Because skin is the largest organ, the body deserves consideration. Writers often discuss the benefits of caring for the body internally, by eating right and working out, but not much is discussed in the way of maintaining or treating the skin, outside of the face. Both men and women can become apprehensive when exposing body parts that were easily hidden under bundles of clothes in cold weather. As warm weather approaches, everyone scrambles to reduce fat, remove excess hair, and hide distressing skin conditions. Offering body treatments is yet another way to help clients feel more confident.

Providing clients with all their skin care needs means we need to ‘shift’ our way of thinking and look at the cosmetic concerns on the skin of the entire body, not just the face.

• Skin tone
• Hair reduction
• Inflammatory skin conditions
• Fat reduction
• Texture

Skin Tone
Skin tone can be altered for several reasons, including hypopigmentation disorders such as vitiligo, poikiloderma, vascular lesions, and so on. As there is not much in the skin care professional’s tool box to help these conditions, the focus will be on hyperpigmentation. Hyperpigmentation is a discoloration on the skin that shows up darker than the normal skin tone, commonly seen as brown spots or patches. While it is one of the most frequently seen conditions by skin care professionals, these common discolorations often occur off the face as well. Discolorations on body skin can be caused by the same issues as on the face – inflammation, sun exposure, hormones, and birth marks. Treatments and products used on the face can also be used on the body to work in the same way.
Topical brighteners can be used to lighten areas of pigmentation. When looking to brighten the skin, there are many options. The most common option is hydroquinone, as it is Food and Drug Administration (FDA) approved as a skin lightener. Hydroquinone is available in two percent for over-the-counter or four percent and higher as a prescription. The use of hydroquinone often shows a decrease in pigmentation in about six to eight weeks. Clients are typically instructed to use hydroquinone for two or three months at a time, take two months off, and repeat the process until the desired outcome is reached. Phytic acid, kojic acid, azelaic acid, emblica, and licorice root are just a few of the many alternatives that have shown results in lightening pigmentation. These ingredients work on varying pathways of the pigmentation process and prove beneficial when combined with other beneficial ingredients.

Topical antioxidants can protect the skin from damage and signs of aging; the gold standard seems to be vitamins A, C, and E. These essential skin vitamins are used to fight off free radicals that cause oxidative stress, as well as lead to hyperpigmentation, sun damage, fine lines, and wrinkles. Vitamin A, in the form of retinoids, are key for stimulating cell growth and stable cell turnover. These are used to slow the aging process, assist in the body’s ability to utilize protein, and normalize healthy functions of the skin. Vitamin C helps tissues grow and repair themselves, as well as protect the skin from ultraviolet (UV) damage that may not have been fully shielded by sunscreen. Several vitamin C derivatives also have skin lightening properties. Vitamin E protects the skin from environmental pollution, has anti-inflammatory properties, and works synergistically with other antioxidants to boost their efficacy. The combination of vitamins A, C, and E and sunscreen prevent signs of premature aging and reduce the chance of hyperpigmentation.

Alpha hydroxy acids are best known for their exfoliating properties. They are water-soluble substances that dissolve the intercellular substances and break down desmosomes. These protein structures hold cells together to maintain barrier function. Lactic and glycolic acids are two of the most commonly used alpha hydroxyl acids. Glycolic acid, derived from sugar canes has the smallest molecular structure of the alpha hydroxyl acids, therefore it is known for its ability to penetrate the skin. It has been shown to strengthen collagen fibers, thereby improving the appearance and texture of the skin. Lactic acid is commonly used due to its hydrating and lightening properties. It is naturally found in milk and is a popular choice for skin care products and peels due to its more gentle nature. They can be used on the body as chemical peels by professionals and can also be used as topical agents, commonly five to 10 percent, by the client at home.

Intense pulse light (IPL) is one of the most requested, yet misunderstood, non-ablative light treatments. As opposed to lasers that are directed at one specific wavelength, IPL emits light with multiple wavelengths of the electromagnetic spectrum. Treatments using IPL are commonly called photo-facials, because the multiple wavelengths can target various indications within a single treatment. It is commonly used to remove discolorations in the skin, including hyperpigmentation and vascular lesions. It also reduces fine lines and wrinkles by stimulating fibroblasts to increase collagen production. Regarding the body, IPL is most commonly performed on areas of excessive sun exposure, including the arms, hands, décolleté, and back. A series of three to five treatments is generally recommended for optimal results.

Visible light lasers are high energy devices that target specific wavelengths or colors of the light spectrum. Laser light in the visible to near infrared spectrum are attracted to color beneath the surface of the skin. The light seeks out the darkened lesions and destroys them. Lasers can be used almost anywhere on the body to treat hyperpigmentation, sunspots, broken capillaries, keratosis, port wine stains, hemangiomas, superficial spider veins, varicose veins, and much more. A series of four to six treatments is frequently recommended for optimal results.

Hair Reduction
Men and woman are continually seeking out methods for removing hair and this is the perfect opportunity for conversion in an aesthetic setting. Several professionals say they do not like to do treatments on areas besides the face. Ultimately, to build a strong clientele it is important to offer a variety of services. By giving one-on-one time with clients already receiving services, having options will provide more opportunity to enhance their appearance; there is no better way to grasp a client’s attention.

Waxing will always be a popular service for skin care professionals, creating a great revenue stream while also converting clients to skin care. Waxing and sugaring are methods known for removing hairs by their root, by applying a tacky substance followed by quickly removing it opposite of hair growth. Waxing can last anywhere from two to six weeks, depending on the growth cycle of each individual. The benefit is that it leaves the area of hair removal smooth for a period of time. The downside is that the client must continually regrow hair between sessions until it is long enough to be removed. Waxing can be done to any area of the body and should be done on a regular basis for continuing results.

Laser hair reduction has become one of the most commonly performed cosmetic medical treatments. Using the same type of energy as skin discolorations, the light gets absorbed by pigment in the hair at the base of the follicle. Follicles with hair in the anagen, or growth stage, are destroyed and are unable to produce another hair. A series of four to 10 treatments, spaced apart according to hair growth, are typically needed.

Inflamatory Skin Conditions
Acne, psoriasis, and keratosis pilaris are just a few of the many inflammatory skin conditions for which skin professionals are often sought. Referral to a physician is typically necessary for diagnosis and to control chronic inflammation. Skin care for these clients is of the utmost importance to balance, protect, and calm the skin.

When one thinks of acne, it is common to picture a full-blown outbreak on a teenager’s face. Acne does not just affect the face, as many people struggle with breakouts on the back, chest, upper arms, and buttocks. Although many treatments for the body are the same as the face, they often need more aggressive treatment due to the differences of the skin. Hormone fluctuations, stress, illness, poor health, and certain medications can all directly or indirectly affect acne formation. These medical conditions and lifestyle choices can trigger or halt the amount of sebum produced, the desquamation of dead skin cells, and/or the ability to fight bacteria — all culprits in acne formation.

Psoriasis is an inflammatory disease that typically shows up as red patches with silvery scales. It is most common on the elbow, knees, and scalp, although some are affected over the entire body. These lesions may be itchy or painful; they can also crack and bleed. When inflammation is under control, treatments to reduce the buildup of keratinized cells are often recommended.

Keratosis pilaris is characterized by visibly raised skin, bumpy texture, and is rough to the touch. Inflammation is sometimes apparent, causing red dots to form just beneath the surface. It most often appears on the back of the upper arms and thighs, but can also appear on the neck, face, and even the buttocks. There are several methods available to reduce keratosis pilaris, but overall, a homecare regimen using products to assist in cellular turnover, as well as exfoliating treatments, are needed. Such methods include retinoids, microdermabrasion, and chemical peels.

Retinoids (such as retinol, retinyl palmitate, and retinoic acid) have anti-aging properties and can affect the growth of epithelial cells, increase cell turnover, and decrease the buildup of follicular epithelial tissue. These retinoids are beneficial in treating body acne on the chest or back, psoriasis, actinic keratosis, photo-aging on the neck and chest, and folliculitis on the arms and legs. Retinoids are skin normalizers, meaning they increase the normal functions of the skin, making them beneficial for all skin types and conditions. Remember, not all retinoids are the same; before recommending a product, ensure the product’s safety and efficacy.

Microdermabrasion is a way of polishing the skin through mechanical exfoliation. As very fine crystals or a diamond tip are glided across the face, dead skin cells are removed to make way for new, healthy cells, while also stimulating circulation. Clients tend to love the feel of the device, since they can feel the dead skin being swept away. Microdermabrasion can be too harsh for the face in many instances, but is a perfect treatment for exfoliation on the body. Removing the outer layers of keratinized cells can help the skin’s natural cellular turnover cycle. Grades I and II acne can benefit greatly from microdermabrasion, since the root cause is a buildup of dead skin and sebum. Keratosis pilaris is often kept at bay with consistent micro-dermabrasion treatments.

Chemical peels work to stimulate cellular turnover by bonds that hold them together. From home use to deep peels done in a medical office, there are several levels of peeling. In essence, a chemical is applied to the affected area, releasing layers of damaged skin to reveal healthy skin. Chemical peels can be a great option for many skin conditions, but when there is a chance of inflammation, the peel must be chosen carefully. Presently, there are several companies that make peels to be used specifically on the body. For these conditions, alpha hydroxy acids, beta hydroxy acid, and/or trichloroanisole is commonly used in low percentages.

Texture
Uneven texture can be caused from various skin conditions, including stretch marks, scars, lines and wrinkles. All of these skin abnormalities are caused by a breakdown in the skin’s structure. In the past, the goal was to create a wound response by removing outer layers of the skin, therefore, triggering the growth of new collagen and elastin. These harsh methods, including dermabrasion, deep chemical peels, and ablative laser treatments did work, but sometimes with an expense. Since the main focus was to injure the skin, there was a much higher chance of complications associated with these treatments.

Medical needling, commonly known as collagen induction therapy, is quickly becoming one of the most requested methods of skin rejuvenation. In this case, we are discussing medical needling treatments performed by a licensed medical professional in a sterile setting. The technique has been used by physicians for decades as it is simply using needles to trigger a wound response, as opposed to creating an actual wound. There are varying methods of skin needling available including stamps, rollers, and, newest to the market, automated devices. Needle depths range and can be as long as 3.0 millimeters, targeting the reticular layer of the dermis. Many clinical studies have shown thickening of the skin with medical needling. Microneedling can be performed on the arms, chest, back, shoulders, abdomen, and legs. For abnormal texture, the needles breakdown damaged proteins to be eliminated, replacing them with healthy proteins. A series of three to six treatments is recommended, depending on the severity of conditions. 

Fractioned laser resurfacing is one of the largest breakthroughs in facial rejuvenation treatments, and the past two decades have presented the advent of fractionated laser resurfacing. The laser beam is fractionated by a specific lens to treat portions of the skin, as opposed to completely destroying the entire protective layer of the skin, commonly seen with past ablative procedures. The idea of healthy skin being left behind can expedite healing, while subsequently stimulating a more effective collagen response. Treating portions of the skin that are left behind result in rapid re-epithelialization, fewer complications, and more consistent results than traditional ablative treatments. Using the same idea as needling, fractionated lasers are used to trigger a wound response in the skin to essentially replace damaged proteins.

Dermal fillers – As we age, we lose subcutaneous tissue that results in thinning of the skin, seen more prominently in the face, hands, and neck. Veins become more prominent, tendons become more accentuated, and loss of volume and elasticity is evident. Dermal fillers such as Radiesse, Juvederm and Restylane can help by restoring fullness to the skin and subcutaneous tissue, hiding veins, and giving the hands and neck a more youthful appearance. Fillers can also be used to treat atrophic or indented scars. Patients are often thrilled with the results, but they are not permanent; results can last anywhere from nine to 18 months.

Neurotoxins are used to temporarily paralyze the muscles of the face and neck, in order to treat the worsening of wrinkles and to tighten the skin. Primarily composed of a polypeptide chain, in essence, the neurotoxin is an enzyme that acts on one of the fusion proteins at the neuromuscular junction. When nerve impulses are blocked, the targeted muscles are unable to contract. Some of the many FDA approved neurotoxins used in treatments today are Botox, Dysport, and Xeomin. Neurotoxins are especially effective in treating prominent vertical bands on the neck, by relaxing the muscles to give the neck a smoother, softer appearance. Treatments will need to be repeated every three to four months to maintain results. Another great use for neurotoxins on the body is for hyperhidrosis, a condition characterized by excessive sweating of the underarms, hands, feet, or scalp. This neurotoxin interrupts nerve impulses that activate the sweat glands, which prevents excessive sweating, leaving patients more confident and satisfied. Results typically last between six and 12 months.

Fat Reduction
Cellulite and excess fat are two of the biggest hurdles women face when trying to improve their appearance. As people struggle every day to lose weight, tighten body skin, and reduce cellulite, technological advances are working hard to make this possible without extreme diets or surgery. Like anything else, some show more promise than others and the definitive answer for these concerns has not yet been met. It is important to thoroughly understand the methods used to help each client get the best treatment. As there are many options to consider, it is important for patients to do their homework before deciding on a treatment.

Weight loss body wraps – There has been an influx of companies advertising miracle wraps that claim to dissolve inches of fat after a 30-
minute treatment. Always take too good to be true claims with a grain of salt. Expectations of permanently losing 10 pounds or three inches from the waist from the application of a wrap are not attainable. Typical results include temporary loss of water weight, skin tightening and some improvement in the appearance of cellulite. These treatments should only be provided to those with realistic expectations, since these results diminish after a couple of days. Unfortunately, disappointment awaits those who are looking to get rid of cellulite forever or permanently shedding pounds.

Cryolipolysis is a non-invasive procedure approved by the FDA to remove localized areas of fat in the lower abdomen and along the sides of the body. It does not cause damage to the surrounding tissue, liver, or bloodstream. This fat-freezing technique uses extreme cold to break down fat cells. This freezes the lipids within fat cells and causes them to dissolve slowly without injuring surrounding tissues. Over the following weeks, this process causes the body to naturally eliminate fat.

Radio frequency has quickly become one of the most sought-after treatments for skin tightening and fat reduction. These devices emit energy to deliver controlled heat deep into the skin, disrupting stubborn fat while at the same time triggering a tightening response. It is a very versatile procedure that can be used on many areas of the body with the same degree of success. The treatment is designed to improve body shape and reduce unwanted fat from areas such as the neck, abdomen, thighs, buttocks, and hips. Radio frequency is effective to use in areas that do not respond to traditional weight loss methods. Patients will require a maintenance treatment every six to 12 months. Most devices are FDA approved for skin tightening, but are used off-label for fat reduction.

Ultrasound technology is another modality used in a medical setting for skin tightening and cellulite reduction. It uses high energy sound waves to stimulate fibroblast proliferation and increase circulation, making it ideal for skin tightening. Ultrasound is typically used to tighten the skin on the face and neck, but is also used to reduce fat bulges in the abdomen, thighs, or other large areas of fat on the body.

Kythera is an exciting new development in cosmetic medicine. It is used to treat submental fat or what is most commonly known as a double-chin. Kythera improves the look of a full neck and double chin, using a series of fat-dissolving injections of deoxycholate. This procedure helps eliminate the pocket of fat under the chin while also tightening the surrounding skin with little to no downtime. It only takes a few minutes and is well tolerated by patients. Multiple sessions are needed to see desired results. Kythera has recently been FDA approved.

Advances in the cosmetics industry are endless, and as a skin care professional, it is important to stay current on topical products, services performed by aestheticians, and treatments performed by medical providers. It is important to assist clients, not just their facial needs, but overall skin care needs as well. The more information industry professionals have, the better the chance to prevent and improve the signs of aging, reduce risks of inflamed skin conditions and potential cancerous lesions, as well as refer to the appropriate medical professional when it is beyond the skin care professional’s scope of practice.

Terri A. Wojak, education director at True U Esthetics and True U Laser, is a highly sought-after professional with 20 years of experience in the aesthetic industry. She is a respected authority on skin care in a medical setting, education, and business development on multiple levels. Wojak has built 30 individual courses based on skin care in a medical setting. Wojak has published two books, “Aesthetics Exposed: Mastering Skin Care in a Medical Setting & Beyond,” and “Mastering Medical Esthetics” She has trained over 3,000 aestheticians and medical professionals on the importance of incorporating skin care into cosmetic medicine.