear foundation of the wrong type. Recommend your client wear a high pigment foundation to protect the skin from the environment with dual purpose to also improve the clinical appearance.

The Glogau type III skin client has "wrinkles at rest." Advanced photo-aging is recognized by obvious dyschromia, telangiectasias, visible keratoses, and the wrinkles at rest. The client is usually 50 years or older, and these individuals always wear heavy foundation, generally of the wrong type. Here is where your make-up skills can be well received and provide yet another reason for client loyalty.

For Glogau type IV, the client has "only wrinkles." Severe photo-aging is characterized by yellow-gray coloration of the skin, prior history of skin indicates malignancies, and the skin is thoroughly wrinkled and sagged. The clients age is usually in their 60s and 70s, or older. This stage 4 condition is where wearing make-up can be a challenge because it “cakes and cracks”. Again, your make-up skills are valuable to provide a cosmetic solution to improve the aesthetic appearance and reduce the aging challenges, protecting the skin from more damage as it enhances the treatments you provide.

Always remember the Glogau photo-aging classification is a visual grading system used to quantify photo-damage. Glogau classification is also very important when assessing aged skin and evaluating the progress of your treatments. Your treatment goal should be to reposition a Glogau 4 to a 3, a 3 to a 2 and a 2 to a 1. This progress is possible with the correct professional treatment and skin care and only effective if photo-dermatology has been conducted. Here your client will know the professional difference because the results will be evident!

One of the worst enemies for an aesthetician is having a client who smokes. Smoking is counter-productive to all treatments retarding the progress of your skin care abilities. I never allowed smoking in my clinic when I practiced, nor did I hire smoking aestheticians. I believe smoking sends a mixed message and erodes client confidence, especially if you are treating non-smoking clients.

Cigarette smoke and smoking produces oxygen-free radicals known to accelerate wrinkles and aging skin disorders that increase the risk for non-melanoma skin cancers. Studies also suggest that smoking and subsequent oxidation produce higher levels of metalloproteinase’s, which are enzymes associated with wrinkles. Smoking also constricts the capillaries and prevents important nutrients from reaching the skin.

Air pollution and ozone, a common air pollutant, may be a particular problem for the skin. One study reported that it might deplete the amount of vitamin E in the skin; this vitamin is an important topical and internal antioxidant to maintain skin health. Proper cleansing techniques should be taught to your client to remove all toxins from the skin’s topical ecosystem for healthy skin to manifest correctly.

Photo-age assessment must be evaluated by determining the amount of lifetime UVR assault and to help decide the definitive age of client’s skin. Using 40 years of age as an example, the formula is as follows:

Determine their amount of daily ultraviolet exposure x 7= weekly damage.

2 hours (as an example) x 7 = 14 hours a week/weekly damage.

Multiply 14 hours by 4.2 weeks in a month = 58.8 hours a month/monthly damage

Multiply 58.8 monthly hours x 12 months a year=705.6 hours year/yearly damage

705.6 hours x 40 years = 28,224 minimum hours of UVR damage.

When evaluating either a man or a woman you factor in the cause and effect of the gradual thinning of skin for men and menopause for women adding 4,000 hours (100 hours a year). Also consider if the UVR exposure was protected or unprotected. Childhood, weekends and vacation time must be factored in at an approximate damage level since more UVR exposure is common during these exposure times. These added hours are evaluated by asking the client questions relating to environmental exposure. Although this measurement is an “approximate” even the minimum UVR damage assessment provides you with insight to why your clients skin exhibits pigmentation, wrinkles, dryness, dullness, rough texture, etc.

This skin appraisal concludes there is approximately between 35,000 – 40,000+ lifetime hours of UVR damage.

Also remember, the more daily UVR exposure, the more UVR damage. Question your client at length regarding prior exposure times and add the additional hours. This reality check allows you to discuss what UVR does to the skin’s integrity and why it is important to apply sunblock daily with frequent application. This consultation also sets the stage for your treatment schedule and home care program consisting of both corrective and preventative measures.

Regular daily protection against the sun from an early age, combined with the regular use of a purely professional skin care, is the best way to maintain a proactive, preventative control over this complicated immune organ to correct and avoid lines and wrinkles, pigmentation oxidation and other age related skin disorders.

When assessing mature changing skin, it is important to note that skin flexibility and resistance relies on water as its main plasticizer. Always protect the barrier repair function of the skin or BRF, incorporating hyaluronic acid as a main TEWL (trans epidermal water loss) shelter for the stratum corneum. Hyaluronic acid is a required treatment component for all skin and because HA is indigenous to the skin naturally and must be replaced twice daily, directly after cleansing and prior to moisture creams and SPF. Be sure your skin care products contain this ingredient in a natural plant form the skin identifies with and not a synthetic or animal by-product that could cause possible allergies and irritations. Simple advice like this wins the confidence of your client. Never underestimate how education and professional direction creates a bond of trust, one of the main building blocks to make a great client for life.

Always educate your clients, no matter what their age. Keep them current on all new ingredients, procedures, and age fighting treatments. If your client knows more than you do, you might be practicing lazy aesthetics and this is a sure way to lose their confidence and eventually their business.

Nutrition is a critical part of your photo-dermatology skin assessment. A primary goal of all skin treatments and skin care is the development of healthy connective tissue. Ten years ago I coined the phrase, “skin begins from within”, and in today’s lifestyle it has never become more important to pay attention to nutrition.

Diet, vitamins and skin care are critical to age management and week by week, magazine articles carry dozens of suggestions concerning how we can make our skin healthier with nourishing food and supplements made available to both you and your client. As we know, healthy skin is the consequence of a well-hydrated and intact epidermis, together with avoidance of sun damage and a balanced diet. When we are fatigued, poorly nourished or stressed, our skin shows it. Most first time clients are at this fatigued skin stage and will embrace your educational guidance concerning the skin’s healthiest foods in addition to the professional treatments and skin care you provide.

While the use of daily vitamins has been recognized since 1954 as an important part of maintaining health, only recently have researchers started paying attention to the relationship between nutritional intake and skin health. Vitamins have long been used in topical skin treatment for their beneficial effects on their skin's surface and for their antioxidant properties, but obtaining skin benefits via ingested supplements had not received much attention until now. Today, a number of studies reveal that certain vitamins and minerals, when taken internally, can positively influence skin appearance, beauty, a woman and man’s overall health, and fight aging in the cellular environment. Supporting the health of your clients skin with proper nutrition and providing natural supplements manufactured only for skin, is as important as the skin care you choose to boost the fitness of the connective tissue.

The skin is a multifaceted organ that requires systemic and consistent care from intrinsic and extrinsic nutrients. Nutritional supplements augment the cleansing and renewal process of the body. They work with natural fluid and blood flow to target organs with necessary nutrients. As the lymph irrigates the tissue, vitamins, minerals, and herbal components support the detoxification of the lymph, the blood, and the skin.

Nutrition is closely connected with well-being. Metabolism refers to the chemical reactions that break down food, produce energy, and synthesize vital substances for healthy body function. Tissue metabolism converts nutrients into coenzymes essential to tissue health. Because many individuals are nutritionally deficient, which affects the health status of the skin; supplements may be an important part of your in-clinic treatment and home care regimen for your client.

Stress is also an important benchmark when evaluating the health of your clients skin. Stress triggers skin disorders and plays a role in exacerbating a number of skin conditions, including hives, psoriasis, acne, rosacea, and eczema. Unexplained itching may also be caused by stress.

Stressful events may cause men and women who have relatively low levels of the neurotransmitter serotonin (and therefore a higher risk for depression or anger) to produce more of certain immune system proteins (called cytokines), which in high amounts cause inflammation and damage to cells.

Aging skin is triggered by inflammation. Your skin care questionnaire should ask the stress level of your client on a scale of 1 – 10. This valuable insight can provide a window to the emotional well-being of your client too. It never hurts to know what your client is feeling. Aesthetics is all about the well-being of your client’s mind, body, skin and soul. On a bad day you could provide that exceptional touch that makes them feel special and builds great client loyalty for life.

Climate can make a considerable difference to the state of all our skins. Change your treatments seasonally to suit the climate conditions. The condition of skin can change from day to day, and even from hour to hour. It may be affected by general health, by changes in hormones during the menstrual cycle, and by the immediate environment. Skin that felt normal in the morning may feel greasy and uncomfortable by the end of the day.

Advise your client that their skin is a reactive immune organ and provide caveats to help them control unwanted situations. For instance, oily skin by noon requires a mild salicylic acid toilette wipe to control the oil trapped on and in the pore. Salicylic acid is a lipid soluble BHA and cleaning will reveal how much sebum and dirt was trapped. This procedure will also control acne outbreaks. Much of your noontime skin care approach has to do with the amount of moisture in the environment, the level of pollution and circadian influence.

Erythemic skin needs more sun protection, making it necessary to apply more sunblock. Establish that point of difference with your client and empower them with simple solutions to give them back control of an out of control skin, especially when climates change and winter is here. Winter, no matter the region, is one of the skins biggest seasonal challenges.

The stratum corneum simply doesn't like the cold. Cold makes keratin stiffer and less flexible - you will probably be familiar with the 'tight' feeling skin has in the winter. Skin needs to maintain water balance with the environment for ideal function. The epidermis, particularly the stratum corneum, acts as a partial water barrier, helping to regulate the amount of water in the skin. This barrier itself needs adequate water (more than 10 percent) to function properly. Hyaluronic acid, ceramides, lipid soluble antioxidants; especially E and A are just a few of several ingredient remedies necessary for winter skin.

This information leads to how the Circadian rhythms influence our skin and why professional skin care products and treatments are synergistically compatible based on this science. Your professional skin care and treatments will be more effective and educating each client accordingly is a great way to build the future of a great client relationship.

What are Circadian Rhythms? How do they affect the skin? Are they significant regarding your skin care treatments and how will Circadian Rhythms improve the relationship with your clients?

Circadian rhythms influence the skin and how we as aestheticians evaluate the condition and treat it. They profoundly affect the skin’s response and should be part of your judgment recommending clinical remedies and skin care for specific conditions related to acne, pigmentation and aging skin.

Since the beginning of life on earth, plants and animals have been in sync to circadian cycles. That is, the physiological and metabolic reactions in living organisms synchronized with the earth’s daily rotation about its axis. Many different functions of cells are programmed in time, including mitotic processes and hormone production. Remember hormones are responsible for over 300 bodily responses and influence the skin greatly.

In the past four decades, we have seen evidence that circadian rhythms are normal properties of all living organisms, including man. These rhythms regulate the behavior, physiology and function of living organisms.

With respect to the skin, the most important rhythm regulator is direct exposure to light when we refer to the circadian cycles of nature.

Sebum excretion has been found to show circadian variations in the number of actively secreting sebaceous follicles with the minimum values recorded at 4 a.m. and the maximal values at 1 p.m. When treating acne it is important to note that it is the oil that fuels this flame. A critical part of an acne remedy is to instruct the client to treat their skin by noon, no later than 1 p.m., using a mild salicylic toilette wipe followed with an application of SPF block. This procedure must be in addition to their morning and evening protocol. This important noon-time step assists in reducing the triglycerides that exacerbate the bacterial environment within the sebaceous follicle to “feed” the acne and helps reduce the inflammatory response associated with this always-scarring skin disease.

When treating aging, pigmentation or photo-damaged skin, epidermal cell proliferation has also shown circadian rhymicity, the peak proliferation being noted around midnight. Ultraviolet induced damage to human skin DNA is known to occur during the day, whereas repair is at night. Because topical skin care products directly affect the stratum corneum (SC), time dependent changes in SC physiology may have an important impact on the efficacy regarding application of treatment products. Direct the needs of your client’s product protocol based on circadian balance. All clients should be on the correct day and evening skin care program. This circadian condition will help deliver the results your clients are seeking in a professional skin care home program.

In a controlled study using rhythmic procedures, the evening application of an active cosmeceutical for accelerating skin cellular renewal was more effective when applied by 10 p.m. as opposed to application in the morning. Nighttime products do have a specific purpose and your customers should be educated to this fact! The explanation for this difference was the existence of an unknown circadian cellular metabolic phenomenon in the epidermis. Logic tells us nature knows what the skin needs naturally and balance is the key to successful skin care.

When treating dry skin associated with acne, aging or environmental assaults, maximum Trans Epidermal Water Loss (TEWL) values were obtained in the evening and the minimum values were obtained in the morning. This conclusive evidence suggests that to insure the skin has appropriate moisture levels, the emphasis of hydration should always begin in the morning focused on the application of hydration containing components indigenous to the SC (stratum corneum) such as hyaluronic acid and ceramides, followed with semi-occlusive moisture creams containing natural lipid and water soluble antioxidants to maintain BRF and to fight UVR.

Alterations in skin temperature may also affect TEWL. Although skin temperature showed circadian rhythmicity, it did not correlate to TEWL. With respect to pH, high values of skin surface pH were obtained at all body sites in the afternoon between the hours of 2-4 p.m. with the lower values in the evening.

We might ask the question, when is it best to apply specific products for morning and evening? Circadian variations in the kinetics of cosmeceuticals should be taken into account when considering skin pharmacokinetics and the desired and undesired effects for the skin.

Acknowledging this research could make it possible to optimize treatments schedules for both home maintenance and clinical care to ensure a healthier skin for your client.

Skin of color plays a significant part of Photo-dermatology analysis. The new skin of color is the ultimate snapshot for the future of your skin care clientele. The hallmark of what the traditional skin care needs of your client are, has dramatically changed over the decade. In the last several years the demographics have shifted and it now requires the aesthetician to be sure the products they are recommending are more safe and effective for all skin colors. When assessing your client’s skin, always inquire about the ethnicity of your client. Your client is more than likely a racial mixture.

In the United States today, racial and ethnic classification of races with pigmented skin, or SOC, would include African-American black individuals, a group that consist of Caribbean-American black persons; Asian and Pacific Islanders which embody Filipino, Chinese, Japanese, Korean, Vietnamese, Thai, Malaysian, Laotian and Hmong descent, Native Americans, Alaskans and Aleuts, and those who report Latino or Hispanic ethnicity comprising people of Mexican, Cuban, Puerto Rican, Central American or Spanish origin. Also included are certain people traditionally categorized as Caucasoid such as the majority of Indians, Pakistanis and Middle Eastern ethnic types. Wide ranges of individuals have been classified as Asians and Mongoloids.

All these infinite racial varieties are now our clients in the skin care environment and many possess the combination of one or more of the ethnic blending that create this new paradigm of skin color today. Aestheticians no longer are working with white skin only.

During my 25 years of clinical experience with SOC, I have developed a classification system that defines a more accurate evaluation expanding the “skin typing” method. This new skin typing comprehends the overlapping of the ethnic kinds providing more insight and a wider margin of safety when treating a particular ethnic skin or blend. SOC, still known as “Fitzpatrick” scale to some, has now been re-classified as Sun Protection Type, or SPT, that makes room for all ethnic skin at I, I.5, II, II.5, III, III.5, IV, IV.5, V, V.5 and VI. I (one) would represent the lightest European class, VI (6) – the darkest African group with everything else between representing the influence of one or many blended races.

SPT typing is based on how the skin burns and tans genetically linking each skin to natural melanin protection and UVR damage. SPT is a genetic skin connection focusing on the importance of the melanocyte cell where melanin pigmentation plays a major role. This skin typing will be the deal breaker that will determine the class of professional peels and treatments best suited for your client’s skin.

The Lancer Ethnicity Scale (LES) is calculated from 1 –5 (1 the lowest/5 highest) and juxtaposes SPT typing to calculate healing and risk factors for pigmentary damage on ethnic skin/new skin of color background of all four grandparents combined. Risk factors include keloids, discoloration, scar atrophy, enlarged pore size and prolonged healing times.

The higher the LES indicator, the greater the likelihood of healing difficulties and the bigger need for a more conservative, progressive method with a longer preparation time, more time between treatments and more healing post home care program.

Pets also play a significant part in building a lasting relationship with your client. Your clients love their pets and given the recent statistics, 60 percent of Americans own a dog. This is significant given the majority of your clients have a dog. Aside from establishing common ground and sharing Fido stories, an important part of your basic clinical skin fact-finding must include questions regarding your client’s pet. It is imperative we as skin care specialists never lose site of the fact skin is a complicated immune organ and it is our professional obligation is to ensure the safety of the skins we care for.

Pet chemicals, especially those with specific molecular structures incapable of breaking down, can remain attached to the hair or skin of the dog or cat indefinitely. Many pet pesticides are sprayed on whereby these particles become airborne and enter the human body via nasal passages. Other pet products are generally applied topically. The precarious chemicals in these pet products have the ability to systemically invade our system via mucus membranes, such as the mouth and eyes, or can directly enter the skin traveling through the blood stream affecting whole body health.

Think of how many pet owners sleep with, hug, stroke, and kiss their pets then unconsciously touch their face, body, or mouth not realizing their skin is being subjected to these potentially dangerous poisons. Charting any suspicious “conditions” of the skin could be related to the pet your client loves so much. Who else but a well-qualified aesthetician would have uncovered this? Another point of difference that sets you apart to define professional skin care from the masses.

1. List all specifics as you have learned when analyzing the skin for Photo-dermatology analysis
2. What are the main points you need to educate your client about the deadly UVR enemies of the skin?
3. Why is nutrition a critical part of your Photo dermatology skin assessment?
4. How do Circadian rhythms influence skin?
5. Describe The New Skin of Color.
6. How are Pets a significant part in building a lasting relationship with your client?

Christine Heathman, Master Esthetician, CME, LMT is the Founder and CEO of Glymed Plus. With over 20 years of practicing clinical esthetics, her experience with the medical profession is well established. As a licensed professional she holds 3 licenses in aesthetics, one in California, a Master License in Utah and on in Europe. As the Director of Education for the Gly-Med Institute of Skin Sciences in Spanish Fork, Utah, Christine directs and provides the skin care professional with exceptional training. Her dedication to education is well established in the skin care industry and is known on a global basis for exceptional schooling in advanced skin care.