There are many reasons why a client may not be as excited about their progress as expected, or why they may cancel their follow-up appointment without a legitimate reason. It could be related to their personal obligations or hectic work schedule, but often, it is related to their post-treatment experience in some way. Perhaps they did not see the dramatic difference they envisioned. Maybe they felt their skin looked worse, or perhaps they picked their skin and are worried about how their peel provider will respond.
Licensed professionals across the board have a deep love and respect for chemical peeling. Not only has it been around longer than nearly every other aesthetics treatment, but it has a unique ability to improve the health of skin and each skin cell in the epidermis. It visually produces luminous skin that is not easily attainable otherwise, and it is extremely versatile for numerous skin conditions, tones, and types. There truly is a chemical peel for everyone. Still, these amazing outcomes can come at a cost, so there are specific pre- and post-guidelines to ensure client safety and efficacy. Following a simple but detailed process can help assure the best client relationship and treatment outcome.
PHASE ONE: CONSULTATIONS
Consultations are key, whether for a brand-new client or an existing one who might otherwise ask mid-treatment about a different service. As gifted problem solvers, skin care professionals get to create a gameplan for how to tackle each client’s individual skin issues. In order to solve their problem, it is crucial to understand a client’s current skin, recognize the severity of the issue, and develop a treatment plan to address it.
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Assessing Skin
Before determining the best chemical peel protocol for a client, providers should take a few steps to learn about their skin. Begin by determining their skin type. This aids in selecting, or rather deselecting, peels that are not appropriate. For instance, if a client is more mature with dry or dehydrated skin, eliminate any peels or aftercare that include salicylic acid or benzoyl peroxide. Once their skin type has been determined, begin assessing the severity of their condition. Most clients battle one of three conditions, meaning acne, hyperpigmentation, or aging. These conditions have been the top three concerns in aesthetics for decades, and they will likely continue for decades more.
The beauty of chemical peels is that they can target multiple issues simultaneously. For example, the goal of treating hyperpigmentation is to lift the pigment through desquamation but at the same time, improve luminosity, texture, and induce collagen stimulation. Select the peel that addresses the client’s primary concern and, along the way, look for other unexpected solutions that could help them.
Game Plan
Once the peel is selected, take some time to determine how many sessions are necessary, the treatment interval, and what preparation is needed. Do not forget to factor in client expectations. Does the client expect every acne scar or bit of hyperpigmentation to be removed, or are they okay seeing a 70% to 80% improvement?
The number of sessions is typically determined by the severity of the condition along with how long it has been left untreated. The following example uses a more difficult condition: Client Jane is a Fitzpatrick V with combination skin and melasma that has been worsening for two years. The peel provider should start by explaining that her condition is chronic and will involve a slow and steady process that includes both in-spa peels and at-home products. The client will need a series of five to seven peels with a very strict home regimen and could become a life-long client.
Additional Considerations
Memberships work great for melasma clients as their condition is chronic. Memberships also work well for acne clients since their progress requires more treatments and maintenance.
The peel interval generally follows natural cellular renewal, or the corticotropin-releasing factor. Only deep chemical peels should be scheduled every four weeks.
Skin care preparation – some chemical peels require no specific pre-care while others do. It is always important to assess a client’s skin and determine what products they need to use leading up to their first peel.
Hydration and moisture are essential for every skin type and condition. A client whose skin is dehydrated or dry will experience greater depth of peel penetration, especially with hygroscopic acids like trichloroacetic acid.
Pigment-suppressing agents are essential for clients with darker skin tones or those who are more prone to post-inflammatory hyperpigmentation. When adding in a product, like hydroquinone or kojic acid, make sure to allow a minimum of three to four weeks of use to obtain the suppressing quality needed.
Retinoids are tricky. They increase cellular turnover, which is great to help speed results for oily or congested skin types. However, depending on the strength, they can also produce irritation, dryness, and inflammation. If retinoids are used to prepare skin pre-peel, make sure to have clients discontinue the use three days prior to their peel treatment to avoid unwanted side effects and risks.
Sunscreen is essential. When clients have a strong routine of sunscreen use before the peel is administered, it is much easier to assure their compliance in the post-peel phase.
PHASE TWO: THE PRE-PEEL EXPERIENCE
It all starts with setting expectations. Knowing what to expect – the good, the bad, and the ugly – makes the client better prepared to handle the treatment and understand the process. First and foremost, describe in layman’s terms what the selected peel will do for the client’s skin. Professionals can say that they are going to do a single-acid peel that contains salicylic acid to work on controlling and clearing up breakouts.
Building Aftercare
Once the client knows what the peel will do for their current skin issue, take one or two more steps to explain how and what the aftercare will look like. Much of this will be based on the selected peel, but the following encompasses most chemical peel treatments:
For the first few days, the client should follow a specific skin care regimen to keep their skin hydrated and to help their skin recover. The peel provider should give the aftercare regimen to the client on the day of their peel, so they do not need to worry about it before. Also, it is important to schedule the peel for a time where the client has a couple of days without any major social or outdoor activities because after the treatment, their skin will need a little extra tender loving care to recover.
Finally, treating the client’s condition is a process, and their skin will change and evolve after each treatment. The chemical peel is working on correcting what the client can see on their skin today and is also resetting their skin health to obtain long-lasting results. Most people need a series of three chemical peels to get the most dramatic changes.
The Paperwork
The pre-peel stage is also a great time to take care of a few operational items so that on the day of the client’s peel the focus can be on their skin needs and overall experience. Consent forms, baseline photographs, and scheduling can be done earlier to alleviate time later.
Consent forms: A great time to have clients complete the needed forms is directly after explaining the benefits and process of their proposed treatment. Peel providers can wait until the client’s treatment date but might have to repeat what they covered, taking time away from the visit itself.
Baseline photographs: Before and after photos are invaluable because they show clients their skin progress, reference pre-existing conditions, and can be used to promote the provider’s skills. However, during a hectic day, they are often forgotten. These baseline photos are crucial because it is impossible to go back in time to see what a client’s skin looked like pre-treatment.
Scheduling: It sounds simple enough, but the date is important. The peel provider needs to make themself readily available for any questions or concerns during those first few post-peel days. They should schedule a client’s first peel when they are reachable for the following 48 hours. For instance, they can plan chemical peels for first timers on Monday, Tuesday, or Wednesday if they work Monday through Friday.
PHASE THREE: THE POST-PEEL EXPERIENCE
During the peel treatment, the peel provider learns more about their client’s skin and skin response, which will feed into their client aftercare guidance. Was there any congestion under the client’s skin? Was their skin so dry that it had to be continually rehydrated? Did they have areas of frosting or excess erythema? The response noted in their skin should roll over into any customized aftercare that will assist their skin in the healing stages post-peel.
Chemical peels have varying acids, percentages, pH levels, and application techniques, but they all possess essentially the same mechanism of action. This mechanism of action uses acids with low pH to induce desquamation. After every chemical peel, the body moves into a healing cascade that includes three phases: inflammatory, proliferative, and remodeling. Aftercare should primarily focus on supporting skin during the first two phases. The length of these phases depends on the strength of the peel used, with superficial peels having the shortest inflammatory and proliferative phases and medium-depth and deep peels having the longest.
Aftercare instructions need to be given to clients in a clear and simple format; nuances can be added based on their skin response during the peel administration. When using a branded peel, the manufacturer will often provide detailed aftercare instructions that can be passed on to clients. When using generic or straight acids, the professional should create their own instruction sheet. Either way, customized instructions should be applied.
All aftercare instructions need to tell the client what to do, what to avoid, what to expect, and when to reach out to their provider. Performing this step during the consultation will not accomplish the client’s goals and might create undue stress on them.
What To Do
It is important for clients to know how they can support their skin during the healing process. If the peel used does not include a pre-set aftercare regimen, focus the aftercare products on reducing inflammation and providing a temporary barrier until the proliferative phase is completed. Here is an example of a simple but effective aftercare regimen for clients.
Use a gentle cleanser to wash the face in the morning and at night. Only cleanse with lukewarm water and apply with the fingertips. Avoid cleansing in the shower, and instead, do so before at the sink. Use a gentle and supportive cream after cleansing and as needed to combat dryness. When outdoors, even on cloudy days, use sunscreen and reapply after two hours. Continue this for the next week, then slowly add in the other products. Professionals can also tailor the aftercare by, for example, when noticing that their skin was a little dehydrated during the treatment, recommending that the client drinks more water for the next few days to help hydrate their skin. This will also prevent the client from feeling too dry while their skin is peeling.
What To Avoid
This area itemizes what clients could do inadvertently that may hinder or create an issue for their skin and their results. The key areas for post-peel healing include avoiding direct and prolonged sun exposure for a week, hot water, the use of washcloths or cleansing machines, rubbing or picking skin, shaving or waxing the treatment area, and any products other than the recommended aftercare.
What To Expect
This is the time to let clients know what is normal and what is abnormal. It can be helpful to set a general expectation of peeling level by letting them know that their skin will peel as much as it needs to peel. Also, inform them when peeling or flaking may occur, which, although dependent on the type of peel used, typically occurs on two to five after the peel.
This is also a great area to customize the expectation. For example, if peel providers noted congestion under the client’s skin while cleansing, they can point out that the peel works by turning over the skin cells and releases anything that is trapped under their skin. This lifting and releasing of all the trapped debris occurs by way of small breakouts. A client with very dry or sensitive skin may have some itching or sensitivity when peeling that is transient as their skin rebuilds.
When To Reach Out
Keep an open-door policy, especially for first time clients. One way this can be done is to add a line on the aftercare sheet that instructs them on how to contact the provider should they have questions or concerns. Verbally communicate this as well. Let them know that they can reach out with anything they feel is out of the norm. This provides the opportunity to intervene quickly and adjust the aftercare if needed. Secondly, and perhaps more importantly, it establishes a stronger relationship between the professional and the client. With this simple statement, they feel supported, and their anxiety is immediately lowered.
PHASE 4: ACHIEVING SATISFACTION
Evaluate and celebrate success with clients. On their next visit, which should be set for an interval of four weeks, invite them to share their thoughts about the process and the progress. Spend a few minutes listening to their perspective as providers can learn a lot about their experience. Sometimes, the experience will be positive, and other times, there may be some aspects a client did not like or expect. Keep note of this. Now that the client has shared their views, begin an evaluation of their skin and progress. Retake their photos, assess their skin status, and share relevant findings with them.
If the assessment of both client and professional align, continue the plan as expected. However, if any discrepancies in expectations exist, take a moment to reevaluate the plan. Was the correct peel selected for their skin needs, or was it too strong or too weak? Was the client surprised that they were sensitive post-peel or that they had a breakout? Do the aftercare instructions or protocol need to be modified? Making these adjustments assures that professionals are tailoring care to both the skin health of the client and the way they learn and retain information.
In skin care, there is no one and done. A client’s condition did not develop overnight, and the remedy will take a few treatments. Stay fluid in the approach and modify the plan when necessary. Within just a few treatments, a client’s acne can be under control. Their scarring smoothed and sunspots eliminated, and a strong client-provider relationship is developed along the way.
If this sounds time-consuming or not really that important, remember that the success or failure of a professional’s interventions can only be determined by client satisfaction. Client satisfaction is based on their overall experience, and the better their experience, regardless of the outcome, the happier and more loyal clients become. Ultimately, establishing clear expectations and instructions supports professionals in achieving optimal results, but it also builds a strong relationship with clients. In this strength, trust and loyalty is built, and professionals position themselves and their reputation as invaluable; the business growth is an added bonus.
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Nancy Miller is the director of education and research for The Vitality Institute, makers of the VI Peel. She has served the aesthetics industry for 20 years as a provider, educator, lecturer, and content creator. She obtained her Bachelor of Science degree in nursing at University of Southern California, holds a Master of Business Administration in health care management, and has significant experience as director of operations at various dermatology practices and medical spas during her aesthetics career. Miller is recognized for providing impeccable aesthetics service, and is known for having a refined aesthetic eye, gentle touch, and calm demeanor.