In a remarkable process of self-renewal, the epidermis goes through the process of keratinization, in which cells rise to the surface and are sloughed away over the course of four to six weeks. As we age, however, cell turnover declines, influencing a variety of physiological changes, which can affect the tone and texture of the skin. The most common treatment sought to remedy this decline is the process of exfoliation, which is achieved through various professional and home modalities.
Exfoliation is the process of removing the top most layer of dead skin cells, bringing new cells to the surface, thus revealing smoother, younger-looking skin. This process gives skin a visibly polished appearance, helping to clear areas of congestion and allowing product ingredients to penetrate further and with more efficacy. Long-term benefits of regular exfoliation include an increase in collagen production and reduction of fine lines and wrinkles. Barrier function is inherently improved, preventing transepidermal water loss (TEWL), leaving the skin healthy and more hydrated.

TYPES OF MECHANICAL AND PHYSICAL EXFOLIATION
Mechanical and physical exfoliation procedures employ a manual rubbing or scrubbing action through the use of a tool such as a facial brush or scrubs applied by hand. Scrubs make use of abrasive particles, like sugar, oatmeal, jojoba, corn cob meal, and rice bran, that polish the skin by means of friction when rubbed against the skin’s surface. By breaking up the keratinized protein which accumulate on the skin’s surface, this type of exfoliation lifts away dry, dull cell debris and buildup, revealing softer and fresher skin. However, care must be taken to avoid the use of crushed fruit pits, walnut shells, and the like, as the sharp edges of these abrasive substances create scratches or micro-tears in the skin, which can lead to long-term, cumulative damage.
Nonetheless, there is no replacement for the results a professional treatment can provide. The most common modalities for professional, physical exfoliation are microdermabrasion, dermaplaning, ultrasonic face scrubbing, and dermabrasion.
Microdermabrasion is a modality that polishes the surface of the skin by utilizing a pressurized stream of aluminum oxide or sodium bicarbonate crystals, which are projected across the skin in a controlled manner. At the same time, a vacuum removes the used crystals, along with superficial dead skin particles, into another separate waste container for disposal.
Also referred to as epidermal leveling, dermaplaning is a highly effective form of manual exfoliation, in which a dermatologist or licensed aesthetician utilizes a sterile surgical blade to gently and precisely remove the uppermost layer of skin in a motion similar to shaving.
A third modality, ultrasonic face scrubbing, is a cutting-edge form of mechanical exfoliation that utilizes low frequency sound waves in a three-stage system for safe exfoliation and molecular penetration.
Dermabrasion, typically performed in a professional medical setting by a dermatologist or plastic surgeon, is a type of surgical skin planning which utilizes a rotating instrument to remove the outer layers of skin.

HOMECARE CONSIDERATIONS
As convenient as it may be for a client to perform self-care in the comfort of their bathroom mirror, professional procedures are best left to be handled in a sterile, controlled environment by a licensed professional. When performing at-home dermaplaning without proper training, a client runs the risk of inadvertently scratching or cutting the skin in a manner not consistent with treatment, possibly introducing bacteria and leading to infection. With at-home ultrasonic spatulas or microdermabrasion, the user may not be mindful of how much pressure is being applied, therefore causing inconsistent results, as well as scraping or scratching the skin.
How often a client should exfoliate will depend on several factors, including their skin type and any conditions that are present, which may be exacerbated by exfoliation. The use of prescription retinoids and alpha hydroxy acids will affect the frequency of application, as well.
Dry or sensitive skin should be treated gently by exfoliating with a warm, wet washcloth once or twice a week, at most, using a light hand and avoiding harsh scrubs, opting for ultra fine exfoliating powders instead.
Oily skin is thicker and, therefore, more tolerant to daily exfoliation, but should be limited to no more than five times a week.
For normal to combination skin, either method is appropriate and can be utilized two to three times a week.

CONTRAINDICATIONS
There are clients who should avoid exfoliation altogether. Clients with rosacea should avoid exfoliation, as rubbing the skin may worsen their condition. If there is cystic or chronic acne present, clients should avoid manual exfoliating techniques due to a high risk of scarring and irritation. Instead, professionals can help them explore alternate methods of exfoliation, such as chemical exfoliants, which dissolve the sticky bonds between dead skin cells. These clients, as well as those with darker skin tones, may develop post-inflammatory hyperpigmentation (PIH) resulting from overly aggressive treatments. The professional should also be made aware if the client suffers from viral conditions such as herpes simplex, because exfoliating may aggravate these conditions and increase the risk of spreading the infection.
Overdoing it with an overly aggressive technique may lead to over exfoliation, resulting in compromised barrier function and advanced aging due to chronic and prolonged inflammation. Obvious signs of over exfoliation include skin that is characterized by visible flakiness, tenderness, excessive dryness, oiliness and persistent redness.

ADDITIONAL DOS AND DON’TS
Here are a few additional guidelines to educate clients on when it comes to what not to do in the pursuit of a smooth, bright complexion:

• Do not exfoliate skin that is already compromised. Stop all methods of exfoliation immediately upon signs of irritation and do not resume until the skin has returned to its normal state.
• Do not neglect skin after an exfoliating session. It is imperative to repair barrier function by replacing vital nutrients through the application of nutritive products that hydrate and heal.
• Do not skimp on sun protection, especially after exfoliation. Even on cloudy days, ultraviolet rays will cause skin damage and freshly polished skin could develop hyperpigmentation.
• Do not combine or compound exfoliating treatments. Keep things simple. A gentle, but consistent, approach will yield cumulative, healthy results without irritation.
• Do not use electric brushes on extremely sensitive skin, broken skin, or inflammatory acne.
• Do not exfoliate skin that has recently received a laser treatment or has been exposed to sunbathing.

The mission of skin care professionals is to develop a healthy relationship with clients, characterized by an open dialogue that facilitates honest feedback regarding skin goals, habits, and lifestyle restrictions. After careful analysis of the client’s skin type, condition, and Fitzpatrick level, the professional is able to extend an appropriate homecare exfoliation regimen that complements professional in-office treatments. Professionals must practice due diligence by staying abreast of new product and tool innovations available to consumers and educate the client on the dangers of aggressive misuse of these devices. Encouraging a gentle, yet consistent, approach will lend far more effective results in the long term.

Growing up, Suzanne Whigham, L.E., owner Fountain of You Aesthetics, lost herself in books. But, more so, she was drawn to beauty magazines. She was intrigued by the aesthetics of the human body, especially the face, and, more specifically, the skin. Soon after her fifth daughter was born, Whigham graduated from the Aveda Institute of Lafayette where she studied esthiology. She continued her skin care training by pursuing certifications in various modalities and treatments and subsequently started Fountain of You Aesthetics. After a suspicious mole on her thigh returned a diagnosis of melanoma, Whigham’s love of skin care took a more defined turn towards educating clients on the importance of sun protection and early detection. Her hope is to continue learning, writing, and growing as an aesthetician and increasing awareness of skin cancer prevention.