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As with most professions, when I graduated from Esthetics school I was just starting my actual training. Sure I learned the basic skill needed to perform my job, but to really get my feet wet I had to put myself in advanced training classes for everything from Brazilians to chemical peels. Still, I didn’t get my real experience till I started treating clients.

I don’t know about you, but “Acids” were very intimidating to me starting out. How do I layer them? What if I peel deeper than intended? How do I choose which acid to use? In this article I will go over my personal experience and education to answer all of the “peeling” questions on your mind.

Consult
Always get a medical history on your client, assess their skin type (Fitzpatrick) and have a consent sheet for all medical treatments. Always talk with your client and make sure that they are fully prepared for the treatment they are about to receive. My clients have always appreciated that I have told them all the facts and warned them of all the possible outcomes. Always make sure to ask your client what their skin concerns are and how much peeling they are prepared for. You might think they need a deep TCA peel for hyper pigmentation but then find out that they are only there for a light exfoliation for fine lines (Never assume). Also make sure that your client has no events coming up and can stay out of the sun. Last but not least always under promise and over deliver! Never promise results, you will have many disappointed clients! Explain to your client that peeling is a process and can take many treatments to reach desired results.

Prepping the skin
Always make sure to prep your client’s skin thoroughly and evenly so that your peel does not penetrate deeper in some areas of the skin and not others. You can get a good idea of how the client will handle the peel by how they handle the prep. I scale everything on a 1-10. 1 being minimal-no discomfort and 10 being “my face is on fire!!” The client should be at a 1-2 during the prep, if they are experiencing more discomfort than normal then you might rethink your peel choice.
• Cleanse twice with a dehydrating cleanser.
• Swipe over skin evenly with a dehydrator such as Alcohol or Acetone. This may seem harsh but it is necessary to make sure there are no oils left in the skin keeping the peel from penetrating evenly. (If client asks what it is tell them it is a prepping agent to dehydrate their skin for the peel).
• Follow Dehydrator with a 2% Salicylic acid to finish the prep.
• Make sure skin is dry before starting peel.
• Your prep and Acids should always be applied in a uniform manner and always away from the eye. Start at the forehead, swipe down the nose and under each eye then left cheek moving down away from eye and right cheek then across lip and downward on chin. Do not double swipe.

Types of Acids and what they treat:
There are many different types of Acids; I will go over the most common types, what they treat and what your client can expect to feel. Always prepare you client for the sensation that they can expect so they are not surprised and have a small hand held fan ready for their comfort.


Glycolic 10%-50% AHA (Alpha Hydroxy Acid) Oily/ Acneic/Ageing derived from sugar cane (Client will feel a sensation like tiny pin pricks)


Salicylic 10-30% BHA (Beta Hydroxy Acid) Oily/Acneic of the Aspirin family found in willow trees (Client will feel more of a prickly burning sensation.)


Lactic 20%-50% AHA Dry/Sensitive/Pigmented/Ageing(Safe for Darker Skin Types) derived from Milk (Client will feel a sensation like tiny pin pricks)


Mandelic 20%-50% Sensitive/Pigmented/Ageing/Oily/Acneic (Safe for Darker Skin Types) derived from bitter Almonds, has antiseptic, antibacterial qualities. (Very superficial, client will feel a slight tingle)


Azelaic 10%-30% Acne/Rosacea/Sensitive (Safe for Darker Skin Types) derived from naturally produced Wheat Rye and Barley has anti-inflammatory properties. (Client can feel an intense burst of heat)


Jessner blend of (Lactic/Salicylic/ and Resorcinol) Acne/Scaring/Cystic Acne/Pigmented (Client should feel strong prickly heat)


TCA (Trichloroacetic Acid) 10-30% Dry/Ageing/Scaring/Pigmented (Client will feel large bursts of heat lasting 1-2 minutes then fading but getting stronger with every layer)


Layering: when layering you must take into account all of the skin concerns and which acids would work together to appropriately treat all concerns. Always wait 2-3 minutes in between layers and remember that the percentages stated below are just recommendations, you may use your own discretion in choosing percentages that would best suit each individual client.


Glycolic Acid: Glycolic acid works wonderfully with Salicylic and TCA. It allows greater penetration when applied over one of these two options.
• Acneic/oily- apply one layer 20% Sal with 1 layer 30% Gly.
• Dry/Ageing/Pigmented-  apply 1-2 layers 10% TCA with 1 layer 20-30% Gly

Salicylic Acid: works best on oily skin. Oily skin that has been dehydrated will benefit from layering lactic or TCA.

• Oily/Acneic/Dehydrated- apply one Layer Salicylic 15-30% with one layer Lactic 20%
• Acneic/oily- apply one layer 20% Sal with 1 layer 30% Gly
• Oily/ fine lines /Pigmented- apply 1 layer 30% Sal with one layer TCA 10%


Lactic: works best when applied as the last layer
• Oily/Acneic/Dehydrated- apply one Layer Salicylic 15-30% with one layer Lactic 20%
• Dry/Pigmented/Acneic- apply one Layer Glycolic 30% one Layer Lactic 20%
• Dry/Ageing/Pigmented-apply one layer TCA 10-20% one layer Lactic20%

TCA:
• Dry/Pigmented/Aged- 1-3 layers 20%
• Dry /Pigmented/Ageing- 1-5 layers 10%
• Dry/Ageing/Pigmented- apply one layer TCA 10-20% one layer Lactic20%
• Oily/ fine lines /Pigmented-  apply one layer 30% Sal with one layer TCA 10%
• Dry/Ageing/Pigmented-  apply 1-2 layers 10% TCA with 1 layer 20-30% Gly


Jessner:
• Inflamed Acne/Non Inflamed Acne- 6-8 Layers Jessner
• Hyper pigmentation/Photo Ageing-  4-6 layers Jessner 1 layer TCA 20%
• Acne/hyper pigmentation- 6-8 layers Jessner 1 layer TCA 10%


PH Levels and Buffering:
The PH level of a chemical has everything to do with the quality of the product and the efficacy and safety of the peel. The lower the ph of an acid is the deeper peel you are going to get. Your skin is made up of water, proteins, lipids, and other chemicals. When the skin's proteins react with an acid of low pH, coagulation occurs (frosting). The acid destroys the existing tissues so that they can be replaced with new tissues. The lower the PH, the stronger the acid and the more frosting you achieve. Buffering is when the ph of the chemical is altered to make it less reactive and safer for a new peeler. You are still getting the same percentage of peel, but the PH is higher, making it less likely to injure the skin and it can be left on the skin longer. If you are new to Chemical Peels I highly recommend working with buffered Acids, learning and getting comfortable with the  acids before diving into the non buffered


Removal:
Have a bowl of ice water available to you and when the peel is concluded you can use soft 4x4’s to “mummify” your client and cool them down using minimal pressure. TCA and Jessner normally self neutralize and many other peels do also. If and when you let a peel penetrate a little deeper than originally planned (because you eventually will) or a client has a negative reaction to a peel, always have a neutralizing mixture available. 2 TBSP Baking Soda to 1 Cup of water should always be pre mixed in a bottle and dated; the mixture is only good for 30 days.

Outcomes/Aftercare:

Always prep your client for their peeling schedule and the possible outcomes. If a client does a deeper peel they can expect to be pink and tight for the first two days, and if they had TCA or Jessner they may have a brownish leather like effect on their skin. Day three they will “crack” starting at the chin and moving outward for the next 3 days heavily, then some light sloughing all over for the next 2-5 days post. After care should be only a sensitive skin cleanser, moisturizer and SPF during the heavy peeling process, they can resume their regular regimen after 7-10 days depending on depth of peel. If they are doing a light peel they can expect light sloughing around the chin moving outward starting on the 3rd day lasting 2-4 days. After care should be only a sensitive skin cleanser, moisturizer and SPF during the heavy peeling process, they can resume their regular regimen after 5-7 days depending on depth of peel. If you do over exfoliate your client, be honest! Let your client know you went a bit deeper than planned and prepare them for the peeling process If your client is prepared then they will not be nervous or surprised the following days. Always follow up with the client within 2 days, 1 if it was a strong peel. If you have peeled deeper than planned let the resident physician know so that there are no surprises. Chart all peels and communication that you have with your medical aesthetic clients so that you always know how to treat going forward. You can treat your clients every 3-4 weeks depending on the depth of their peel and always remember it is better to have to treat a client an extra couple times then to overdo it the first time and burn them. Explain to the client that the first treatment you are getting to know their skin and how it will react to the chemicals. Good luck and happy peeling!

(Chemical Peel Consent forms and After Care instructions can be found at Skindipity.com)

Legal Disclaimer: Information provided is intended to be used as general information only and is in no way intended to replace medical advice or a professional training program, nor is it to be used as a medical treatment program, nor to diagnose or cure any skin condition. Consult a qualified physician before administering these treatments on clients. You are singularly and solely responsible for the use abuse or misuse of this information, and for actions and consequences of that use or misuse.

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