Friday, 28 November 2014 15:34

Avoiding Complications With Chemical Peels

Written by   Lydia Sarfati

Winter can be a time for skin renewal, especially if you have clients who tend to spend a lot of their summer in the sun. While skin exfoliation is a naturally-occurring process, most skin types can stand some help. Our skin naturally sheds every 28 days, but with age, this process slows, causing dull and tired-looking skin. The regular use of exfoliants dissolves dead, flaky skin cells, stimulates collagen production, and builds elasticity.

If skin is exfoliated, it is forced to create new cells, revealing fresh, healthy skin cells. Chemical peels can be an effective and safe method to achieve beautiful results for your clients, if they are done correctly. If done incorrectly, you could inadvertently cause more damage to the client’s skin. To understand how to provide effective chemical peels for your clients, you first need to understand them.

The Origins of Peels
Chemical exfoliation is not a new concept; in fact, chemical exfoliation goes back as far as Ancient Egypt. Egyptians used abrasive tapes made with alabaster, honey, and sour milk. They were using lactic acid even back then! Once the tape was removed, the tightened skin was then abraded with finely-ground sand – talk about harsh. The Greeks utilized early facial peeling techniques as well, combining limestone, mustards, and sulfurs.

Chemical Peels Today
While there are many options for professional peels, it is key to understand the properties of each.
Phenol (carbolic acid) – Phenol is a classic deep chemical peel that was discovered in 1900 to treat acne scarring. Original phenol peel solutions were very painful and most practitioners would perform it under either general anesthesia administered by an anesthesiologist or nurse anesthetist. After a phenol peel treatment, the client’s face will be swollen and uncomfortable; full recovery can take up to a month.
Trichloroacetic Acid (TCA) – Trichloroacetic acid chemical peels are mid-level peels that involve applying trichloroacetic acid to the skin. They are done on an outpatient basis, but may require light sedation depending on the concentration of the acid used. Higher concentrations of the acid will penetrate the skin more deeply, resulting in more dramatic improvements, but this may also cause more client discomfort during the procedure and a longer recovery time afterward. Although trichloroacetic acid peels are applied in the same way as milder peels, the acid used in trichloroacetic acid peels is much more potent, causing a more significant burn. ‘Frost’ on the skin is a result of the trichloroacetic acid coagulating with the protein in the skin. Trichloroacetic acid penetrates to the papillary dermis or the upper reticular dermis when full frost is achieved. After a trichloroacetic acid peel, your client’s skin will form a superficial crust over the treated area and then will begin to blue in three to seven days.
Salicylic Acid – Beta hydroxyl acids (BHAs) are known for having superior exfoliating properties without causing the irritation associated with more aggressive peels. Because salicylic acid peels exfoliate both the surface of the skin and within the pores themselves, they are a perfect option for clients who wish to rid themselves of years of dry, dull skin buildup. This is effective in the improvement of sun-damaged and aging skin, as well as in the reduction of mild acne scars.
Alpha Hydroxy Acids – Alpha hydroxy acids (AHAs) are a group of organic carboxylic compounds such as glycolic acid, lactic acid, malic acid, citric acid, and tartaric acid. Glycolic acid naturally occurs in sugar cane. It penetrates the surface layers of the skin and loosens the dry, thick skin that makes the complexion look aged and dull.

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The Downside to Aggressive Peels
So, what could go wrong if we use aggressive acids to burn off all of our aged and damaged skin? A lot can go wrong. Chemical peels can have a number of side effects including mild peeling, redness, irritation, blistering, burning, swelling, changes in pigmentation, solar sensitivity, scarring, crusting, numbness,
or infection.
To help keep your client’s side effects to a minimum, advise them to avoid abnormal stimulation and barrier disruptions caused by strong acids, strong alkalis, and surfactants. Another method that should be avoided is combining microdermabrasion with chemical peels to provide more instant and dramatic effects. What we need to understand as skin care professionals is that the skin is delicate and it is there to serve a purpose. When it comes to exfoliation, you need to think of the skin like an apple. An apple with skin looks plump and hydrated. When you peel an apple, it becomes brown and shriveled. When exfoliating, it is important not to overdo it. The skin is a protective barrier – do not tear down your client’s defenses!

The Importantance of pH
Potential hydrogen (pH) is a unit of measurement that indicates whether a substance is acidic, neutral, or alkaline. Alkaline is sometimes called ‘base.’ Just as degrees measure temperature and inches measure distance, pH measures the amount of acid or alkali in a water based solution. As a skin care professional, you need to understand pH in order to choose the best chemical peel for your clients.
The pH measurement scale ranges from 0 to 14, with number 7 as neutral. Numbers less than 7 indicate acid while numbers greater than 7 indicate alkaline. The scale is logarithmic, which means each step or number increases by multiples of 10. pH 6 is 10 times more acidic than neutral 7; however, 6 is 10 times less acidic than 5, which falls in the range of the average pH of hair, skin, and scalp. So when you are using products that are pH 6 or ‘only one number’ away from the average pH of hair, it is actually 10 times less acidic. That is a big difference. For example, have you peeled an orange and as the juice from the orange came in contact with your skin, you felt a slight tingle? The pH of an orange is approximately 2, which is only three steps away from the pH of your skin (4.5 to 5.5) but in reality, it is almost 3,000 times more acidic than
your skin.
At the top of the scale is 14, which is 10 million times more alkaline than 7. As you can see, a very slight variation in pH will greatly affect the acidity of any spa product.
Acid balanced and pH balanced are two terms that are sometimes confused in the industry. When a product says “pH balanced,” it means the pH is balanced at a certain number, but not necessarily from 4.5 to 5.5. Acid balanced means just that – balanced within the acid range of 4.5 to 5.5. Your task as a skin care professional is to use products that will help maintain the acid balance of the hair and skin at the 4.5 to 5.5 acid range levels.
Understanding pH measurements and values will greatly assist your ability to keep the skin in the best condition possible.

peelRecommend Chemical Peels for Best Results
By using gentle, yet effective chemical exfoliation solutions, skin care professionals will be able to provide clients with amazing results without the harsh side effects.
Proteolytic Enzyme – Think of enzymatic exfoliation like the game Pac-Man. It stays on the surface of the skin, digesting the dead skin cells. Based on papain, the proteolytic enzyme derived from the latex of the green papaya fruit, this exfoliant gently removes uneven old squames, revealing brighter, younger looking skin by digesting dead surface protein. Although most enzymes are not very stable, new stabilizing technology allows us commercial feasibility. Be sure to keep the solution wet by using a hydrating facial spray; this will keep the enzyme active. Do not use a steamer as the heat could deactivate the treatment. This kind of chemical peel is particularly effective for those with mature or sensitive skin types.
Glycolic Acid in a Seaweed Base – Glycolic acids can be safe and effective when they are used in a seaweed base. I suggest using a formula with 30 percent glycolic acid with a pH of 3.5. Your clients will still be able to see beautiful results, but they will not see the skin irritation. For best results, do not perform a glycolic peel on:

  • Women who are pregnant or breast feeding.
  • Clients with rosacea.
  • Clients with salicylic acid allergies.
  • Open lesions.
  • Thin, highly sensitive skin.
  • Clients taking Accutane.
  • Clients with herpes simplex (Hv1) in active stage.
  • Clients with atopic dermatitis.
  • Clients who have chronic urticaria (hives).
  • Clients with somatic diseases in an acute stage including SARS.
  • Clients who have recently had depilatory waxing or laser hair removal.

For clients who need intensive skin rejuvenation, have them come in once a week for a treatment for four weeks, then once a month thereafter.

Peel and Reveal
After a chemical exfoliation treatment, it is important to protect, hydrate, and rebuild the skin. By using a chemical peel, you can overdry the surface of the skin by removing the natural covering, thus the skin’s natural moisture factor (NMF) evaporates. After a chemical peel, apply a skin-nourishing serum and suggest upgrading your client with a hydrating facial mask to immediately sooth the skin. Then, apply a daytime protection cream with a physical and mineral barrier such as zinc oxide. This way your client’s newly-exposed skin is not unprotected against harsh elements, pollution, and environmental aggressors.

The Bottom Line
Skin exfoliation, especially facial exfoliation, will generally cause some mild irritation. As skin care professionals, you must be careful not to exfoliate excessively. If the skin is exfoliated properly, taking the proper precautions and using the correct post-treatment care, your clients will be able to see a dramatic decrease in visible lines, creases, acne scars, and hyperpigmentation. When used correctly, you will be able to provide your clients with a beautiful, glowing complexion that will leave them extremely happy with their treatment.

Lydia-Sarfati 2015Lydia Sarfati, president and founder of Repêchage, is an internationally recognized skin care expert quoted in Vogue, In Style, Glamour, and New York Times, as well as featured on CNN, CBS, and FOX. Sarfati is the creator of the world-renowned Four Layer Facial® and has over 30 years of experience as an aesthetician, spa owner, manufacturer, and consultant. She authored Success at Your Fingertips: How to Succeed in the Skin Care Business. She has recently been appointed honorary chair of EstheticsAmerica, CIDESCO USA and is Skin Care & Spa Council Director of Intercoiffure North America.

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