Exfoliation is the first step to attaining and maintaining beautiful skin. With so many options to choose from and the majority of our clientele being unfamiliar with the various exfoliation methods, it is imperative to be well educated about what is available to us as professionals. From chemical peels to microdermabrasions to enzymes, rotary brushes and scrubs, it is our job to inform our clients on which procedure is right for their skin type and crucial to their skin care goals. Exfoliation removes dead skin cells, unclogs pores, stimulates cellular turnover, reveals a healthier layer of skin cells, and brightens skin by removing surface hyperpigmentation. It is great for acneic skin as it unclogs pores, helping oil to reach the surface and reduce breakouts.
By partially removing the skin's natural barrier, products with smaller molecules are able to penetrate to the lower levels of the skin where they are more effective. For these reasons, a broad spectrum sunscreen must be worn daily, without exception.
When determining whether your client needs chemical or physical exfoliation, a client consultation and a careful skin analysis can help narrow down which method will bring the best results and avoid costly mishaps. After carefully reviewing your client's intake form, speak to the client to verify and further probe into their skin care regime. If a client does not currently wear a broad spectrum sunscreen, explain why a clinical exfoliation, whether chemical or physical, may not be right for them. At that point, you can make the correct recommendation in order to achieve their desired results. Advise your client that a series of treatments of either method is recommended to achieve and maintain best results.
Chemical peels have become widely popular. Chemical peels are comprised of an acid and work by lowering the pH level of the skin causing a controlled injury. The wound starts to heal itself by generating new cells in the basal layer and shedding the old ones sitting on the stratum corneum. The acid destroys protein in the skin, enabling shedding and promoting rejuvenation.
Alpha hydroxy acids/beta hydroxyl acids/enzymes – Enzymes are the mildest of the chemical exfoliants, usually derived from pumpkin, papaya or pineapple enzymes. They are considered the most gentle and can be used on sensitive and acneic skin that is inflamed. They are common at-home exfoliation products because they are gentle and usually cannot cause harm.
Salicylic acid is a beta hydroxy acid – Beta hydroxyl acids are oil soluble and work by breaking down the fats and lipids in the skin's barrier and dissolving oil plugs. Acne, psoriasis and keratosis pilaris types benefit from salicylic treatments. However, it is not recommended for skin types IV, V and VI on the Fitzpatrick scale due to hyperpigmentation risks.
Alpha hydroxy acids (AHAs) are comprised of fruit acids and are water soluble. Glycolic and lactic acids are AHAs. Depending on the pH level, AHAs can be mild enough to treat sensitive and rosacea skin types. AHAs focus on the outer layer of the epidermis due to their water soluble ability and are good for treating fine line wrinkles and surface hyperpigmentation.
TCA peels are comprised of trichloroacetic acid and are considered medium depth peels that penetrate the epidermis and upper dermis (reticular dermis). Because this type of acid penetrates deeper, it is better at correcting shallow scarring, blemishes and hyperpigmentation.
Deeper peels, considered medical grade peels, are much lower in pH and have higher levels of acid and penetrate the skin deeper. These types of peels address scars and are performed by doctors in a medical setting.
It is imperative to go over the contraindications of chemical peels with your client, which include sunburn; inflammations; heightened allergies; open wounds; certain medicines that cause skin sensitivity; regular use of retinols; alpha hydroxyl acid or salicylic acid; couperous, acneic skin with pustules, papules, pustular acne; very thin skin or skin with visible capillaries; recent facial cosmetic procedures; and pregnancy.
Dermaplaning is a form of exfoliation that uses a 10 gauge scalpel to gently remove dead skin cells and also removes the fine vellus hairs known as peach fuzz. Short smooth strokes are used to ensure a safe and effective exfoliation. This method of exfoliation is good for pregnant and lactating clients as there is no use of harsh chemicals. The only contraindications are allergies to the metal nickel, inflamed acne pustules, and papules or any raised lesions. Microdermabrasion can achieve a lighter or deeper exfoliation depending on the types of crystals used or the pressure applied to the wand in the diamond tip method. The number of passes performed is also indicative of the depth of the exfoliation.
The crystal method uses a wand to spray and vacuum up aluminum oxide or sodium bicarbonate crystals. Aluminum oxide crystals come in grits of fine (120) and medium (100). A coarser grit (90) is used in body scrub lotions. The crystals basically sandblast off dead skin cells in the epidermis revealing a healthier layer and causing the skin to react to the injury and produce new skin cells quicker. Sodium bicarbonate (baking soda) is being used as a natural alternative to aluminum oxide and sodium bicarbonate crystals and give a gentler result.
Diamond-tip microdermabrasion uses vacuum technology in a hand-held wand with varying degrees of diamond encrusted tips. Diamond tips come in grits of 100 (rough), 150 and 200 (smooth) and are changed during the treatment from roughest to smoothest. Gliding the diamond tip over the skin smoothes away dead skin cells while the vacuum whisks away the debris. How aggressive the exfoliation depends on two variables. First, the strength of the suction from the vacuum, and second, the varying grit of the diamond heads. A typical protocol would be six treatments about 10 to 14 days apart for both modalities.
Scrubs are the oldest at-home exfoliators. Choose a scrub for the feel of its microbeads. It should feel smooth when rubbed between your fingers. A more cylindrical bead is best to avoid scratching the skin and causing micro-lacerations. It is best to avoid scrubs containing natural walnut husks and apricot seeds which have sharp edges. Many clients over-exfoliate their skin using rotary brushes. Clients come to me and say when they started using the brush, their skin looked great but now they are breaking out more and have patches of dryness that they never had before. When asked how often they use their rotary brush, clients tell me that they use it every day. When I ask them why, they say their skin does not feel clean unless they use the brush. I then explain that they are over-exfoliating and removing their skin's protective barrier. I review the functions of the skin and remind them that rotary brushes are meant to be used one to three times per week as an exfoliator and not as a cleanser.
Contraindications to physical exfoliation are sensitive or reactive skin, broken blood vessels, telangiectasis, sunburn, active or uncontrolled diabetes, active viral lesions, herpes simplex, shingles, eczema or seborrheic dermatitis, rosacea, oral blood thinners, vitaliago, skin cancer and autoimmune disorders, and recent facial cosmetic procedures.
While sensitive skin cannot take a medium-depth chemical peel and keorpous skin cannot undergo a microdermabrasion procedure, there are plenty of safe modalities to choose from. Armed with knowledge and a thorough client consultation, including reviewing contraindications, followed by a complete skin analysis, we can recommend a combination of clinical treatments followed by at-home products that will achieve flawlessly exfoliated, glowing skin for our clients.