Like it or not, clients performing their own skin care treatments at home is an all too common reality for most professionals. In some cases, these homecare efforts can complement professional treatments and help maintain results between appointments. However, in other instances, these attempts can lead to undesired outcomes and even serious damage. When it comes to chemical exfoliation, while there are some peels that can be safely performed at home, others are best left to the professional. Communicating the difference to clients is vital.
Entrenching itself as a cornerstone of effectual skin care, exfoliation is one of the most effective therapeutic skin treatments an individual can implement to achieve younger, healthy-looking skin. But, unless harnessing the genes of the goddess Athena herself, achieving a coveted glass-like complexion requires a bit of diligence. Through the process of exfoliation, dead skin cells that have accumulated on the skin’s surface, giving the skin a dull appearance, are removed through physical or chemical means. And, while both methods essentially provide a smooth and polished result, the difference lies in the manner in which dead skin cells are loosened, as well as the range of benefits each can provide. Regardless of age, exfoliation is a necessary step that should become a staple of any skin care regimen.
BENEFITS OF EXFOLIATION
Contrary to physical methods, which utilize an array of scrubs or manual tools to polish away dead skin cells through friction, chemical peels employ a variety of acids which work to loosen and chemically dissolve the intercellular glue that holds keratinized skin cells together. This process creates a controlled wound which allows the skin to regenerate itself.
Introduced in the late 1980s, earlier acids were considered unstable and presented a cause of concern to clients. Today’s formulas, however, are much safer and the chemical peel is in many ways considered a gentler option than some of its physical counterparts. And, with such a broad range of acids available, a professional is able to devise a tailored approach consistent with the client’s skin type, condition, and expectations.
While chemical exfoliation can result in discernible improvement in the skin, it is imperative that the client has an understanding of not only their own skin type and needs, but also which chemicals are safe for use at home and which should only be performed in a medical setting by a licensed skin care professional. Generally speaking, the type of chemical peel, along with its strength and pH, will determine its level of user-friendliness. In any case, professionals should discuss safe at-home practices with their clients to ensure they gain a working knowledge of products, safety precautions, and post-care, which is necessary to avoid causing serious damage to the skin. The goal is to integrate chemical exfoliation into a skin care regimen in a way that allows for effective, consistent results, while providing for client safety and avoiding overuse, which can lead to unnecessary irritation and unwanted side effects.
TYPES OF PEELS AND WHICH CAN BE USED AT HOME
The safest at-home approach to chemical exfoliation comes in the form of enzyme peels. Fruit enzymes, such as papain (papaya), bromelain (pineapple), and protease enzymes, break down the keratin in skin by decomposing proteins into smaller fragments, which induces a sloughing of dead skin only. This process causes no injury to live tissue, making enzyme peels a suitable choice for those clients with sensitive skin or clients looking to achieve softer skin and refined pores with no downtime.
Enzymes aside, acid-based chemical exfoliants normalize cell turnover in the epidermis and stimulate healthy skin formation resulting in a more youthful appearance. These acids generally fall into two categories: alpha hydroxy acids, including lactic, glycolic, citric, malic, and tartaric acid, which are the mildest of all chemical peels; and beta hydroxy acids, which include salicylic acid. While beta hydroxy acids effectively break down the bonds between cells, alpha hydroxy acids primarily affect the skin by normalizing skin cell turnover in the epidermis, thereby causing the cells themselves to detach. Because they are water-soluble, alpha hydroxy acids cannot penetrate deep into pores, making them less effective than beta hydroxy acids, which reach deeper into the skin and pores. Both fall under the category of superficial peels, while Jessner and TCA peels are considered medium deep peels. Phenol peels are the deepest type of chemical peel and should always be administered by a physician.
Alpha Hydroxy Acids
A gentle, lightweight peel to begin with is a lactic acid peel. Made from sour milk, lactic acid is an excellent peel for at-home use because it provides hydration to chronically dry skin, improves minor wrinkles, and directly inhibits tyrosinase activity which aids in the improvement of pigmentation, all with little to no visible peeling.
A second alpha hydroxy acid, glycolic acid, is derived from sugar cane and has the smallest molecular structure of the alpha hydroxy acids, allowing it to penetrate into the deeper layers of the skin. Glycolic acid peels diminish the appearance of fine lines and wrinkles, stimulate the production of collagen, refine skin texture and post-acne indentation, brighten skin, and combat hyperpigmentation. The results of a glycolic acid peel are cumulative and, with consistent use, will deliver excellent results. Safe to use during pregnancy, glycolic acid is a user-friendly, at-home method of exfoliation, so long as the client is mindful of the warning signs of overuse, such as excessive dryness and irritation. Ideally, the client should use a glycolic peel with a pH between two to three and a concentration of 30 to 50 percent, never exceeding 70 percent. As a precaution, at-home peels are usually buffered with slightly higher pH levels, providing extra time as a measurement of safety for the client.
Mandelic acid, an alpha hydroxy acid derived from bitter almonds, is a gentle, yet effective exfoliator that improves skin texture, refines skin tone, reduces acne, and improves fine lines and discoloration. And, since its molecular structure is larger than that of other alpha hydroxy acids, mandelic acid penetrates the epidermis slowly and more consistently, making it less likely to cause irritation and inflammation. It is a great peel for all skin types that can be used weekly. The mandelic acid can be applied at a 20 to 25 percent concentration, leaving higher percentages to licensed professionals.
Beta Hydroxy Acids
Unlike alpha hydroxy acids which are water-soluble, salicylic acid is an oil-soluble beta hydroxy acid which penetrates and exfoliates the pores deeper, effectively dissolving congestion and debris, which makes it an excellent peel for the treatment of acne. Salicylic acid has anti-inflammatory properties and does not increase sun sensitivity, or erythema, as does glycolic acid, and is great for treating photodamage, skin discoloration, and the buildup of dead skin. This peel is contraindicated for clients with a sensitivity to aspirin products.
With versatility of depth as a superficial, medium, or deep application, the Jessner peel is comprised of equal parts lactic acid and salicylic acid, with or without resorcinol, in a 95 percent ethanol solution. It is available in one strength, with the level of depth determined by the amount of layers of the solution that are applied. This alpha and beta peel is an excellent choice for clients with oily or acneic skin looking to improve cystic acne, as well as clients hoping to diminish the effects of photoaging, melasma, and post-inflammatory hyperpigmentation. Clients may experience frosting, an effect in which areas of the skin turn white due to the skin’s surface being exfoliated away by the acidic solution. Downtime from this application can range anywhere from a few days up to a week.
The trichloracetic acid (TCA) peel is a highly versatile, professional-strength acid classified as a medium-deep peel according to the strength and percentage being used. While TCA peels are generally well tolerated by most skin tones, the risk of pigment change in darker skin tones warrants a cause for strong precaution. TCA peels effectively treat advanced pigment irregularities, deeper wrinkles, skin laxity, acne scars, rough skin texture, and photodamage. As a superficial peel, it can be used in conjunction with salicylic acid or other acids. It is recommended that clients initially administer this peel at a lower percentage of 15 percent and seek the consultation of a physician for percentages above 20. TCA peels are the strongest among the medium-deep peel category with an accompanying downtime of 7 to 10 days.
Phenol (carbolic acid) peels are the strongest chemical peel solutions which penetrate the lower dermal layer and result in dramatic facial rejuvenation with long-lasting results. Always administered by a physician, this aggressive peel addresses more serious skin concerns such as deep, coarse wrinkles and imperfections such as blotchiness, acne scars, and pre-cancerous growths. A pre-treatment course of products carefully selected by a physician, usually a retinoic acid, should be adhered to for several weeks to prepare the skin to allow for deeper and more even penetration of the chemical solution. Before the peel, the client will be administered a local anesthetic or sedative to manage discomfort during the procedure. Recovery is lengthy and uncomfortable compared to other peels and is generally performed only once or twice in a lifetime.
When the depth and intensity of a peel is increased, so are the results. There is also a rise in downtime, peeling, inflammation, healing, and the risk of complications. For the client looking to administer chemical peels in the comfort of their home, the safest approach is to begin with superficial peels, applying the product at the lowest strength to gauge sensitivity, increasing the percentage and the time of application accordingly. It is imperative that the peel is purchased from a reputable source and attention should be paid to the expiration date, as product strength and effectiveness will change over time. The client should have a general working knowledge of the product’s pH and acid content, because in the hands of an untrained person, an acid having a pH of 3.0 or below could injure the skin and result in permanent scarring. Also, the client must be aware of the various complications that may occur during and after a chemical peel, as well as the important of practicing diligent pre- and post-treatment care. Immediate complications will occur within minutes to hours of performing a chemical peel and include pruritus, erythema that does not subside, edema, burns, and irritation. Delayed complications may present within days up to weeks post-treatment and may include allergic reactions, scarring, milia, hyper- or hypopigmentation, and infection. The risk of complications increases with the depth of the peel and is more prevalent in clients with darker skin tones.
DOS AND DONT’S
With the health and safety of the skin being of optimal importance, there are some guidelines the client should follow in regards to what not to do before, during, and after administering a chemical peel at home.
Clients with darker skin tones or who notice dark spots after acne breakouts from bug bites should not perform chemical peels. Clients should not perform a chemical peel if they have open cuts, wounds, or a sunburn. Clients with cancer or an autoimmune disease should not do at-home chemical peels. Teach clients no to pick, peel, scratch, or scrub their skin. Also, they should not exercise or sweat for a few days following a chemical peel. Clients should not perform a chemical peel if prone to cold sores. They must not use electronic exfoliation devices after a chemical peel until the skin is healed. Teach them not to perform a chemical peel if they have been off Accutane less than six months. Educate them on not waxing or bleaching the area at least three days before administering a chemical peel. Clients should not skimp on the sunscreen. It is especially important after exfoliation of any kind. Lastly, they should not use chemical exfoliants such as alpha hydroxy acids or beta hydroxy acids, ascorbic acid, or prescription retinoids for at least 10 days following a peel.
To maximize the benefits of a chemical peel, the client should practice vigilant post-care by incorporating hydrating products into their regimen that promote wound healing. Skin-identical ingredients such as hyaluronic acid, ceramides, and peptides work to repair damage and strengthen the skin’s natural moisture barrier. Performing a patch test will help a client determine skin sensitivity prior to administering a product and thus avoiding an allergic reaction. It is crucial that the client follow the instructions on the product carefully and discontinue use should the skin exhibit excessive redness or swelling, burning, oozing, blistering, or pain. Immediately after application, a broad-spectrum sunscreen should be applied, as well as during the healing period and afterwards to avoid pigmentation issues. Administering the peel at night is ideal because the active ingredients in the peel will encourage skin repair.
Gentle enzyme peels and superficial chemical peels such as alpha hydroxy acids or beta hydroxy acids are considerably safe for at-home use, considering the client follows the instructions on the product carefully and practices conscientious post-care. And, while it is advised to practice extreme caution when self-administering medium-strength peels such as Jessner peels, these are best performed under the guidance of a licensed professional. Deep peels, such as phenol chemical peels, penetrate the middle layer of skin very deeply and should never be practiced at home.
As licensed professionals, it is important to counsel clients on the possible complications that can be anticipated both during and following a peel, as well as discussing preventative techniques to ensure a safe and pleasant experience. The importance of adequately priming the skin before administering a chemical peel, as well as post-care and the benefits of each should be explained. Take the opportunity to identify clients who may be at risk of increased complications through proper consultation. Those factors that may affect the type of peel the client receives and contraindications to receiving treatment may include past medical conditions, allergies, products the client currently uses, occupation, history of photosensitivity or post-inflammatory hyperpigmentation, history of keloids, and photosensitizing medications. Educate the client on the benefits of having professional level chemical peels done in-office, while providing guidance in product selection should an at-home peel be considered. Encourage a conservative approach, as results are cumulative and advancing to more aggressive peels initially will not bring the desired results faster. In fact, this may cause skin damage and become a major setback in the quest for skin rejuvenation. While peels developed for application at home can provide mild peeling and are effective at maintaining an even-toned, healthy complexion, a chemical peel performed by a licensed professional will benefit from a lower pH, which allows for deeper penetration and substantially better results. During a professional service, a client is also continuously being monitored for signs of unusual skin reactions such as swelling, frosting, and erythema, while at home, a client is left to his or her own discretion.
Working together to develop an effective at-home regimen will complement and maintain the results of a professional chemical peel. A mutual plan of action pairing the client’s expectations with the appropriate professional and at-home treatments should be discussed to ensure compatibility and client satisfaction. Great skin care should involve a well-balanced approach pairing a series of chemical peels with supportive antioxidant nutritives, as well as a personal dose of responsibility in knowing a professional’s product, understanding skin and its limits, and practicing due diligence by seeking professional consult and applying that knowledge at home.
Growing up, Whigham lost herself in books, but more so she was drawn to beauty magazines. The aesthetics of the human body, especially the face, and more specifically the skin intrigued her. Soon after her fifth daughter was born, she graduated from the Aveda Institute of Lafayette where she studied esthiology. Whigham 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, her love of skin care took a more defined turn towards educating clients on the importance of sun protection and early detection. Whighham’s hope is to continue learning, writing, and growing as an aesthetician and increasing awareness of skin cancer prevention.