Before discussing all things post-exfoliation, it is necessary to talk a little about pre-care. There are several factors that help aestheticians decide and determine which peel or exfoliating treatment may be best suited for their clients.
Some of the biggest factors that play a part of the skin’s condition include medical conditions, medications, lifestyle, homecare, Fitzpatrick types, and so on. In order to obtain this information, a thorough client consultation must be performed each time clients have an appointment at the spa. Do not think because a client has been coming to the spa for years that they will automatically think to mention any changes that have occurred in their lives, such as medical changes, pregnancy, medications, and other changes. This is why it is crucial for a consultation with each visit. This is also a chance to explain the expectations and responsibilities that will help protect their skin before, during, and after treatment. Remember, homecare accounts for 80% of the skin’s condition. Once the client leaves the treatment room, their skin is in their hands. It is, however, 100% the professional’s responsibility to prepare them and educate them on all things pre- and post-care.
So, let’s talk briefly about pre-peel considerations. Any medical conditions where a client’s healing time is slowed or somewhat altered, such as diabetes or autoimmune disorders, should be avoided or, at the very least, under the authorization of a medical doctor. Clients do not always understand what contraindications there may be that are associated with certain conditions. They may experience a change in their skin due to their illness and may be desperate for help. It is the professional’s job to say no when it may be best for the client’s skin.
Certain medications, such as antibiotics, steroids, or antihistamines, can sensitize the skin. Clients should be off of them for five to seven days, depending on the medication, to allow their skin time to recover. Antihistamines may not be as much of a concern, but they could very well dehydrate the skin, which could slow the healing process.
Lifestyle should be considered for several reasons, including if the client spends a lot of time outdoors, whether for work or for fun. Skin will be extremely photosensitive, and with some peels, sun should be avoided for several weeks, even with sunscreen use. Smoking and alcohol use can also have an impact on the skin’s hydration. Lack of oxygen to the epidermis from tobacco use can also slow down the skin’s healing process.
Homecare is essential. Clients’ skin should be used to alpha hydroxy acids or other exfoliating treatments prior to any peel treatment. Clients should have, at the very least, a basic homecare regimen to ensure that they understand and will follow through on proper care of their skin post-care.
A thorough understanding of Fitzpatrick types is essential for any advanced treatment. Chemical peels can trigger melanin production, due to inflammation. The professional may need to consider whether a tyrosinase inhibitor is necessary for clients to use for a few weeks prior to a treatment and to continue to use while the skin is healing.
These are just a few things to consider prior to treatment. Knowing how to treat the skin properly, by getting clients’ skin in optimal condition prior to a peel, will significantly influence post-treatment results.
When it comes to post-exfoliation or post-treatment, it is important to understand that there are different protocols for each type of treatment and each depth of peel that is performed.
Peels range anywhere from lunch time or no downtime peels to some that require a week or more of down time. Having a thorough understanding and knowledge of various types of peels and what falls under the skin care professional’s scope of practice is imperative before performing any advanced treatment. Skin care professionals must not only protect themselves, but also their clients, as well.
To begin, it is always important to follow the manufacturer’s guidelines on the proper use and precautions of the specific peels used. It is also imperative to make sure the specific peels are approved and safe to use on all Fitzpatrick types.
Preparing a client for what their recovery time will be is something that should be discussed ahead of time, as well as frequency of peel and future course of action.
Low Depth Peels
Lunch time peels, or peels in which the client generally does not have to hide from the public for a few days, are lower level lactic, glycolic, and even alpha beta acids. These are under the category of light or very light depth peels. The client truly can come in on a lunch break and leave with their skin beautiful and glowing if they want to. They can put makeup on technically but should be discouraged. With their skin so recently worked on, and not knowing how often they clean their makeup brushes or sponges, their makeup tools could unknowingly be breeding grounds for bacteria. Also, their skin, depending on the client, may be a bit pink, which generally will subside within an hour or so.
Some clients may experience a bit of sensitivity when they touch their face afterwards, but overall, they should feel great. With any peel, no matter the level chosen, the most important step for their skin is sunscreen. If they choose their peel series in the summer, encouraging them to stay out of the direct sun for a few days, even with sunscreen, is recommended. With any exfoliating or peeling treatment, skin could be much more photosensitive. Why risk any pigmentation issues for clients if the goal is to get rid of what they already have? Explain to clients why this is important and the potential side effects of sun exposure after peels. As mentioned earlier, the professional can only control so much of what goes on when a client leaves the treatment room, but they need to educate them on all risks and side effects. With a thorough client consultation, this would have already been done. Send them home with the same information, so they have it to look back on. Encourage clients to avoid sweating for 24 hours and no gym time because of the risk of bacteria. A lot of people work out, then run errands or do things around the house before washing their faces. They should avoid extreme heat directly on their faces from warm towels, hot tubs, saunas, and so forth, as these could increase the amount of erythema or redness the client may experience and they could feel a bit flushed and have a little feeling of activity. Clients that tend to experience a bit more sensitivity or even light flakiness can apply a topical ointment, such as Aquaphor, or anything that will provide an occlusive barrier to help prevent the skin from feeling too dry and irritating. They can reapply as needed. This usually is not necessary for low-grade peels, but everyone has a different experience afterward.
For the most part, clients can, in fact, pick up with their same homecare routine the following day after low depth peels. They may want to avoid any abrasive exfoliating treatments for a few days. Any alpha hydroxy acids products or ingredients may also be something they want to consider taking a few days off from. If dealing with an acne client who uses salicylic acids or benzoyl peroxide, tell them to pick back up with those around day three. This gives any sensitivity for already potentially sensitive skin a little more time to subside and heal.
Clients can normally have low depth peels done in a series of six, recommended weekly, about five to seven days apart, for six weeks. Then, give their skin about six weeks before starting another series, if necessary. These peels are also great as event peels in preparation for a party, the holidays, or a wedding. Just make sure to have experience with the client’s skin and know how they may react beforehand. Also, give them a few days to heal before their event. Vitamin C serums are a great product for samples and retail. This will help to heal the skin nicely afterward and will help with any potential pigmentation issues they may have. Low depth peels are a great way to introduce clients to peels. The word peel tends to scare some people, as they assume they are going to lose all of their skin like a snake. Prepare them by letting them know everyone reacts differently, but that these peels should result in mild flakiness, at most. Generally, there are very few, if any, side effects on the skin.
When moving up to more advanced peels, such as Jessners or TCA blended peels, there is more that goes into the appointment and aftercare. Clients may experience more immediate activity or sensitivity while the peel is applied. If necessary, these peels may be layered to make them more intense. The downtime of these peels will be much more significant – seven to 10 days of downtime on average. These peels may have significant peeling associated with them. The use of an occlusive barrier is a must until the skin completely heals. There should not be any water applied to the skin for at least 24 hours after the peel. Clients can, however, apply sunscreen and Aquaphor, or similar, after the peel. Advise clients that absolutely no makeup should be applied for at least seven days after. This tends to be one the biggest issues clients seem to have when deciding on whether or not to choose these peels. It is important to explain the risk of bacteria, especially with skin peeling and new skin forming underneath. Clients that tend to pick may not be suitable to receive these peels, as the risk of them peeling off skin that is not ready is high. Doing so will disrupt the skin’s healing process and increase risk of infection, as well as pigmentation issues. Clients should avoid touching their faces until their skin heals. Even after that, encourage them to stop touching their faces.
For the first 24 hours, clients can reapply ointment as often as necessary. After 24 hours, they can lightly rinse their face with cool water, pat dry, and reapply their ointment. On day three, they can use a mild cleanser, such as an oil or light milk cleanser, to clean their faces, followed by application of the ointment. They should start seeing some peeling or light flaking around day three to four. Many clients tend to think that they should let their skin stay tight and dry, but, in reality, it is ideal for them to stay hydrated. So, continuing the application of their ointment is crucial until all the skin has shed and healed. A basic daily moisturizer will not give clients enough moisture on the skin; from day three on, their skin will absorb it very quickly. They can start to use a vitamin C serum around day four, which will be helpful with the healing process. If clients tend to peel quickly in some areas, specifically around the mouth, the skin underneath may not be ready and may be very raw. If this happens, they can use mix of vinegar and water and apply it with a cold compress for several minutes. This method helps take some of the burn they may feel from the exposed skin. Avoid any alpha hydroxy and beta hydroxy acids or harsh acne products until the skin is completely healed. Manual or scrub exfoliation can be added back after around 10 days, as long as the client does not have any sensitivity to touch.
Encourage clients to allow a full seven days of healing before applying any makeup or going back to their daily skin care routine. Direct sun should be avoided for several weeks to a month after the peel. Their skin will be extremely photosensitive for a time, making this is a great peel during the fall and winter months, when clients may not be as exposed to direct sun. Sunscreen should be worn always.
Clients that need to can receive advanced peels every eight to 10 weeks, until they see the results they are looking for. Not all manufacturers will recommend this, so do research on what your brand states. Clients should follow up in about 10 to 14 days to receive an enzyme facial. This will help to dissolve any remaining dead skin that is hanging around. It also gives the professional an opportunity to see how the skin has been healing and to know whether the client is following through on homecare and specific directions. After about month, results can be maintained with the lower-grade peels weekly, if necessary. Any homecare ingredients containing acids specific to the client’s concerns are a great way to maintain results between peel treatments. Any cleansers, resurfacing pads, or moisturizers that have acids such as lactic, glycolic, or salicylic will benefit the client.
It is the professional’s job to make sure clients are comfortable from start to finish. Always be honest with the fact that they will feel some activity, but keep in mind each client is different. A follow-up call a day or two after their peel will help make sure the client understands the correct procedures to protect their skin. This also gives the opportunity to make sure that they know what is normal and what may be a concern. Encourage them to take pictures every other day, starting the day of their peel, to see the results. They may not notice a significant difference until they look back at the before pictures, when they will notice their new glowing, healthy, beautiful skin.
Andrea Gregaydis is a licensed aesthetician and International CIDESCO Diplomat. She holds multiple additional licenses as a New York state instructor and nail technician, as well as certified laser technician. Gregaydis is the lead instructor at the Aesthetic Science Institute and has over 10 years of experience as a practitioner, team coordinator, and role model for hundreds of future skin care professionals. She is a contributing author to top industry trade magazines, as well as a speaker at various aesthetics conferences across the United States.