Always check with your doctor or dermatologist prior to beginning any skin care regimen.
First, I would like to say that I am of the opinion that “PEELS USING SOLUTIONS OVER 10% STRENGTH SHOULD NOT BE PERFORMED AT HOME. In most states, Estheticians are licensed to perform glycolic, lactic and other alphahydroxy peels up to 30% strength. They can also use a Jessner’s peel at a 14% level and can apply up to 3 coats. Trichloroacetic (TCA) should only be performed by dermatologist or plastic surgeons. Please use a licensed professional that has experience with chemical exfoliation. Serious consequences can occur.
Clients who want a professional chemical exfoliation/peel stronger than 10% should be using an 8%-10% peel solution at home for two weeks prior to receiving and chemical peel higher. They should also be using a night cream with Retin-A (vitamin A) as an ingredient. Proper preparation will give the best results and will please your client. Remember that “prior planning prevents poor performance.”
I would also like to state that my intent with this article is to provide information to licensed estheticians and other skin professionals. This article is not intended for the general public. However, education is crucial to better understanding. As a general rule, no one should use peeling agents on themselves, but rather to inform them of a standard protocol that a licensed skin care professional would provide if this service is rendered. (See my link from the TV show “THE DOCTORS”).
Please refer to the Fitzpatrick Scale and determine if the client is an ideal candidate for chemical exfoliation. Allow the client to read and sign an informed and consent form. This is very important. DO NOT PERFORM STRONG PEELS ON FITZPATRICK TYPES VI, V or VI. Also, know your contraindication before administering a peel. Do not perform any chemical exfoliation on inflamed, irritated or broken skin. The best advice I can give to you is this: “WHEN IN DOUBT…DON’T.”
With that said, let’s get started.
1. Remove makeup: Usually the best choice is a milky cleanser placed on a gauze or cotton pad and swiped across the skin. Repeat until the makeup is removed. Do not use Vaseline due to its occlusive properties.
2. Cleanse the skin: The esthetician should thoroughly cleanse the skin with warm water and a mild but effective skin cleanser. This cleanser should not be too harsh, but be strong enough to remove dirt, debris and sebum (oil). I recommend a gel, or foamy cleanser for oily, combination and problematic skin types because the surfactants help to break down oil. For dry and sensitive skin types, I recommend a lotion or milky cleanser. Rinse the skin with lukewarm water several times and pat the skin dry. DO NOT RUB THE SKIN.
3. Defat the skin: This step involves stripping the skin of its oil by applying either a 70%, 90% isopropyl alcohol or acetone to the skin with a gauze pad or cotton pad. Be careful when using 90% isopropyl alcohol and acetone as they are very drying. I usually use 90% or acetone on oily and combination skin types. Defatting the skin allows the peel solution to uptake more evenly as the peel solution does not have to cut through the sebum. Let the solution evaporate off completely before proceeding to step 4.
4. Prepare the treatment are for the peel: This is a crucial step in performing chemical exfoliations. There is nothing worse than not being prepared. Make sure that you have either a neutralizing product available and handy or that you have a bowl of cool water mixed with about 3 to 4 table spoons of sodium bicarbonate (baking soda). Either of these products will be a life saver if something goes wrong. They will neutralize the chemical peel solution, thus helping to prevent further damage to the skin. Prepare your eye pads with the standard butterfly cotton pads or large eye rounds soak in cool water. Use a Q-tip to put a small amount of Vaseline as close to the underside of the eye and on the upper eye lid. This will prevent any of the peel solution from being absorbed. Place the protective eye pads over the client’s eyes. Hand the client a portable fan and turn it on. The fan will help to ease the discomfort as the chemical peeling agent is applied to the skin. Now you are ready to apply the chemical peeling agent.
5. Applying the peeling agent: After ensuring that the client’s eyes are protected, begin applying the peeling agent. Use a gauze square or large peeling Q-tip to apply the solution. Typically you should begin on the forehead and swipe across. Then proceed down the nose and across the cheeks, then to the chin area. Use a small Q-tip saturated with the peel solution to swipe under the eye area. NEVER APPLY PEELING AGENT ON THE UPPER EYELID. If you are using glycolic acid; lactic acid; or an Alphahydroxy acid (AHA) solution, the amount of time left on the skin has a direct correlation to the strength of the solution applied to the skin. In other words, a 10% solution can be left on longer than a 30%, 50% or 70% solution. The stronger the solution the less time on the skin. Also, if this is the first time the client is receiving a peel then you would not want to leave the peeling solution on for the maximum amount of time. Typically most AHA’s, glycolic, and lactic acid peel solutions can be left on for up to 10 minutes. Lactic acid is the best choice for dry and sensitive skin types as it tends to be not a drying. Watch for increased redness and irritations to occur. Then remove by rinsing with the cool water. Rinse the skin at least 3 to 6 times. Then use the water and baking soda mixture to stop the chemical reaction. Blot the skin dry. DO NOT RUB SKIN.
If the peel solution is a Betahydroxy acid (BHA) like salicylic acid, time is not the only factor in determining when to end the peel. You MUST look for the “frosting.” Frosting is the process of keratin being broken down in the skin. Usually, the skin will turn white like frosting on a cake. One coat might be sufficient, sometime 2 to 3 will be needed. If more than one coat is needed, wait about 45 seconds to 1 minute before applying additional coats. Be aware that you are not looking at salicylates precipitating. It resembles frosting but is only the salicylic acid reacting to the air. Frosting will look more pinkish white. Once the frost is presented, allow it to remain on the skin for about 1 -3 minutes, then rinse off with cool water. DO NOT RUB THE SKIN. BLOT DRY. BHA peels cannot be neutralized. A cool towel applied to the skin is usually enough to ease the discomfort.
If the peeling agent is a Jessner’s solution, it should be a 14% solution. The Jessner’s peel consists of 14% salicylic, 14% lactic acid in a resorcinol solvent. This peel is strong and provides great results when used correctly. Similar to a salicylic peel, the Jessner’s peel is great for clients that want to improve skin tone, acne, and fine lines and wrinkles. Frosting occurs with this peel also. The use of a fan is required with this peel. Wait about a minute between layering. Esthetician can usually apply up to 3 coats, while physicians can apply more and can use a higher strength. Again, this peel is ideal for clients that have oily to combination skin types. Once the frosting appears do not apply more solution. Allow it to remain on the skin for about 3 minutes, and then apply a cool towel to the skin.
If the chemical exfoliation is a Trichloroacetic acid (TCA), a physician should be administering the peel. Estheticians should not perform this peel. If you want information about this peel, go to your dermatologist or your physician. Sorry.
Now that the peel has been performed, what next? Well, in my opinion it is crucial to apply a Hyaluronic serum to the skin. Hyaluronic acid is a hydrophilic (water loving) non-drying ingredient. It is essential for all skin types. As a matter of fact, Hyaluronic acid naturally occurs in the deeper tissues of the skin. Originally discovered in the comb of a rooster, it is now synthetically produced for cosmetics. It is silky, smooth and helps to plump up the skin. Make sure you have a product on hand that has it in it.
After, you have applied the Hyaluronic acid serum, apply sunscreen to the client’s skin and send them home. Your client should take home products to help in the healing process. Hyaluronic serum, a skin lightener (alpha Arbutin), Retin-A, moisturizer and most importantly an ant aging sunscreen with SPF 30+. Follow up with the client for the next 3 days by phone. About 10 days after the peel the client should come back to the salon for a follow up visit and for a facial. This is when you, the esthetician can evaluate the peel. During the healing process you want to reassure the client that what is happening to their skin is expected. Give them a take home form that reminds the client that what they are experiencing is normal. Encourage your client to keep their skin cleansed and hydrated. Make sure they use plenty of moisturizer and sunscreen. Advise them to avoid prolonged exposure to the sun for the next month. They should not use manual scrubs to abrade or expedite the peeling process. The slower the peeling process, the healthier.
Remember that peels can produce different results on any given individual. It is your responsibility to obtain an informed and consent form from your client. If you thoroughly screen your clients and use the proper tools (i.e. Fitzpatrick Scale) you should be able to deliver great anti-aging skin care to your clients.