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Monday, 24 July 2006 08:48

Customized Peel Protocols

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As we are all aware, the skin care business is booming! The portion of the skin care market that is especially hot is skin repair and rejuvenation. The baby boomers are aging and shelling out billions of dollars a year for services and products that help them restore, repair, and rejuvenate themselves to a more youthful appearance. Skin care is the fastest growing segment within the category of cosmetics today. People aged 50+ represent over one third of our population, Healing Arts Guide – MJL Associates.

Specialized Skin Treatments
As a primary service of repair, skin peels or chemical peels are a leading source of revenue for salons/spas that understand how to customize for optimum results. As the term "peels" can be a little scary to the consumer, many salons/spas are changing their menus to call them rejuvenation or repair treatments to soften the perception. Different peel products are specifically made for specific skin issues. In order to choose what peels suits what skin type you need to first determine what you are treating. Know your objectives.

The most common objectives in ANY Skin Treatment is one or more of the following:

  • Elimination of damage and dysfunction (hyperpigmentation)
  • Stimulation of protein - cell division - migration (anti-aging)
  • Correct challenges and increase functionality (acne - rosacea)
  • Increase cell nutrition - replace nutrients (maintenance/enhancement)
  • Protection - for anti-aging control (keep skin hydrated to prevent lines/wrinkles)

All of these objectives can be met using different levels of peeling modalities.

Overview of Peels
The aesthetician's peel product exfoliates the top layers of the epidermis. Because this peel product works with the stratum corneum, (depth depends on strength and pH) to achieve desired results the aesthetician must use this treatment in a series of six to eight treatments once a week. The physician may use a deeper level peel and achieve the same result after one or two treatments. Different kinds of peel products available to the aesthetician are as follows:

(in order of depth)

  1. Salicylic Acid (Beta Hydroxy acid) - breaks up keratinized cells ie; takes the lid off the stratum corneum. This is an oil-loving (alipidic) product good for treating acne to digest the outside stratum corneum and allow deep cleansing of the follicles as well as disinfect the infection sites.
  2. Lactic Acid - (Alpha Hydroxy Acid) - made from milk products has a larger molecular structure, therefore more controlled for dryer/sensitive skin types, and more hydrating.
  3. Glycolic Acid - (Alpha Hydroxy Acid) - smaller molecular structure - dissolves intercellular cement that hold cells together in the epidermis. This is more wound inducing and "seeps" slightly farther down into the epidermis. Good for aged, or normal to dry skin that needs rejuvenation, as it will stimulate more collagen in response to the wound.
  4. AHA Blend - A combination of Lactic acid, and Glycolic acid, lactic acid slows down Glycolic acid for more control. Good for normal to dry skin with a question on skin sensitivity Alpha/Beta Blend – A combination of Salicylic and Glycolic, Salicylic digests top layers of stratum corneum, which allows for Glycolic to penetrate further into the Stratum Corneum producing a deeper wound, resulting in deeper cell regeneration.
  5. Jessners - A peel created by Dr. Jessners combines several different acids.

The usual Jessners blend is 14 percent salicylic acid, 14 percent lactic acid and 14 percent resorcinol.

The most caustic and wound inducing acid is the resorcinol. Resorcinol is used by physicians for papillary dermis, or upper reticular dermis peels. Also available is a more modified version of 11 percent of each, and a blended Jessners without Resorcinol. This makes it a more mild peel, but still stronger than AHA or a Salicylic. Jessners is one of the only peels that is left on the skin. Client does not wash skin for 48 hours. By then skin starts to peel. They should not pick it off.. This is the natural peeling process of the skin and it needs to naturally peel off. After about 1 week, they may get a very mild enzyme exfoliation to take dead skin off. Depending on strength of the peel, you apply up to eight to nine layers or until the skin "frosts" whichever comes first.This is a very good peel for aging skin, light acne scarred skin, and hyperpigmentation.
The risks of peels are that the darker pigmented the persons skin is to begin with, such as a Skin Type III and above, the higher the risk that the deeper the peel, will result in more hyperpigmentation. One of the ways the skin responds to trauma is to produce melanin. The chart below identifies Skin Types as outlined in the Fitzpatrick Skin Types Model.

SKIN CLASSIFICATION TYPES

Skin Type Working Classification Physical Characteristics

I Always burns, never tans, sun sensitive Red-haired, freckles

  • Celtic, Irish-Scots

II Burns easily, tans minimally

  • Fair skinned, fair-haired
  • Blue-eyed, Caucasian

III Sometimes burns, tans gradually

  • Average skin

IV Burns minimally, tans to moderate brown

  • Mediterranean-type
  • Caucasian

V Rarely Burns, tans well

  • Middle Eastern
  • some Hispanic
  • and Blacks

VI Never burns,

  • deeply pigmented
  • Blacks

In Medical Peels where the solution is stronger and more aggressive, a physician will put a patient they feel is a slight risk such as Skin Type III on a prophylactic hydroquinone treatment for two to three weeks prior to the peel.
The aesthetician, usually, depending on the state license is not allowed to use peeling modalities that cause wounding to the skin any lower than mid-epidermis. Aestheticians must use more superficial types of peels in conjunction with longer term topical treatments.
AHA's (Alpha Hydroxy Acids) are the most commonly used superficial peeling agents used by aestheticians. The word superficial is used to describe the peel depth as opposed to a physician strength peel. The following chart breaks down the difference in language between the aesthetician and physician:

Aesthetics model Physicians model

Superficial= Stratum corneum Superficial = Basal layer
Epidermal= Dermal junction
Medium= Stratum Granulosum Mid-Papillary dermis
Deep= Basal layer Mid-Reticular dermis

Variables that effect Peel depth
One of the most important variables in choosing a peel is pH, which stands for Potential of Hydrogen. Simply put, as hydrogen is very reactive, the lower the number on the pH chart, the more hydrogen ions. The higher the number on the pH scale, the fewer the number of hydrogen ions. The more hydrogen ions present the more reactive the substance such as in the case of acids. Acids on the pH chart run from 0-6.9. Seven on the pH chart is neutral. The water and oil of the barrier of the skin measures 4.5- 6.5. Therefore, to get the skin to react, we need to drop to a lower level than the skins natural pH of 4.5. Most aesthetic pH solutions are around 3.0 on the pH chart. To drop just one number however, is still a large jump in intensity of hydrogen ions. Each number on the pH chart is multiplied by the 10th power. Remember this concept from high school math? So, when you start at neutral seven you would say six is 10 times greater in acidity than seven, five is 100 times greater in acidity than seven, four is 1000 times greater in acidity than seven, three is 10, 000 times greater in acidity than seven and so on. Therefore, if you are using a peel with a pH of two, you are using a product that is 100,000 times greater in acidity than neutral seven. The difference between two and three on the pH chart is approximately 10,000 times. Therefore, you need to know the pH of your product. The following are the components to look for in deciding how to use the acid of choice:

Type of peeling agent (active solution)

  1. Concentration of acid used – 30 percent salon - 60-70 percent physician strength
  2. pH of the acid
  3. Time peeling agent remains on the skin
  4. Condition of the epidermis prior to application of peeling agents including, prior acid usage, thickness of the skin and lipids of the skin

Protection and Follow-up
After any peel, it is MANDATORY that a sunscreen with an SPF of 30 be used to protect the skin from even very minor UV Radiation. Remember, the skin has been burned and wounded and ANY UVR can cause additional wounding and unexpected hyperpigmentation. It is also important to understand how often to perform these peels. It is recommended to allow the skin to fully heal before creating another series of wounds in the skin to cause regeneration. Therefore, it is recommended to allow an additional six to eight weeks healing time AFTER the completion of the six to eight weeks of peels. So many people think, if a little is good, a lot is better, WRONG! If you keep re-wounding the skin before it can properly heal, you are actually creating more damage for the skin. It needs to heal and regenerate, which is the purpose of the peel.

Proper home care is also essential for maintenance of peels.
Once you understand how peels are used for what skin type, and how to choose the right peel product for your client's skin, you will be on your way to building a clientele that is loyal, committed to proper home care, and ready and willing to spend money on their skin.

Patricia Heitz, CIDESCO DIPLOMATE, has been in the beauty industry since 1975, as a Cosmetologist and Esthetician. She has worked as a manufacturers representative and trainer for Skin and Hair product manufacturers, and more recently as an Esthetics School Director and Instructor. Having earned the prestigious title of CIDESCO Diplomate, is also an educator and contributing author for Milady/ Thomson Learning with both the Standard Text and Comprehensive Text for Estheticians. Currently, she owns Patricia Heitz Consulting, -Dermatech Academy offering online and onsite Skin Technology Training and Consulting for Schools, Spas, and Distributors, and is an exclusive Industry consultant to Gerson/Lehrman Financial Analysts Council of Advisors in New York. She can be reached at (518) 261-1236 or This email address is being protected from spambots. You need JavaScript enabled to view it.

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