Microneedling remains one of today’s top cosmetic, nonsurgical treatments because radiant skin is always in style. This treatment involves pricking skin with tiny, sterilized needles that cause small wounds to the area being treated; in turn, more collagen and elastin are produced to heal those wounds. Collagen is nature’s skin filler that results in dewy, glowing skin. As far as pain goes, typically, a topical numbing cream is applied to the treatment area to minimize discomfort.

There is an old saying that tomorrow is not what it used to be – and that could not be truer than it is today. When the pandemic hit, there was tremendous uncertainty in many service industries, and the skin care industry was no exception. Not only did professionals not know when spas would reopen, but they did not know whether clients would be interested in spending money on spa treatments while being stuck at home or wearing masks in public. Talk about challenging times. 

These challenging times helped breed innovation. Professionals quickly learned to pivot towards virtual consultations, online education, and social media events. Interestingly, the exact opposite of what aesthetic practitioners feared would happen – happened. Due to this, as spas slowly reopened, clients became even more interested in spa treatments as a way to feel good about themselves while sheltering in place. 

During this time, what is commonly known in the health and beauty industry as the lipstick index, proved for the first time in 30-some years to be untrue. This phrase refers to the pattern in which people will still splurge on lipstick and other types of makeup during economically uncertain times. However, today people are less interested in makeup and more interested in skin and body care. They want treatments that make them look and feel good in the long run, without having to wear much makeup. Therefore, medical spa treatments are still in demand and the trend is predicted to climb.

Louis Silberman, CEO of National Laser Institute, pioneered the medical aesthetics training industry and is the largest educator in the country. Its medical spa operations see up to 3,000 clients per month. Silberman was a semi-finalist for the Ernst and Young Entrepreneur of the Year Award 2014 (prior award recipients include the founders of Google, Starbucks, and Amazon). Known for starting Health4her.com – a health and beauty retailer which became the sixth most visited pharmacy website with 500,000 visitors per month – out of his garage, Silberman has been written up in many publications, including Entrepreneur Magazine and Fortune Small Business. 

Even during COVID-19, non-surgical cosmetic procedures such as laser hair removal remain in high demand. While it has been commercially available for about 25-years, technology advances continue to make laser hair removal a very desirable procedure today. In fact, according to the website “American Society of Plastic Surgeons” as of 2019, it remains in the top five non-surgical cosmetic procedures, along with Botox and similar-type injections, dermal fillers, chemical peels, and microdermabrasion.

Louis Silberman, CEO of National Laser Institute, pioneered the medical aesthetics training industry and is the largest educator in the country. Its medical spa operations see up to 3,000 clients per month. Silberman was a semi-finalist for the Ernst and Young Entrepreneur of the Year Award 2014 (prior award recipients include the founders of Google, Starbucks, and Amazon). Known for starting Health4her.com – a health and beauty retailer which became the sixth most visited pharmacy website with 500,000 visitors per month – out of his garage, Silberman has been written up in many publications.  

Everyone knows by now that baking for long hours in the sun – think poolside, margarita in hand, body slathered in baby oil – is one of the deadliest sins of skin care (right up there with smoking, popping pimples, and not washing off makeup at night). But, clients often forget about the accidental sun exposure they receive almost daily while walking to their cars, driving, and taking their dogs for a walk. There is also forgetting to reapply sunscreen when engaging in outdoor sports and activities. All this makes more several opportunities for sun damage. Luckily, there is a solution for sun-damaged skin – good, old-fashioned (relatively speaking) photofacials.

With all the cutting-edge cosmetic treatments available today, it is easy to overlook some of the technology that has been around a little longer. Sometimes the basics are the best. Since the late 1990s, photofacials have been a very popular and affordable option for removing sun spots (and other common skin issues) and achieving more youthful-looking skin.

WHAT ARE PHOTOFACIALS?

Photofacials are intense pulsed light (IPL) treatments that passes through the epidermis, going deep within the skin, stimulating cells, and encouraging collagen production without damaging the skin’s surface layer. Treatments are quick (just 15 to 30 minutes for most body parts), noninvasive, have minimal side effects, and require no recovery time. While it is used more for tone improvement rather than wrinkles (though it does offer minimal temporary tightening), clients love the fresh, bright results they get from a photofacial.

Photofacials are used to treat unwanted brown and red spots including freckles, liver spots, sun damage, port wine stains, facial vascular lesions, cherry angiomas, rosacea, and acne (also killing underlying bacteria).

For deeper lines and wrinkles, photofacials are not an appropriate treatment. Those would be better suited for more invasive treatments such as deep peels, laser resurfacing, and injections of fillers and Botox.

One of the many advantages of a photofacial is that it can be used on any part of the body – face, neck, décolletage, hands, legs, feet, and so forth. It can also be used on larger areas such as the back. While photofacials can be used to treat smaller facial vascular lesions (spider veins or similar), they should not be used on larger leg veins including varicose veins (those should be treated with a 1064 laser or injected by a medical professional with a sclerosing agent).

Photofacials can be used to treat most skin types (Fitzpatrick I to IV) and, with extreme caution, some Fitzpatrick V types. An experienced laser technician will need to carefully evaluate the client’s skin to avoid creating any further discoloration. Most experts agree that Fitzpatrick VI types should not be treated with photofacials. All ages – from teenagers to senior citizens – can benefit from this treatment, as it is an excellent modality for improving tone, texture, and acne breakouts and even minimizing the appearance of acne scars. While photofacials do not resurface the skin like some other more aggressive treatments, they pull out redness from scars, making them less noticeable. Photofacials can also temporarily improve the appearance of oversized pores.

According to Kristin Warne, a certified laser technician and instructor, “Everyone loves photofacials. They are really one of the staples of our industry. I live and work in Scottsdale, Arizona, so we get a lot of snowbirds here from cold weather climates like Canada. My Canadian clients just rant and rave about photofacials. They are perfect for treating sun damage on faces, necks, hands, and bodies. Even when we’re not thinking about, we still get a lot of sun exposure, especially on our left sides when we’re driving. Photofacials handle that beautifully.”

Warne also enjoys working with teenagers who have been struggling with acne. “Acne can have such a negative effect on the way a person feels about themselves,” she says. “The results of a photofacial can literally change their world and their whole demeanor improves. It makes me feel incredibly happy, too.”

Unlike more aggressive treatments (which may yield more dramatic results, but with downtime involved), photofacials are gentle enough that clients can even be treated on their lunch hour. There is no recovery time involved. Treatments are quick and results are noticeable.

A photofacial involves very little pain. The device’s flashing light feels a lot like a very warm lightbulb touching the skin or the snapping of a rubber band. For more sensitive clients, a topical numbing cream can be applied to skin 20 to 30 minutes prior to treatment.

Clients should avoid sun exposure (and tanning beds – always) for at least two weeks (four weeks would be ideal) before photofacial treatments, so that the device’s light can more easily target brown and red pigmentation. It is important to stress this to the client in a pre-treatment consultation so that they will get optimal results.

With a photofacial, just three to five treatments (once a month) will typically do the trick for most skin issues, blasting away hyperpigmentation and leaving skin looking fresher, smoother, and more evenly toned. Results can last up to one year if sunscreen is used daily. Touch-up treatments can also take care of any new spots that pop up. Some clients return for treatments simply because they love the fresh-looking results they get with a photofacial.

Clients with acne may need more treatments, depending on the severity. Acneic clients can be treated once a week. A photofacial is very effective on acne and an excellent alternative to harsh prescription medications, both oral and topical, that have side effects and can overly dry out skin.

SIDE EFFECTS AND POST-TREATMENT CARE

Following treatment, there is some redness and minor swelling, but clients can apply an ice pack if they feel any discomfort. They can immediately resume their regular activities excluding anything that heats up the skin, such as exercise and steam treatments, for at least 48 hours. Small blisters and temporary brown spots may appear on some clients but fade quickly. Treated dark spots can sometimes harden and flake; clients should be told not to pick at any of these if they occur.

According to Warne, the most important thing clients can do after a photofacial is apply sunscreen – specifically, one with a high SPF (30 to 45) that blocks both UVA and UVB rays. It should be reapplied throughout the day and on all exposed face and body parts (ears, neck, décolletage, hands, shins, feet, and so forth). “Clients tell me they reapply sunscreen when they’re at the pool or on the beach, but they forget that when they’re working all day in an office and touch their faces, they are rubbing away their sunscreen,” she says. “Sunscreen makes such a difference, especially on our faces and hands, because they are exposed all day long.”

For clients with acneic skin, Warne recommends using a topical silver gel (available at many medical spas), which is used to treat wounds and burns and acts as an anti-infective agent; after applying the silver gel, they should apply sunscreen on top.

INCORPORATING PHOTOFACIALS INTO THE SPA

Because so many different types of clients can benefit from a photofacial, it is an easy add-on treatment to existing facial, peel, and hair removal clients. All a skin care professional really has to do is educate them about the amazing results of a photofacial.

It is a good idea to “tell stories” to make sales, as opposed to using traditional sales-y techniques. Most people do not appreciate when a service provider tries to push a product or treatment on them; even if done in a nice way, they will naturally resist. Instead, when doing a facial and the client is relaxed, explain that the spa is now offering photofacials and how other clients are getting excellent results with them. Their interest will peak. Give them an example of another client whose skin is smoother and more youthful looking because of a photofacial and how it has made such a difference in helping them get rid of age spots, acne, sun damage, and so forth – without any downtime. Once the client starts asking questions, mention that the spa is running a special for a limited time – maybe a package deal of three to five treatments – and if they would like to make a purchase today, they, too, can experience a photofacial. Sweeten the pot with a sample treatment on a small spot that has been bugging them.

Another advantage of a photofacial is that it can easily be paired with many topical products (that the spa probably already sells) to obtain maximum results. For example, to speed up lightening of darker brown spots, a topical skin lightening agent can be used between treatments without worrying about any interaction. Or, as mentioned previously for acneic clients, a topical silver gel works beautifully.

MANAGING CLIENTS’ EXPECTATIONS

Each client is different, and each client’s skin is different, too. So, it is important to fully discuss the client’s expectations and skin care goals before any treatment. Let them know what a photofacial can and cannot do (zap most types of red and brown spots? Yes. Eradicate wrinkles? No.), and how the client can help achieve better results by strictly following pre- and post-treatment procedures.

Warne says, “In my experience, 10 out of 10 clients are happy with a photofacial’s results. But I am also very honest with them upfront about what they should expect from one treatment, two, three, and so on.”

She remembers one male client in particular who had been bothered by an increasingly large sun spot on the left (driver’s) side of his face. He was dubious that a photofacial would actually get rid of the spot in just a few treatments. “I told him, you have to trust the process.” she says. “And sure enough, he was thrilled with the results.”

COST

Prices vary, depending on location and whether the spa is an upscale or discount type of business, but most photofacial treatments cost between $200 to $400 per treatment. Considering that each treatment takes only 20 to 30 minutes (depending on treatment area), and most clients require three to five treatments, photofacials can be a very lucrative treatment for the skin care provider.

When compared to other treatments, such as chemical peels (where redness can last significantly longer and peeling can be somewhat unsightly for a week or so) and microdermabrasion (where results are not as visible), photofacials remain a top choice for clients who are on-the-go but wanting visible results. They are proven, safe, and effective treatments to address sun damage, freckles, liver spots, port wine stains, facial vascular lesions, cherry angiomas, rosacea, and acne. Photofacials are an ideal choice for clients with light and medium skin types wanting smoother, clearer, younger-looking skin without any downtime. A photofacial may be one of the basics, but it works.

Louis “The Laser Guy” Silberman is CEO of National Laser Institute, a national cosmetic laser and medical aesthetic training center founded over a decade ago, and owns medical spas in Scottsdale, Arizona and Dallas, Texas. He is the author of “Make It Happen Online” and a motivational marketing speaker. Silberman created the sixth most visited health and beauty website and was a semi-finalist for the Ernst & Young Entrepreneur of the Year Award 2014. Contact him at This email address is being protected from spambots. You need JavaScript enabled to view it. and follow him on Instagram at louisthelaserguy.

Today, it is a no brainer that social media is an essential part of any spa practice’s business and marketing plans. However, utilizing this platform to its fullest potential can be a tricky task to master. From boosting posts to content planning and creation to dealing with negative feedback, here are top tips for creating an effective social media presence that any spa can incorporate.

BOOST IT FOR BETTER RESULTS

The ability to market directly to a target audience and even change or refine that audience when desired is just one of the many benefits of social media marketing. Boosting a post simply means paying to distribute the post to a specific audience. For example, a spa can select an audience that shops at upscale stores like Nordstrom, frequently purchases health and beauty products, is into fitness, has a college degree, likes dogs, or enjoys traveling. A spa can easily set a budget, the number of days to boost the post, and the number of people to reach.

Here is an example of the wonderful benefits of boosted or targeted posting. Imagine that a spa posts inspirational quotes and videos on their Instagram feed. They post about 10 times and notice the average engagement is around 100 people. Then, they post a video and engagement is over 300 people. So, they decide to spend $70 to boost it, targeting people who like inspirational and motivational posts, as well as health and beauty. The inspirational video reaches individuals interested in health and beauty who then decide to click on the spa’s story (the little circle with the spa’s profile photo at the top left, showing what the spa has been up to the past 24 hours), which leads them to direct message the spa with questions and then purchase services. Perhaps the original intention was to inspire, not necessarily to sell, but through boosting their post, the spa does both – a win-win.

You can easily do the same. Every 10 or so posts, track how many likes, shares, and views you are getting. If you post a video that gets 200 views, it is obviously more engaging than one that gets only 20. Boost popular posts to maximize reach. The key to boosting posts is selecting those that have already gotten good organic views from the existing audience. Although it is a form of pay to play, boosting is a powerful marketing tool because it minimizes a lot of the risks associated with traditional advertising such as radio, television, and print. You are not shooting in the dark because you already know the post engages the audience.

PLANNING POSTS

Social media is one of the easiest and most affordable forms of advertising, but there is a catch. Because we are all walking around with smart devices these days, we are pretty casual when it comes to posting. It only takes a few seconds and boom – you are out there. This is fine when sharing cute pictures with buddies, but not always a good thing for a business owner or employee trying to grow his or her business. In business, think before posting. Consider the content, visuals, and message carefully.

In fact, sit down for an hour each week and plan out the next 14 posts. Post a minimum of once a day, but no more than twice – stay in front of the customer but do not bombard them. If short on time, find a free or low-cost scheduling app or platform that will publish pre-scheduled posts.

CONTENT IS KEY

How about those posts from friends, family members, and businesses where they are always trying to sell something? Even if the posts are visually pleasing, do you look forward to them? Probably not. That is why no more than 25% of posts should be salesy. The other 75% should be engaging but also relevant to the business or you personally. If you enjoy traveling, cooking, or reading, find a way to incorporate those bits of your personality into posts. Viewers appreciate knowing that you are much more interesting than a “limited time only and special offer.” They want to know what makes the business unique and how you bring that quality into the business.

HANDLING NEGATIVE COMMENTS

In the game of social media, everyone has an opinion and those opinions are not always subtle or kind. In fact, they can be brutal. However, if the complaint or comment is a valid concern, use the opportunity to turn it around in the spa’s favor. Respond quickly and professionally. Response time is probably the most important factor in this scenario – do not let something negative go unanswered for days or weeks, allowing others to see it and perhaps even plant seeds of doubt about the business.

On the other hand, if someone is being a hater on your feed, there really is not a need to respond. Try to delete or hide the post and move on. If it cannot be deleted, tell the person you appreciate their concerns, show them some empathy, and explain your side of the story, but do not be defensive. Other viewers with nicer personalities and less time on their hands for nonsense will recognize that Mr. or Ms. Grumpy’s comments are unwarranted, so do not worry too much about losing hard-earned reputation to someone who is spouting off.

GETTING PERSONAL

Comments are also a terrific opportunity to build relationships with those who reach out. If a viewer asks a simple question such as, “How much does the treatment cost?” or “Does the facial work on acne?” post a generic response and send them a direct message with details. Doing it this way is much more personal and allows the viewer to perhaps open up privately about their struggle with acne. It also offers some tailored suggestions that might work for them, such as “I offer a chemical peel that is wonderful for clearing up skin and I also have a product that I think you would love.” Throw in a few simple emojis, making the dialogue seem less formal, more personal, and more memorable.

CONTENT CURATION

It is important to share other people’s and business’ information. Some may be thinking, “Why should I post other people’s content? Won’t that take viewers away from my page? I thought the idea was to keep them reading my stuff!” That is a legitimate concern, but content curation, when carefully done, actually helps you become a trusted source of valuable information. Content curation focuses on finding and sharing the best information available – it should be quality rather than quantity.

For example, Gwyneth Paltrow’s website, Goop, has become a well-known source for alternative (and sometimes controversial) health and beauty referrals, among other things. You will not find many articles on Goop that are mainstream or yesterday’s news, but if looking for an expert on what types of crystals to keep in the workplace to encourage serenity, Goop’s got just the right person (and article) for it. The actress has established herself (and her e-commerce business) as an expert on things that might not be found elsewhere.

Of course, it is not beneficial to encourage viewers to hop over to a competitor’s social media feed or website, so do not share their posts. But posting about the latest and greatest treatments and products, industry specialists, celebrity beauty obsessions, and more can both entertain and educate viewers and they will start looking forward to those posts because of the time taken to share something valuable. Sign up for alerts from relevant sources (industry publications, celebrity news, and other sources), and during weekly, one-hour planning sessions, think about content curation, too. Ask if the articles to share and repost add value to the audience. Do they educate, inform, or entertain? Are they from credible sources? This cannot be stressed enough. One article that you did not properly vet can do more damage than 10 good ones. Add a few comments regarding why the content would be valuable to followers and be sure to credit any sources used.

A FEW DOS AND DON’TS

Do: Post balanced content, varying between entertainment, special offers, funny and light-hearted moments, expert and educational information, and other forms of content.

Don’t: Include profanity. Even though it seems like everyone curses these days, refrain from cursing in posts. You never know who will be offended, and you just might lose someone’s business over something that was not necessary. The same is true for inappropriate pictures or videos (for example, too much skin-baring or anything with sexual references). Keep it professional.

Do: Post content that is synergistic to the business’ goals; even if it is something random, funny, or obscure, find a way to tie it back to the brand.

Don’t: Slam anyone, whether it is the worst customer ever who is blasting you on social media, a gossipy ex-boyfriend, or shady competition. The business’ social media pages should always focus on the positive.

Do: Take posts seriously (even when they are light-hearted). Social media has become one of the most powerful marketing tools known to humans – you are not just posting, you are building a business.

Don’t: Post without triple-checking grammar, spelling, and accuracy.

GOING VIRAL

What makes any post go viral? Whether it is an article, video, or picture, posts that go viral contain something that followers feel is share-worthy. Often, it is something very funny, slightly shocking, or unique in some way. Going viral has put many small, unknown companies on the marketing map, simply because they (or their marketing departments) created content that was share-worthy. An example that comes to mind is the Dallas-based company PooPourri, an essential oil spray that blocks the scent of well, you can probably figure it out from the company’s name. PooPourri launched a humorous video in 2013 entitled “Girls Don’t Poop” and, to date, it has had more than 42 million views on YouTube. Why did so many people share the video? Because it is hilarious, a little shocking (crass, yes, but not too crass), and relatable – everyone worries about bathroom smells.

Use this as a template for your own attempts to go viral. What can you say or do that will make the spa stand out in a good, fun, or heartwarming way, and be share-worthy? Brainstorm with friends, family members, and co-workers. All that is needed is some creativity and a camera.

When it comes to growing a business, think about the client. Tailor posts to what interests them while, at the same time, staying true to who you are as a business and individual. And, always, have fun while doing it.

Louis “The Laser Guy” Silberman is CEO of National Laser Institute, a national cosmetic laser and medical aesthetic training center founded a decade ago, and owns medical spas in Scottsdale, Arizona and Dallas, Texas. He is the author of “Make It Happen Online” and a motivational marketing speaker. Silberman created the sixth most visited health and beauty website and was a semi-finalist for the Ernst & Young Entrepreneur of the Year Award 2014. Contact him at This email address is being protected from spambots. You need JavaScript enabled to view it. and follow him on Instagram at louisthelaserguy.

Results are everything. In the aesthetics business, this is especially true. If clients are not seeing smoother, firmer skin as a result of services, they will not keep coming back for more. But, this is just step one. Seeing great results or simply talking about them is only part of the picture. If a professional want to grow their business, then they also have to share great results. That is why, when it comes to getting the word out to new and existing clients, collecting testimonials and before and after photos and videos is absolutely essential.

DEVELOP A HABIT
There is a famous quote that goes something like this: “The best time to plant a tree was 20 years ago; the next best time is now.” Any professional should have been taking before and after pictures for every single treatment performed since they first hung up their open for business sign. But, if not, now is the time to start doing so. Plant that tree today.

There are so many reasons for taking before and after pictures and videos and marketing is just the tip of the iceberg. No matter how skilled or careful an aesthetician is, things happen. Clients are not always forthcoming about the last time they used retinols or hopped under a tanning bed. Heck, there is even the occasional client who “forgot” to mention that they have just had surgery, who is on blood thinners or antibiotics, or who got Botox two days ago. When it comes to looking good, it seems like people are sometimes willing to take unnecessary risks. While that is a scary fact in this business, it is also a very real reminder that a professional should not be one of them: risk plus risk invariably spells disaster. As a business owner or service provider, professionals have to protect their interests and be able to cover any potential liability. A simple before picture speaks volumes to the difficult client who insists that she now has a hole in her face because of the chemical peel that was given to her. This is not about he said she said – it is about good business practices in general. Professionals should look out for their clients and themselves.

WHICH ONES DO I SHARE?
One might think all of them – because any marketing is better than no marketing, right? Wrong. Professionals should not share any before and after pictures that do not clearly demonstrate significant improvement. Before and after pictures where potential clients cannot really tell the difference between the two and need a magnifying glass to see whether they are missing something can actually hurt a professional’s credibility, rather than help it.

So, whether posting on a website, Facebook, Instagram, Twitter, or other social media or distributing pictures through marketing materials, the rule of thumb is: do not post or publish just for the sake of posting. Make sure it is something that will be viewed as miraculous – so much so that viewers will want to book an appointment right away.

GETTING PERMISSION
When taking before and after pictures or videos for every client, ask everyone to sign off on a form in which they give permission to publish their pictures. Again, only those that show amazing results should be shared, but having those signed forms in the client files will save many headaches, not to mention potential legal concerns. Many clients are happy to share their images; others will do so only if their identities are withheld; a few will say no, and that is okay, too. Professionals can also offer an incentive as enticement, such as a free product or service.

THE POWER OF VIDEO

Videos are quickly becoming even more popular than still images. Videos feel more personal and interactive – the trick is finding the sweet spot for optimal viewer engagement. In general, they should not be too long, too short, or too technical, though they should be informative and entertaining. Fifteen to 30 seconds is typically plenty of time to demonstrate the product or service being promoted. While one does not need to hire a professional to film the videos, keep in mind that the viewers will see everything and everyone in the treatment room, so it should be pristine. 

A good question to ask before posting a video is, “Would I want to watch this?” It sounds simple but think about it. If the clients in the video look like they are bored out of their minds, would you want to watch it? What if, instead, they are having fun and talking about the procedure that is going on and the client is explaining how her skin used to be very sun-damaged and she was self-conscious about it and now she looks and feels so much better about herself? These are the types of videos that typically get more views.

OTHER TYPES OF TESTIMONIALS
While images are fast and powerful to the viewer, do not limit marketing efforts to pictures and videos alone. There are many other ways to share great results that will not cost a dime.

Written testimonials are perfect for a website, Facebook, or Yelp page, which many clients will access before making the decision to book an appointment. If a potential client sees multiple glowing reviews about the services, it will reassure them that they have come to the right place.

Interview formats are not only fun to either write or film, but can also be turned into blog posts, YouTube videos, or articles that could even be published in local magazines and newspapers. Come up with a list of five to 10 questions and ask favorite clients to answer them. Focus on the services where he or she got the best results, but also throw in a few personal questions to round it out. If filming the interview, practice a few times with the client before recording.

Speaking of getting published, many local magazines (both digital and print) and newspapers are hungry for personal interest stories with a feel good ending. Google the publications nearby and check their websites for editors’ contact information. Do not be afraid to reach out and let them know about a unique story
in which they might be interested.

Testimonials and before and after pictures are one of the easiest, least expensive ways to market a business. Do not hesitate to ask clients to help in this area. They will probably be happy to do so, and, in the process, they will underscore the professional’s credibility and capability a thousand-fold.

Louis “The Laser Guy” Silberman is CEO of National Laser Institute, a national cosmetic laser and medical aesthetic training center founded a decade ago, and owns medical spas in Scottsdale, Arizona and Dallas, Texas. He is the author of “Make It Happen Online” and is a motivational marketing speaker. Silberman created the sixth most visited health and beauty website and was a semi-finalist for the Ernst & Young Entrepreneur of the Year Award in 2014. Contact him at This email address is being protected from spambots. You need JavaScript enabled to view it. and follow him on Instagram at louisthelaserguy.

When it comes to exfoliation, the skin care industry is rich with options, each providing a variety of results. Understanding the differences between various modalities can not only aid professionals in equipping their spas with the right tools, it can also help in knowing which method to choose based on each client’s desired results and expectations for downtime and cost.

Most are probably familiar with the saying, “Out with the old, in with the new.” While the concept can be applied to many things, it speaks directly to the process of exfoliation, which refers to any means of removing dead skin from the surface, thereby encouraging new skin growth.

And, while exfoliation is all about new skin, there is nothing new about exfoliation. Humans have been purposely sloughing, scrubbing, and shedding their epidermises throughout history: ancient Egyptians made scrubs with alabaster and sand; American Indians used dried corn cobs; and folks in the Middle Ages discovered old wine made an excellent peel. Today, “fish pedicures” have clients dipping their tootsies in water containing dozens of tiny Garra rufa fish that nibble away at callouses.

With such intriguing methods for sloughing off dead skin, exfoliation must be important. But, why is exfoliation so important? For starters, as individuals age, cell renewal naturally slows down, leaving the top layer of skin dead, dull, and thickened. Crystal Disheroon, certified laser technician, clinical laser educator, and licensed aesthetician, compares this process to the body’s metabolism, which also decreases as individuals age. If a person does the same exercises every day or eats the exact same diet, they will either gain weight or hit a plateau. How do they counteract plateaus? By continuously surprising their body with new exercises and alternating the foods they eat. In the same way, exfoliation surprises the skin; by removing old cells, new cells will continuously regenerate at a faster rate.

Exfoliating also allows moisturizing, antiaging products to penetrate more deeply, rather than being absorbed by the dry top layer. For those with oilier, thicker skin or tendencies toward clogged pores, acneic skin conditions, folliculitis, pseudofolliculitis barbae, or keratosis pilaris, regular exfoliation reduces the possibility of bacteria pockets developing under dry skin and worsening these conditions.

If these reasons to exfoliate are not enough, how about the skin’s physical appearance? As one might suspect, dead skin does not reflect light, which makes it appear less luminous – and lower luminosity means less youthful-looking skin. Additional benefits include improved texture, a softer feel to skin, and minimized fine lines and pores.

This leads to the million-dollar question: what type of exfoliation is best for the skin?

Are there concerns for sensitive skin types? How often should one exfoliate? And what about pre- and post-exfoliation recommendations?

It is time to shed light on shedding skin.

AN OVERVIEW OF EXFOLIATION MODALITIES

There are three basic types of exfoliation: physical/manual, chemical, and mechanical/equipment.

Physical

Physical/manual exfoliation refers to any means of removing dead skin with the use of an abrasive brush, implement, or product. Exfoliation is performed either wet or dry by massaging, brushing, scraping, or filing the skin. Tools include dry skin brushes for the face and body, loofah sponges, washcloths, cleansing cloths, surgical scalpels (dermaplaning), and stainless-steel tools with a crushed diamond head piece (dermafiling). (Note: Some would include microdermabrasion in this category, although others would place it more in the mechanical/equipment category).

Many of these modalities may be performed at home but to avoid any risk of infection, dermaplaning and dermafiling should be performed only by a skin care professional. Dermaplaning removes dead skin cells and also vellus hair and pore congestion, such as black heads. Dermafiling provides similar results but skin is filed, rather than scraped, with a blade.

There are many products that physically remove dead skin – typically scrubs and cleansers with added exfoliating particles, including beads, ground pumice, rice particles, nut shells, diamonds, crystals, and diatomaceous earth (which is almost entirely made of silica). Some products are more aggressive than others and, while it might feel good or at least productive to use a harsher version, it is important not to tear the skin or cause abrasions. In particular, ground up walnut shells and apricot kernels are quite rough and jagged and should be used with care.

Beads made of plastic, known as microbeads, are rounder and smoother than shells but no longer available because they are derived from polyethylene and, therefore, not biodegradable. Eco-friendly alternatives are often made from bamboo and jojoba beads, both of which are gentle enough for regular use and do a nice job of exfoliating without harming the skin.

Chemical

Chemical exfoliation includes chemical and enzyme peels. The main difference between chemical and physical/manual exfoliation is that chemical peels are applied topically and the ingredients do all the work by penetrating into the skin’s glue layer.

Chemical peels include: alpha hydroxy acids, including lactic, malic, tartaric, citric, and mandelic; beta hydroxy acids, the most common of which is salicylic acid; trichloroacetic acid (TCA); and phenol. Many enzyme peels are naturally derived from active ingredients in fruits, including papaya, pineapple, and pumpkin.

Most peels either go through or around skin cells and destroy them. Alpha hydroxy acids disrupt the ionic bonding of corneocyte cohesion by dissolving the lipid bonds between the cells at the lower levels of the stratum corneum, causing the cells to unglue and shed. Beta hydroxy acids dissolve the glue that holds corneoctyes or dead skin cells in the top layers, allowing fresh cells beneath to emerge.

Mechanical

Mechanical/equipment exfoliation simply utilizes machines or specialized equipment to remove dead skin. Equipment ranges from devices suitable for homecare – such as electronic cleansing brushes – to equipment found in medical spas, like direct and indirect high frequency, microdermabrasion, and laser/IPL devices.

EQUIPMENT EXFOLIATION 101

Electronic cleansing brushes have come a long way since they first became popular in the at-home market about 14 years ago. They now come with regular or sensitive brushes and some are tapered to reach the nooks and crannies around the nose, mouth, and eyes. They also come with a wide range of price tags. While many people swear by their electronic cleansing brushes for both deep cleansing and exfoliation, most experts agree – clients should not overdo it. Once every day (or every other day, depending on the skin) is sufficient, and the brush should not be combined with harsh or exfoliating cleansers.

There are two methods of high frequency: direct and indirect. Direct high frequency increases circulation, helps reduce bacteria on the skin, and aids in exfoliation. Indirect high frequency involves the use of a current and may be combined with oils that aid in exfoliation.

Microdermabrasion has been popular for a number of years. It continues to be an in-demand treatment and with good reason. It is suitable for all skin types, has no down time, and can be used with antiaging serums and many other treatments, including chemical peels, for enhanced results. The hand piece is used to lightly spray medical-grade crystals across the skin, which sloughs off dead cells, and a suction attachment vacuums them up and away. There has been some question as to whether the tiny crystals can get embedded in the skin; for that reason, there are also crystal-free hand pieces which use a diamond-tipped head.

At the medical spa level, there are several options, including: laser resurfacing treatments that apply a 2940 erbium ablative laser beam over the treatment area, removing a fine layer of skin and helping create a skin renewal process; medical-grade hydradermabrasion that cleanses, exfoliates, and infuses skin, utilizing high pressure water infused with active serums and a vacuum to remove surface cells (clients often see immediate benefits of increased hydration, clarity, and tone0; and a combination of LED and ultrasound – first, a hand piece that feels like rough paper exfoliates, then, it creates CO2 bubbles to bring oxygen to the tissue. These treatments may be performed on the face or body.

Advantages of Equipment Exfoliation

One of the biggest advantages of equipment exfoliation is what is known as long-term collagen remodeling. While this can be achieved in moderation with less aggressive treatments, in general terms, the more aggressive the treatment, the more dramatic the result.

Equipment exfoliation can also be more precise and targeted and any time it is combined with a heating element, it will result in skin that is tightened, giving it that toned, more youthful appearance.

According to Michelle Williams, certified laser instructor and clinical laser educator, a client’s decision to choose equipment exfoliation over other types should factor in not only the results he or she wishes to achieve but also skin type, lifestyle, and budgetary considerations. “Clients love the faster, more dramatic results that typically come with equipment exfoliation but, because these treatments go a bit deeper, there’s often more downtime associated with them. If someone cannot take off a few days from work to heal, then it might not be the right choice. Also, because they’re results oriented, they tend to be more expensive,” she says.

WHO IS A GOOD CANDIDATE?

Without a doubt, skin type plays a key role in determining whether a client is a good candidate for equipment exfoliation. Those with Fitzpatrick skin types I through IV typically do well with it, while those with skin types V through VI have to be a bit more careful to avoid potential hyperpigmentation. “We also have to look at what subcategories a client might walk in with,” says Disheroon. “For example, a client might be a II on the Fitzpatrick [scale] but also have melasma or sensitive skin.” Men who shave every day are often good candidates for equipment exfoliation because their skin is not only thicker but already accustomed to the daily shedding process.

However, those with sensitivity, rosacea, and acne may do best with chemical peels because physical and equipment exfoliation can aggravate their conditions. “Each layer of skin communicates with the layer adjacent to it; when you remove the top layer, it tells lower layers to make new cells. So, if a client has, say, acneic or bacteria-prone skin, it will produce more of the same,” says Disheroon.
The 2940 laser treatment can also be used to treat crepiness on the neck and chest, providing collagen production up to 12 months.

If a client is simply wanting smoother skin, he or she might do well with a series of chemical peels or a mild laser peel to get a rosy glow. But, if there are deep acne scars, surgical scars, or stretch marks involved, then, more aggressive treatments will be required. “This is why it’s so important [for clients] to consult with a skin care professional before any type of treatment – someone who really understands the skin and will take into account other factors,” Williams say. “If a client has sensitive skin, budgetary, or downtime restrictions, we can stretch out a series of less expensive treatments over time so that results are cumulative. We can get close to the results that more aggressive equipment offers; it will just take more time and patience.”

PRE- AND POST-CARE FOR EQUIPMENT EXFOLIATION

When using exfoliation equipment, sun exposure should be avoided for a minimum of two weeks prior to treatment. Retinoids, whether prescription or over-the-counter, should also be avoided anywhere from two days up to two weeks, depending on the strength.

With more aggressive treatments like the 2940 erbium ablative laser, a numbing cream is typically applied 30 minutes prior and downtime lasts five to seven days. Skin will be slightly blistered and swollen, similar to a bad sunburn, and a moisture barrier ointment should be applied for three to five days until skin heals.

Following treatment, skin should be cleansed with a mild, non-oily cleanser. A vinegar and distilled water rinse may also be applied, beginning on the day after treatment, three times a day for three days, to normalize the skin’s pH balance, minimize inflammation and risk of infection, and encourage the healing response.

More aggressive treatments can cause skin to purge impurities, so clients who tend to break out following treatment can also apply an antibacterial, antimicrobial gel to prevent this. Lotions with copper peptides, cooling agents, and mild enzymes can also be applied with care to help reduce inflammation, discomfort, or scar tissue formation.

Once skin is no longer red or irritated, foundation makeup can be used and an SPF of 30 or higher is a must, as skin will be especially sensitive to sun exposure. Tinted sunscreens are ideal post-treatment because they tend to be gentler and easier to wash off.

Exercise should also be avoided until skin is no longer red or swollen.

COMBINING EQUIPMENT EXFOLIATION WITH OTHER PROCEDURES

Some equipment procedures, such as IPL photo facial, do provide mild exfoliation because they produce heat, but they do not really remove much of the stratum corneum. However, applying a salicylic acid directly after a photo facial treatment can help penetrate products more deeply into the skin.

Photo facial can also be performed before 2940 erbium ablative laser peels and before fractional laser treatments.

Very oily, photo-aged, and leathered skin may benefit, first, from either a microdermabrasion treatment or dermaplaning to remove the top layer and bring oxygen to the skin via circulation, followed by a simple facial and glycolic or TCA peel. For the same type of skin but with added laxity, a 2940 erbium ablative laser peel yields excellent results.

EXFOLIATION FREQUENCY

Disheroon and Williams agree that mild exfoliation (brushes, gentle scrubs, products containing mild acid, retinoids, and so forth) should be part of a regular routine to keep skin looking polished. Clients with oily, thick, or photo-aged skin can typically exfoliate every day. Clients with normal or combination skin can exfoliate as often as every day or every other day. For sensitive skin types, exfoliation might be every two or three days. “If a client incorporates exfoliation into her or his regular routine, they can help prevent or at least slow down dead skin buildup,” Williams says. If skin experiences increased oil production, acne, dryness, sensitivity, or so forth, clients should simply back off on exfoliation for a day or so.

Major exfoliation (like equipment exfoliation) can be performed once every few months to keep a rosy flow and sun damage at bay. “Once you get your skin in the condition that you want,” Williams says, “then it’s just about maintenance. Most clients come in once every few months for milder forms of exfoliation and once a year, or even every other year, for more aggressive options.”

Regardless of skin type, many clients believe they get the best results from exfoliation by switching back and forth between physical, chemical, and mechanical modalities. As Disheroon reminds about keeping physically fit, “Doing the same exercises all the time yields the same results. The same is true with our skin. By continuously trying new types of exfoliation, we get different and better results, and many of these results are cumulative.”

Working with clients to determine the best types of exfoliation for their skin types, lifestyles, budgets, and skin care goals is an important step in helping them put their best face (or, in this case, skin) forward.

Louis “The Laser Guy” Silberman is CEO of National Laser Institute, a national cosmetic laser and medical aesthetic training center founded a decade ago, and owns medical spas in Scottsdale, Arizona and Dallas, Texas. He is the author of “Make It Happen Online” and is a motivational marketing speaker. Silberman created the sixth most visited health and beauty website and was a semi-finalist for the Ernst & Young Entrepreneur of the Year Award in 2014.
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