Peel first, mechanical exfoliation second. Or is it mechanical exfoliation first, peel second? The truth is, the order in which exfoliants are layered does matter. In fact, a variety of desired results can be achieved, depending on how treatments are layered. Find out how different exfoliants work and the benefits associated with various methods of layering them.

To address consumer demands, today’s aesthetician must be able to develop highly customized treatment plans that provide thorough exfoliation, but do not necessarily promote visible skin peeling. This is quite a task, but thanks to modern chemistry, today’s treatments can provide the much-needed exfoliation without all the downtime associated with yesterday’s old school chemical peels. To treat clients’ skin without causing trauma or downtime, consider going back to the basics, layering and customizing treatments that incorporate an enzyme, light chemical peel, and mechanical exfoliation.

EXIGENCY OF EXFOLIATING

As people grow older, the rate of cell turnover slows down dramatically. The cells in the stratum corneum take much longer to desquamate – a fact that tends to accentuate fine lines and can make clients’ complexion look dull and lifeless. Exfoliating these dead skin cells – whether physically with scrubs or chemically using acids or enzymes – helps make up for the gradual slowing down of the natural skin’s renewal process, improving the tone and texture of skin.

Here are some of the reasons why clients need to exfoliate their skin regularly:

• It diminishes age spots by removing dead skin cells containing the pigment.
• Exfoliating unclogs pores and allows the release of natural skin oils.
• Pore size and superficial scars will minimize.
• It makes fine lines and wrinkles look less visible because the newly exposed layer of skin reflects light better.
• Exfoliation allows for better absorption of moisturizers, antioxidants, and serums by removing the top layer of dead cells. This also holds true for acne medications and other types of skin treatments for which penetration is important. This is another reason why regular exfoliation should be part of a basic skin care regimen.

CHEMICAL OR PHYSICAL?

There are two ways to exfoliate skin: chemical exfoliation, which uses acids or enzymes to remove dead skin cells, and physical exfoliation, which utilizes a hard substance to manually remove the dead skin cells – think microdermabrasion. As a rule of thumb, acne-prone and highly sensitive skin responds very well to chemical exfoliants, as they are less likely to cause irritation. But, one can certainly use both a physical and chemical exfoliant in conjunction with one another and benefit greatly from both; however, practice caution, as over-exfoliation is never an intended outcome.

COMPARING CHEMICAL EXFOLIANTS

If clients prefer a chemical exfoliant, among the most common types are alpha hydroxy acids (AHAs) and beta hydroxy acids (BHAs). Both AHAs and BHAs work by combining with the structural lipids in the stratum corneum and dissolving them so that the dead skin cells can desquamate.

Alpha Hydroxy Acids

They are among the most common types of light chemical peels. The AHA family of acids is derived from natural sources such as fruit, milk, or sugar. Two of the most widely used in skin care products today are glycolic acid (made from sugar) and lactic acid (made from milk). AHA-based facial exfoliators are an excellent choice for people with oily skin.

Beta Hydroxy Acids

Like AHAs, BHAs are a light chemical peel. In general, BHAs are a more effective treatment for acne-prone skin. BHAs (also called salicylic acid), are synthetic derivatives that come from the same source as aspirin.

Enzymes

For sensitive skin, it is often recommended to look for facial exfoliants that are enzyme-based. These enzymes come from a natural source, like fruits, and work in the same way as acid-based, but at a much slower pace, allowing for an extremely safe and gentle exfoliating process.
By nature’s design, enzymes and their individual properties deliver a myriad of skin benefits. For example, papain or kiwi enzymes are gentle, while a pumpkin enzyme can be much more active and aggressive. Depending on the skin condition and concerns of the client, choose an appropriate activity level. Today’s market offers the aesthetician a wide variety of enzyme choices.

Enzymes such as papaya/papain are used in skin care to digest dead skin, revealing fresh, healthy skin cells. The use of fruit acid enzymes also provides skin with the beneficial effects associated with that fruit. For example, the skin can benefit from the brightening effects of lemon, due to their ascorbic acid. Fruit acids also provide skin with antioxidant protection. Enzymes can be used alone for sensitive skin – for clients who have contraindications to chemical peels and for softening the skin for easier extractions. Most product lines produce an enzyme that is used for exfoliation purposes. To ensure efficacy and safety, read the manufacturer’s directions for intended use.

ENZYME TREATMENT PROTOCOL

Use enzymes in facials once a month to gently exfoliate and brighten the skin for an overall effect of clean, exfoliated, and nourished skin with the following protocol.

1. Cleanse skin twice.
2. Apply enzyme for seven to 10 minutes (steam optional).
3. Perform extractions (optional).
4. Apply treatment serums (may be applied before or after nourishing mask).
5. Massage skin.
6. Apply nourishing mask.
7. Apply toner.
8. Add moisturizer and SPF.

Duration and Price

This process takes from 30 to 70 minutes, based on the length of the massage and whether extractions are included. Prices can typically range from $39 to $150, depending on
duration of service and inclusion of optional factors. Pricing is also based on the professional’s experience level and economic climate of the geo-graphic location.

Contraindications

Contraindications for pure fruit enzymes are minimal as they are gentle and suitable for most skin types; however, consider any fruit allergies. Some enzymes contain acids such as lactic or glycolic already blended into the formula and contraindications to this include pregnancy, lactation, and Retin-A or Accutane use.

MECHANICAL EXFOLIATION AND PEELS

Mechanical exfoliation, such as microdermabrasion, dermablading, dermafiles, and scrubs polish the surface of the skin and are very effective at removing the keratinized corneocytes at the surface of the skin, but they do not address pigmentation in the lower levels of the epidermis. The overall effect is soft, polished skin.

Protocol

Perform the following mechanical exfoliation every four to six weeks.

1. Cleanse twice.
2. Degrease the skin.
3. Perform three passes with mechanical exfoliation.
4. Apply moisturizer and SPF.

Duration and Price

This process is typically 20 to 30 minutes. Prices usually range from $125 to $225, depending on the length of service and options included. Pricing is also dependent upon experience level of the professional and the economic climate of the geographic location.

ABOUT CHEMICAL PEELS

Chemical peels are one of the oldest cosmetic procedures performed in the world. There are various types of chemical peels that can aid in skin rejuvenation. Most skin care professionals offer a variety of chemical peels of different strengths to help reduce the signs of aging, scars, and blemishes and to restore the natural beauty of skin. Chemical peels remove a layer of skin with a chemical preparation, allowing the skin to grow back smoother than before and with reduced imperfections. This leaves clients with a younger, fresher appearance. There are several types of chemical peels available.

Light Chemical Peel (Glycolic or Salicylic Acid)

These chemical peels are used to improve dry skin and uneven pigmentation. They can also be used to help improve the effects of sun damage
and control acne. Multiple treatments may be necessary to achieve the
desired results.

Medium Chemical Peel (TCA)

This type of chemical peel is most often used for those who want to improve the appearance of fine wrinkles, mild blemishes, and uneven pigmentation. This type of peel can be used anywhere on the body.

Deep Chemical Peel (Phenol)

Deep chemical peels are used to smooth deep wrinkles and remove major blotching usually caused by aging or extensive sun exposure. This type of peel can only be used on the face.

Acne Chemical Peels

Mild, medium, or deep chemical peels can be used to help control acne and smooth the appearance of acne scars. The strength of the peel will depend on the client’s skin condition.
Chemical peels are designed to help reduce wrinkles, sun damage, blotchy skin, and uneven pigmentation, ultimately restoring skin’s youthful appearance. The type of chemical peel being received will determine the specific aspects of the procedure.

Below is a general protocol of a chemical peel procedure.

• Skin should be thoroughly cleansed.
• The chemical peel solution should then be applied. Clients can expect to feel a slight tingling or stinging sensation as the peel is being applied.
• Once the peel solution has set on the skin for the prescribed amount of time, it is typically neutralized with a solution of baking soda mixed with water.
• The aesthetician is responsible for providing clients with aftercare instructions.
• There is no such thing as a “miracle peel” where the client will have just one treatment. Rather, expectations should be set that multiple chemical peels may be necessary, depending on the strength of the peel received and the client’s skin condition.
• The type of peel received will determine the length of recovery time. Some clients can resume normal daily activities immediately following treatment, while other, more intense treatments may require clients to take a week off from work for optimal recovery.

While there are rarely any complications associated with chemical peels, certain risks do exist including scarring, swelling, infection, cold sore outbreaks, and possible changes in skin tone. To help reduce side effects associated with chemical peels, it is important to provide a thorough skin consultation and analysis with a complete medical history for each client. Also, clients must follow post-treatment instructions.

CUSTOMIZE TREATMENTS

One protocol can be applied to 20 different clients and produce 20 different results. While all the exfoliation methods work well, consider customizing treatments for clients. Aside from pigmentation, many clients have various levels of acne or want to address aging concerns. For most clients, recommend a series of six treatments, spaced one to two weeks apart, for best results. The following is an example of a typical protocol.

1. Cleanse twice.
2. Place a fruit acid enzyme in a dish and boost it with a chemical peel. Use lactic or mandelic for dry, mature, pigmented skin, glycolic for keratinized skin, and salicylic for oily
   skin. Advise the client that a peel boost is being added to their treatment and their skin may be flaky for three to four days. The overall effect is a power facial.
3. Light mechanical exfoliation.
4. Extractions (as everyone wants clean pores).
5. Apply treatment serum (may be applied either before or after the nourishing mask).
6. Apply a nourishing mask.
7. Apply toner.
8. Apply moisturizer and SPF.

When a thorough skin analysis is performed and the correct enzyme and peel is chosen for each client, professionals achieve the best results to address each client’s concerns.

EXFOLIATION ORDER

Different results can be achieved, depending on the order that treatments are performed. Knowing the desired end result is key in determining exfoliation order.

Enzyme/Peel First, Mechanical Exfoliation Second

Here the enzyme and/or peel softens the stratum corneum, first, and, then, the mechanical device (like dermaplaning and/or microdermabrasion) exfoliates more surface skin.

The result will be a more polished, softer skin. This method is effective at removing the surface of skin and smoothing the stratum corneum.

Types of skin conditions that respond well to this type of dual exfoliation are closed comedones (remove surface so trapped oil can escape) and rough, dry skin.

Mechanical Exfoliation First, Enzyme/Peel Second

When an aesthetician mechanically exfoliates the surface of the skin and then applies an enzyme or peel, the peel will penetrate further into the skin, as some of the surface cells have been removed, making the skin more receptive to peeling solutions.

The result will be better penetration of the peel. The peel will move deeper into the skin and the client should expect some flaking.

This method of dual exfoliation will be more progressive. This may be beneficial when the aesthetician needs to deliver skin lighteners or where the end result desired is lots of peeling.

Enzyme First, Mechanical Exfoliation Second, Peel Third

This order is reserved for clients with resilient skin. Here the enzyme softens the stratum corneum, then the mechanical device buffs or polishes skin for further penetration of the peel. The peel will, of course, penetrate further into the skin for acne and pigment.

The result will be lots of peeling and probable down time. The aesthetician needs to address client expectations to make sure the client is clear on any possible down time or other concerns. Keep in mind, this is only for clients who are well versed and conditioned with proper homecare. Compliance with product use is paramount.

For this method, clients must have resilient skin (thick, oily skin), acne, pigmentation, or texture issues in which the result will be peeling. After completing a treatment series, stop and evaluate the results. Is the client happy with the results? If not, add two to four additional weeks to the protocol. After the desired result is achieved, put the client into maintenance mode and perform a monthly facial to keep their skin looking its best.

Contraindications

Contraindications to consider for microdermabrasion and chemical peels include, but are not limited to, pregnancy, lactation, and Retin-A or Accutane use. There are many great products on the market for addressing pigmentation issues. Look for antioxidants or tyrosinase inhibitors, such as kojic, arbutin, and azelaic acid with pH levels low enough to allow the ingredients to penetrate. Perform treatments consistently and frequently to achieve the best results and emphasize the
importance of homecare to clients, as well.

Keep in mind that 80 percent of clients’ success will come from consistent daily use of professional products at home, backed up by a series of professional treatments, such as light peels. The professional who takes the time to educate the client on the importance of a professionally-recommended homecare routine will increase his or her success rate when it comes to client satisfaction and retention.

It may be necessary to redirect a client’s thought process away from a quick fix to a longer series of treatments that will be much more beneficial for their skin. A paradigm shift is often necessary for the professional, too. Most aestheticians think of the professional treatment session as the thing they are really trying to sell and see retail products for homecare as a nice extra if the client is willing. However, what if the opposite were considered?

First, educate the client about the importance of using a recommended homecare routine to address this specific skin issue. Make this the first requirement of the treatment plan, not an afterthought. If he or she is willing to commit to this routine and purchase the necessary products, then he or she is ready for the recommended series of professional treatments.

Second, keep the actual treatments short and very affordable. Cleanse the skin, apply an enzyme or peel, neutralize if needed, and finish with SPF – each session should take less than 30 minutes. By keeping the treatment prices lower, clients will be able to afford to purchase a full line of home-care products.

This new way of thinking creates a win-win situation. The client wins with great skin. The professional wins by making the same amount of money with less hands-on treatment time and creating a dedicated customer who gets results and raves about their results.

Be a skin care coach. Establish rapport with clients. Listen to their concerns and make recommendations based on those concerns. Do not lose sight of the fact that, at the end of the day, it is the client who is truly responsible for his or her skin, because it is the client’s daily habits that will make a long-term difference. The professional’s expertise and education is simply the guidance clients need to develop beautiful skin.

Dave Waggoner is a licensed aesthetician with experience as both an educator and practitioner. He has a master’s degree in education and currently serves as director of education and public relations at Skin Script Skin Care in Tempe, Arizona. Contact him at This email address is being protected from spambots. You need JavaScript enabled to view it..